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Showing posts from March, 2013

Less nursing, more medical errors

Recent Canadian Institute for Health Information (CIHI) data indicates that Ontario has a relatively high number of "nursing-sensitive adverse events" compared to other provinces.  An "adverse event" (or "medical error") occurs when something happens in the hospital that hurts rather than helps a patient.

Over the last three reported years (ending 2011-12), nursing sensitive adverse events for surgical and medical patients averaged 5.1% higher in Ontario compared to the Canada-wide average.  (If Ontario could be removed from the Canada-wide average, the discrepancy would be higher still.)

Ontario funds hospitals at just about the lowest level of any Canadian province. So the same CIHI data also indicates that nursing hours per patient (or, more specifically, "per weighted case") are 12.5% more across Canada than in Ontario.  That means an extra 5.32 hours of nursing care per patient Canada-wide compared to Ontario.  
It sounds pretty reasonable …

Management wage increases dwarf others

Earlier I noted that while the provincial government was imposing concessions (and, yes, of course, wage freezes) on unionized public sector workers, the Conference Board of Canada was predicting 2.7% increases for non-union employees in Ontario in 2013 (up from 2.6% actual increases in 2012).

Now, Statistics Canada data suggests this may be part of a long term trend.  Data in a new report indicates that in Canada between 1998 and 2011 the hourly wages of full time management occupations went up 34.7% in real terms (i.e. after accounting for inflation).  
The rest did much worse.  "Health occupations" saw a 3.8% real increase.  That is about a quarter of one percent per year -- management occupations did about  nine times better.  "Social Sciences, education, and government service" did worse still with a 2.5% increase over the 13 years. 
Worst of all? "Occupations unique to processing, manufacturing, and utilities" at 1.5%. 
Outside of management, "…

Ontario homes:1 hour less care per elder per day

The death of a resident at a Toronto long-term care facility, allegedly at the hands of another resident, has raised concerns about inadequate staffing levels in Ontario.

Recent Statistics Canada data indicates that Ontario "homes for the aged" fall well short of staffing for homes for the aged in other provinces.  The total hours of staffing per resident  in Ontario homes for the aged are significantly less than the Canada-wide average.  
For Ontario the average is at 4.0 paid hours per resident per day while the Canada-wide average (including Ontario) is 4.9 hours.   That is almost one hour more paid staffing time per resident per day -- or 22.5 % more.  If Ontario were excluded from the Canada-wide data, the gap would be even larger.  
Three caveats.   The data refers to paid hours, not worked hours.  This overestimates the actual amount of care as paid hours includes vacations, holidays, sick leave, etc.   Second, the Stats Canada data reports allstaffing hours, including m…

Nursing levels low and getting lower

Yesterday,  I wrote about the significant lack of nursing care in Ontario hospitals compared to the other provinces.  Even on a Canada-wide basis, there was 5.32 hours more nursing care per patient than in Ontario in 2010-11 (year end March 31).  
That sounds kind of shocking.
But it looks like it is getting worse.  Other data from CIHI indicates that over the course of 2011, Ontario hospitals lost thousands of nurses. Specifically, there was a sharp reduction in the number of Registered Nurses (RNs) working in Ontario hospitals in 2011, with a cut of 2,750 RNs to 58,699 according to new CIHI data.  That is a loss of 4.5% of RNs.  
Compounding the problem,  there was a decline in the number of Registered Practical Nurses (RPNs) working in hospitals in Ontario as well, with the numbers declining from 13,373 in 2010 to 13,126 in 2011.  That's a decline of 247 RPNs  -- or a loss of 1.8% of RPNs in one-year.  This is a significant change from the previous years: there was 19% growth …

Hospital costs lower in Ontario

The “cost per weighted case” in Ontario hospitals in 2010-11 was $5,143, according to a new report from CIHI.   (This indicator measures the relative cost-efficiency of a hospital’s ability to provide acute inpatient care.)  The Ontario cost per weighted case compares with a Canada-wide average of $5,230.96.

In other words, the Canada-wide average is 1.7% higher than Ontario.   Ontario has improved its position relative to the other provinces since 2009/10, when the  Canada-wide average was only 0.08% higher.   Ontario’s lower costs are especially significant as (presumably) Ontario hospital wages (like other wages) are higher than most other provinces.  Of all the other provinces, only Quebec has a lower cost per weighted case.
As well, despite the lower costs per weighted case, clinical lab hours per weighted case, diagnostic services hours per weighted case, and pharmacy hours per weighted case were all higher in Ontario than the Canada-wide average.  
Of the reported data, only …

Private sector settlements 2.1% more than public sector

The  Ontario government's report on collective bargaining agreements came out yesterday for the month of January.

Naturally it included the "agreements" for school board employees.  It also included settlements in other parts of the public sector.  Although not imposed, annual wage settlements in these other parts of the public sector were also close to zero (six public administration settlements covering 36,000 employees saw an annual average wage increase of 0.1% and ten health and social service agreements covering 4,300 employees saw an average annual increase of 0.7%).

In total, public sector wage settlements covering just under 309,000 employees will see an annual average wage increase during the life of the contracts of 0.0%. (Of course, the government imposed benefit concessions as well.)

The government also reports private sector settlements covering 17,000 employees.  Their average annual wage increase is 2.1%.

In an updated version of the same report, the g…

MRSA and C. Difficile rates fall (but not here)

A new report from the Chief Medical Officer of Health in England reports that "rates of C. difficile have fallen consistently in all English regions in recent years. MRSA has fallen markedly and is now very low in many areas."

As noted in  November, there is no evidence of that in Ontario, as the incidence of both MRSA and C. Difficile is about the same as when public reporting started (i.e. over about the same period as when the rates of MRSA and C. Difficile were falling in England).
While England has made good progress on MRSA and C. Difficile, the new report also indicates an alarming increase in other types of bacteria including new strains of E coli and Klebsiella, which causes pneumonia. There are now many more cases of these than MRSA. As many as 5,000 patients die each year in the UK of gram negative sepsis – where the bacterium gets into the bloodstream – and in half the cases the bacterium is resistant to drugs, the Guardianreports.
"Antimicrobial resistance pos…