Dive Brief:
- According to a U.S. News analysis, patients at thousands of U.S. hospitals face a higher risk of death or complications because their surgical teams don't do a high enough volume of certain procedures to maintain their skills.
- The analysis found that the death rate for elective knee replacements at one low-volume hospital was 24 times the national average; for hip replacements, it was three times the national average.
- Using the U.S. News analysis, Dr. John Birkmeyer, a surgeon who conducts research on the effect of patient volumes, determined that as many as 11,000 deaths could have been prevented nationally between 2010 and 2012 if patients who had gone to the lowest-volume fifth of the hospitals had instead gone to the highest.
Dive Insight:
There has been a long-standing debate about whether or not requiring a minimum number of procedures in order for a physician to maintain privileges would improve patient safety. Although Dr. Mark Chassin, president and CEO of The Joint Commission, agrees that many studies have shown a relationship between low volumes and worse outcomes, he doesn't believe volume alone should discourage hospitals or surgeons from doing procedures. "I don't think thresholds or minimum requirements will change things for the better," he told U.S. News and World Report. "It will reduce supply and indiscriminately remove both good and bad performers. That's not a prescription for improvement."
Ultimately, hospitals are responsible for making sure their physicians are competent to perform procedures. "What we've urged, and what we require, is that all hospital clinical departments set up criteria for credentialing of physicians or surgeons and take into account how well they do—track their performance," said Chassin.
Want to read more? You may enjoy this story on the three major academic medical systems that have imposed minimum-volume standards.