How Volume Affects Quality of Care
November 1st, 2016 by Wapner Newman
Common sense says that someone who doesn’t do a particular activity very often, especially a complicated one, simply isn’t going to do it as well as someone who does it frequently. That holds true for professionals as well, particularly physicians. While it might be more convenient to go to a local doctor or hospital for care, selecting a surgeon with minimal expertise to perform a high-risk procedure or a hospital that lacks experience caring for patients who have had a specific procedure may not be the safest choice.
In 1979, a study of mortality rates for 12 surgical procedures in almost 1,500 hospitals found that patients who underwent operations at hospitals that did more of those surgeries had considerably lower death rates than patients treated at hospitals where they were seldom done. This relationship between surgical volume and surgical mortality has been proven repeatedly over the last 40 years. Last year, U.S. News & World Report promoted the “Take the Volume Pledge” campaign as part of its Best Hospitals for Common Care rankings to prevent certain surgical procedures from being performed by surgeons who perform relatively few of them or at hospitals where relatively few such procedures are performed. While not well-received by all medical professionals, three major health systems did take the pledge to restrict the performance of 10 surgical procedures to hospitals and surgeons who perform more than a minimum number. The annual volume thresholds ranged from 10 per hospital and 5 per surgeon for carotid stenting to 50 per hospital and 25 per surgeon for hip and knee replacement.
Other than organ transplants, doctors and hospitals have few restrictions on performing whatever surgeries they wish. While surgeons should exercise judgement about their capabilities, the burden is really on the patients to take responsibility for their own health care. Some useful resources include ProPublica’s Surgeon Scorecard, Consumer’s Checkbook Surgeon Ratings, Consumer Reports hospital ratings, and Medicare’s Hospital Compare.
Although patients with serious illnesses or complex diagnoses have long been encouraged to seek care from experienced specialists, many don’t know what questions to pose or where to begin. Consider asking:
- How many of that specific procedure does the surgeon do in a year?
- How many of that procedure does the hospital do in a year?
- What is the hospital’s surgical infection rate? What is the surgeon’s infection rate for the procedure?
- What are the hospital’s and surgeon’s success rates for the procedure, how do the rates compare with national benchmarks, and how is success defined?
- Is the surgical approach or device proposed for your operation new to the surgeon?
- If you want a second opinion, can you easily obtain your medical documents and images?
If you have any questions about this topic, or if you believe that a medical error may be responsible for your injury or for the wrongful death of loved one, the attorneys at Wapner Newman can help. For almost 40 years, we have been the trusted advocates for countless personal injury victims and their families throughout Pennsylvania and New Jersey. We offer risk-free consultations and work on a contingency basis, which means that we do not require you to pay any fees until we have secured a recovery on your behalf. We encourage you to contact us today by calling 1-800-LAW-6600 or filling out a free case evaluation form.