Maps: Patient safety in hospitals

The Ministry of Health released a new set of patient safety indicators today, measuring hospital performance in eight areas: clostridium difficile associated disease, Methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococcis (VRE), hospital-standardized mortality ratio (HSMR), central-line primary bloodstream infection (CLI), ventilator-associated pneumonia (VAP), surgical site infection prevention and 'hand hygiene compliance,' which refers to consistent hand washing by health care workers.

This last has been given a new urgency by the spread of a new strain of swine flu or, as the World Health Organization now calls it, 'influenza A (H1N1)'.

Megan Ogilvie's story is here.

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Today, we map two of these indicators: hand washing and C. difficile. As always, click on an icon or zoom on for information:

Hand hygiene compliance: Apr 01, 2008 - Mar 31, 2009

Clostridium Difficile Associated Disease (CDAD) Mar 01 - Mar 31, 2009

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Here is the complete data for all GTA hospitals:

Ajax And Pickering Hospital Site - ROUGE VALLEY HEALTH SYSTEM

Baycrest Centre for Geriatric Care

Bloorview Kids Rehab

Brampton Civic Hospital Site

Bridgepoint Hospital

Casey House Hospice

Centenary Hospital Site - ROUGE VALLEY HEALTH SYSTEM

College Street Site - CAMH

Credit Valley Hospital (The)

Etobicoke General Hospital Site

Georgetown Hospital Site - HALTON HEALTHCARE SERVICES

Hillcrest Hospital - TORONTO REHAB INST

Hospital For Sick Children

Humber Memorial Hospital Site (Church Site)

Lakeridge Health - Bowmanville Site

Lakeridge Health - Oshawa Site

Lakeridge Health - Port Perry Site

Lakeridge Health- Whitby Site

Lyndhurst Hospital Site - TORONTO REHAB INST

Markham Stouffville Hospital

Markham Stouffville Hospital - Cottage Hospital Site

Milton District Hospital Site - HALTON HEALTHCARE SERVICES

Mount Sinai Hospital

North York General Hospital

Northwestern General Hospital Site (Psychiatric Unit Only)

Oakville Trafalgar Memorial Site - HALTON HEALTHCARE SERVICES

Princess Margaret Hospital Site

Providence Healthcare

Queen Street Site - CAMH

Runnymede Healthcare Centre

Salvation Army Grace Hospital

Scarborough General Hospital

Scarborough Salvation Army Grace Hospital

Southlake Regional Health Centre

St John's Rehabilitation Hospital

St Joseph's Health Centre - Toronto

St Michael's Hospital

Sunnybrook Health Sciences Centre

Sunnybrook Health Sciences Centre - Orthopaedic And Arthritic Hospital Site

Sunnybrook Health Sciences Centre - Women's College Hospital Site

Toronto East General Hospital (The)

Toronto General Hospital Site

Toronto Western Hospital Site

Trillium Health Centre - Mississauga

Trillium Health Centre - West Toronto

University Centre Site - TORONTO REHAB INST

West Park Healthcare Centre

Whitby Mental Health Centre

York Central Hospital

York-Finch General Hospital Site

Maps: Hepatitis

Map: Hepatitis B

Map: Hepatitis C

This week, we continue our disease series by looking at hepatitis B and C.

Hepatitis B (map) clusters in a stretch of downtown south of Bloor stretching east from Bathurst, and across the Don into south Riverdale. In the suburbs, there is a cluster centred more or less on Warden and Steeles, between Bayview and Markham Rd.

Hepatitis C (map) has three clusters - the east downtown through south Riverdale, the Beaches and eastern East York, with Thorncliffe Park; lake shore Etobicoke generally, with an area east of Dixie Rd. north to Burnamthorpe; and the area north and west of Pearson.

Housekeeping

- Herb at ibiketo.ca overlays the KML file from our bike accident map on a map of density of cyclists by census tract: link. The map was also discussed here and here.

- The blog’s lifetime traffic is just under 570,000, or about 1,760 hits a day as a lifetime average. Recent traffic has been higher – for April so far, we have been getting an average of about 5,100 hits a day.

Map of the Week: Food-borne disease

This week, we continue our disease series by mapping the GTA's three most common food-borne diseases:

Campylobacter enteritis (map)

Salmonellosis (map)

Yersinosis (map)

Click on the maps to see how your neighbourhood fared.

The data comes from reports sent to medical officers of health in Toronto, Peel, Halton, York and Durham sent to the Ministry of Health in 2008. The Ministry released a spreadsheet in response to an FOI request with the reported disease, the region that the report came from, and the first three characters of the postal code of the patient, which was available in most cases.

The maps show reports of cases in 2008, per 1,000 of population.

Note: These maps show the cases which are officially reported. The statistics in this morning's story are an attempt to estimate the number of cases which actually occur, based on the reported cases.

Can you find Google’s GTA mistakes?

Google Maps is fine for the big picture, but sometimes not reliable on the level of urban detail. Here are three examples, two of which resulted in errors in the Star in print, on line or both:

1) Misspelled street name in the Christie/Dupont area:

This spelling was on the site for a while, in a story about a power outage, until a Web editor who used to live in the area corrected it. (Correct spelling is Wychcrest.)

2) East York is labelled outside the historic East York boundary (grey polygon):

3) Mislabelled park in Ajax. This wrong name was used a graphic, which ended up as a formal published correction and the fussy but in this case necessary process for correcting a graphic online.

Here's what Google shows:

and here's the corrected graphic:

There have to be more errors out there – these are just a few that we stumbled on by accident.

So: has Google led you astray? Are there roads on the map that don’t exist on the ground, or vice versa? Spelling mistakes? Leave your answers in the comment section. We’ll gather the responses and send them off to Palo Alto.

Google isn't the worst offender. MapArt’s recent atlas of the Golden Horseshoe depicts two villages outside Ancaster, Summit and Trinity (complete with a tiny pink area where the mapmaker imagines people might live), which stopped being plausible hamlets a hundred or so years ago.

Anybody trying to find these places is in for a confusing surprise.

For how many generations have mapmakers been copying each others’ work without ground-truthing it? It’s an interesting question.

Map of the Week: Tuberculosis

This week’s map (link) shows rates of tuberculosis.

The data comes from reports sent to medical officers of health in Toronto, Peel, Halton, York and Durham sent to the Ministry of Health in 2008. The Ministry released a spreadsheet in response to an FOI request with the reported disease, the region that the report came from, and the first three characters of the postal code of the patient, which was available in most cases.

The map shows reports of TB cases in 2008, per 1,000 of population.

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Parkdale (M6K) leads the GTA for TB, followed by Cabbagetown and St. Jamestown (M4X) and the neighbourhoods off the Allen north of Lawrence (M6A). Next is L6P, the northern corner of Brampton, followed by M5T, centred on Dundas and Spadina. Next is M1S, a chunk of Scarborough bounded by the 401, Kennedy, Finch and Markham Rd.

Low-population M5E (St. Lawrence neighbourhood) shows up because of its one case.

I haven't been able to find a pre-1920 map for TB in Toronto (there's one for smallpox), but I'd be curious to know how different the downtown pattern in this one is.

TB is present at some level, even if it's only one case, in most of the GTA's postal areas.

4% of cases had no postal code available, and do not appear on the map.

Maps of the Week: Sexually transmitted disease

Our series on communicable disease begins this week with five sexually transmitted diseases.

As explained earlier, the data comes from reports sent to medical officers of health in Toronto, Peel, Halton, York and Durham sent to the Ministry of Health in 2008. The Ministry released a spreadsheet in response to an FOI request with the reported disease, the region that the report came from, and the first three characters of the postal code of the patient, which was available in most cases.

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Chlamydia (map)

Chlamydia appears in two strong pockets in the GTA. One is in the central city, strongest in areas east of Yonge and the neighbourhood centred on Spadina and Dundas, and then spreading out at a lower level along the waterfront neghbourhoods from Parkdale to Ashbridge's Bay. A second pocket is centred on the 400 and 401, spreading south to Keele and Eglinton and north to Jane and Steeles. At a lower level, the pocket spreads west into north Etobicoke and east into York University. In Peel, chlamydia is centred in Brampton in a corridor along Queen Street.

Only one residential postal code in the entire GTA had no cases - low-population L4V, east of Pearson, with only 1,012 people.

13% of cases had no postal code available, and do not appear on the map.

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Gonorrhoea (map)

Gonorrhoea shows a similar pattern, with the east downtown and areas roughly along Jane St. strongly represented, and nearby areas also affected. A third area covering much of mid-south Scarborough and Malvern also appears, but at lower levels.

13% of cases had no postal code available, and do not appear on the map.

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HIV (map)

is strongly concentrated in the city's east downtown, with a suburban pocket east and southwest of Jane and Sheppard. South Riverdale and Harbourfront also have higher rates.

34% of cases had no postal code available, and do not appear on the map.

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Infectious syphilis (map)

This map covers much of the older part of the central city, with a centre more or less at Yonge and Dundas.

16% of cases had no postal code available, and do not appear on the map.

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Other syphilis (map)

This map shows a roughly similar pattern to chlamydia and gonorrhoea, with the east downtown and a corridor roughly centred between Jane and Keele represented, and less-affected areas spreading out from there.

Low-population L0H appears on the map with its one case. With a population of 713, one case of anything can make L0H stand out, depending on the subject.

10% of cases had no postal code available, and do not appear on the map.

The Star's neighbourhood map, version 3.2

TONY BOCK/TORONTO STAR

Link to the map

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Some changes have been made to the Toronto neighbourhood map:

1. Tritown was rejected by residents of the area, and has been removed.
2. Added Scarborough Junction. Boundaries: Eglinton to the north between Kennedy and Brimley. East boundary: Brimley down to the railway tracks. From there, railway tracks to St. Clair, along St. Clair to the Danforth, and then along the Danforth to Birchmount. Western boundary: Birchmount north to the railway tracks, then follow back up to Eglinton.
3. Added Leacock, carved out of Tam O’Shanter.) Boundaries are Sheppard north to Finch, between Birchmount and Warden.
4. Added Corinthian, from Sheppard to Finch, between Pharmacy and Victoria Park.
5. Added Town and Country, between Highway 401 and Sheppard between Pharmacy and Victoria Park.
6. Added West Lansing, the portion of Lansing south of Sheppard.

A mashup with pen and ink

WIKIMEDIA COMMONS

The modern understanding of infectious disease began what we would now call a mashup.

The Industrial Revolution transformed Britain into a country which was richer, but filthy, dangerous and miserable for the millions who poured into its growing cities. London became the largest city in the world, and the largest city any human society up to that point had produced.

Sanitary arrangements, however, had not caught up the metropolis's vast complexity. Water came from public wells drawing from the city's mysterious innards, while what was euphemistically called 'nightsoil' was allowed to accumulate under houses.

Nightsoil men had to be paid to remove the nightsoil, and property owners who were broke or just indifferent often didn't bother to hire them. Author Steven Johnson, in The Ghost Map, quotes an engineer writing in the 1840s:

"I found whole areas of the cellars of both houses were full of nightsoil to the depth of three feet, which had been permitted for years to accumulate from the overflow of the cesspools ... Upon passing though the passage of the first house I found the yard covered with nightsoil from the overflowing of the privy to a depth of six inches and bricks were placed to enable the inmates to get across dryshod."

From a modern point of view, the results seem inevitable. In the summer of 1854, a devastating outbreak of cholera struck the Soho area of the city.

The outbreak attracted the interest of maverick physician Dr. John Snow, who had an eccentric theory, not widely accepted, that disease could be transmitted through water. The medical establishment of the day had reached a consensus around the miasma theory of disease, in which illness was spread through bad smells.

Snow and his collaborator, local clergyman Henry Whitehead, painstakingly investigated every case of cholera, concentrating on what the victims’ source of drinking water was. All were mapped, with the hardest-hit houses accumulating a sad row of black marks.

The map combined four data sets: the underlying geography, the victims, the pumps, and lines showing the closest pump from any given point – in the area’s winding streets, this was not always the closest as the crow flew. Once the information had been mapped visually, one thing was clear: at the centre of the outbreak was the pump on Broad Street, seen above.

Ironically, the Broad Street pump had been popular because its water tasted and looked cleaner than the water from many other sources.

After the information in Snow’s map forced local authorities to look closely at the well, a decaying brick sewer was found next to it, fouled by what Whitehead described as ‘abominations, unmolested by water, which I forbear to recite.’

Johnson explains:

The “ … investigation had unearthed the gruesome truth. The contents of a cesspool were seeping into the Broad Street well. Anything living in the intestines of the residents of 40 Broad had direct access to the intestines of about a thousand other human beings. That was all the V. cholerae had needed.

Snow’s map had a longer-term influence as well:

As the waterborne theory of cholera became increasingly accepted, the map was regularly invoked as a shorthand explanation of the science behind the theory. It was easier to point to those black bars emanating ominously from the pump than it was to explain the whole idea of microorganisms invisible to the human eye.

The understanding which Snow's map had helped to emerge then led to the enormous project of giving London a recognizably modern water and sewage system. Snow's mashup is the direct ancestor of the applications for interactive mapping we use today - it's just that our tools are faster and more sophisticated.