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In the news: Hospital and surgeon volume

Medical Staff Leader Connection, February 12, 2003

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Dear Medical Staff Leader,

Medical executive committees (MECs) and credentials committees long have been concerned about the relationship between surgical volume and outcome. In many medical staffs, minimum volume is a prerequisite for certain invasive procedure privileges. Hundreds of articles have been published addressing this complex and controversial issue.

According to a recent article in the New York Times, published February 10, a large number of physicians and hospitals in New York have relatively little experience performing specific complex procedures. The article indicated that many physicians performing complex procedures, such as carotid endarterectomies, performed those procedures fewer than 10 times annually. The report also indicated that nearly a third of all physicians performed a carotid endarterectomy only once, and that physicians who performed more than 30 annually accounted for more than half such procedures performed.

Physicians have long known that volume does affect quality. Physicians also know that low volume is not an absolute predictor of outcomes.

This newly released report (available for free at www.medicalconsumers.org) represents a detailed look at the work done by individual hospitals and physicians in New York. The report should prompt your MEC to investigate your organization's performance for the 44 procedures studied. Institutional and physician procedure volumes may spur a dialogue at your organization and shed more light on this complex issue.

It has often been said that "knowledge is power." MECs should review the study's findings before other members of the organization misinterpret or attempt to misuse the "power."

That's all for this week.

All the best,

Hugh Greeley

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