‘Action is needed’ on heart care variations

Two sister hospitals in neighbouring counties have emerged as having the country’s best and worst death rates for heart attack patients in their care.

‘Action is needed’ on heart care variations

The Midland Regional Hospital, Portlaoise, Co Laois, has a mortality rate of 3.84% while the Midland Regional Hospital, Tullamore, Co Offaly, has a rate of 11.96% — three times higher.

Nationally, the average rate is 6.68%, but there are many variations, with the best being Portlaoise, The Mater in Dublin (3.96%), and Kerry General (4.12%), and the worst being Tullamore, Cavan General (10.36%), and the Midland Regional, Mullingar (8.88%).

Deputy chief medical officer Deirdre Mulholland stressed that, nationally, the picture was positive as heart attack deaths had fallen 40% between 2004-2013, but she said the variations between hospitals had to be addressed. “It’s telling us that there is something there that needs further exploration.”

Similar variations have emerged for deaths from strokes, with the rate for deaths from haemorrhagic stroke in Naas General Hospital the highest in the country, three times the rate in Beaumont Hospital, Dublin, with the lowest rate.

For ischaemic strokes, the variation is also threefold, with Cavan General having the highest mortality rate, and Tallaght Hospital, Dublin, the lowest.

The data comes from the first annual report of the National Healthcare Quality Reporting System, which shows striking differences under a number of headings.

Immunisation rates for MMR (measles, mumps, rubella) range from 97.6% for children covered by the Roscommon Local Health Office — above the national target rate of 95% — to 89% in West Cork, Dublin North West, and Dublin South East, which is below the target.

For the meningitis C vaccine against meningitis and septicaemia, Roscommon has once again the highest at over 95%, and West Cork the lowest at just 75%-80%.

Caesarean sections have been increasing in general in recent years, but the variations between hospitals is even more significant, with just 21.1% of women having c-sections at Sligo General, compared to 35.4% in St Luke’s, Kilkenny.

Waiting times for emergency hip fracture surgeries also show considerable differences, with Mayo General and St Vincent’s, Dublin, getting more than 95% of patients on the operating table within 48 hours, compared to Cork University Hospital, which only achieves 66%.

The report warns: “A delay in surgery can mean that as well as an increased length of hospital stay for the patient, there may also be an associated increased risk of serious illness and death.”

There are also significant variations in the numbers hospitalised for chronic conditions that ideally should be managed by GPs and community care clinics.

Longford has the highest hospitalisation rate for asthma — four times higher than Monaghan, which has the lowest rate. Hospitalisation rates for chronic obstructive pulmonary disease are three times higher in Offaly than Kerry, and the rate for diabetes is twice as high in Carlow than in Leitrim.

The report says the data is not necessarily a reflection on the quality of care but might be explained by the nature of the local population, the availability of hospital beds or access to specific treatments.

Dr Mulholland said the data was “the start of a conversation and it’s a conversation that we want the public, patients, service providers, politicians and policymakers all to become involved in”.

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