Hip fracture deaths more likely at small and medium community hospitals: study

Canadians with broken hips are more likely to die after seeking treatment at a medium or small community hospital, compared with large and teaching hospitals, a new study says.

The report by the Canadian Collaborative Study of Hip Fractures found that for every 1,000 patients admitted with a hip fracture, 14 more die at medium community hospitals, and that increases to 43 more at small community hospitals.

Dr. Pierre Guy, a University of British Columbia associate professor of orthopedics, co-authored the study and said it isn't about assigning blame.

"Health-care workers across Canada and hospitals are always trying to improve the care they deliver. The way we see this paper is sort of a call to action," he said in an interview on Monday.

"What can we identify in these various hospitals as factors that could be improved to take care of patients?"

The study defines teaching hospitals as those that are members of the Association of Canadian Academic Healthcare Organizations, while community hospitals are defined by bed number and divided into three categories: small, medium and large.

Small community hospitals have fewer than 50 beds, medium community hospitals have between 50 and 199 beds and large community hospitals have more than 200 beds.

There are 30,000 hip fractures reported every year in Canada and about one in 10 patients dies in hospital, according to a release about the study.

The study, published Monday in the Canadian Medical Association Journal, examined outcomes of patients 65 and older who were admitted to hospital with a hip fracture not caused by a disease between 2004 and 2012.

It found no difference between teaching hospitals and large community hospitals.

No reason for increase found

Researchers didn't examine the reasons for increased death at medium and small hospitals, but the study says future research should explore the impact of teaching status, volume, demand and bed occupancy.

"If there are factors that we can identify in the system within the delivery of care that we can improve, I think we should target those and really work hard to optimize that," said Guy.

In cases where the patient underwent surgery, death was more likely at medium community hospitals. For every 1,000 surgeries, there were 11 more deaths at medium facilities.

The study says these hospitals have fewer beds, staff and equipment to ensure timely care.

The risk of death without surgery was higher at medium and small community hospitals, with an additional 10 and 34 deaths per 1,000 patients, respectively.

"The time required to transfer patients from medium and small community hospitals for care contributes to potentially harmful surgical delay," the report says. "It may be necessary to prioritize these patients on arrival at larger hospitals."

The hospitals were not identified by location other than province, so whether small and medium community hospitals serve more remote populations was not a part of the analysis.

Guy said smaller communities are more likely to have a small hospital, but these facilities also exist in urban areas across Canada.