The majority of hospitals are still electively performing high-risk procedures without the adequate, ongoing experience to do so, highlighting persistent deficiencies in meeting surgical safety standards, according to a new survey from the Leapfrog Group.
The independent, national healthcare watchdog organization has released Safety In Numbers: Hospital Performance on Leapfrog's Surgical Volume Standard Based on Results of the 2019 Leapfrog Hospital Survey, which analyzes whether hospitals are performing a sufficient volume of high-risk surgeries to safely do so, and whether the hospital grants privileges only to surgeons meeting the Leapfrog minimum volume standard.
The report also records whether hospitals actively monitor to assure that each surgery is necessary.
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The news isn't all bad. In fact, there's been improvement: A higher percentage of hospitals are meeting Leapfrog's minimum volume standards in 2019 than 2018.
To the credit of rural hospitals, the vast majority do not perform these high-risk surgeries. Those that do are much less likely than other hospitals to meet the volume standard for patient safety.
Meanwhile, a sizable percentage of hospitals have implemented protocols to monitor for appropriateness, potentially protecting patients from getting unnecessary surgeries.
WHAT'S THE IMPACT
Unfortunately, the vast majority of hospitals performing high-risk procedures aren't meeting clear volume standards for safety, potentially putting patients at risk of complications or death -- a high risk when operating room volume is low.
Safety In Numbers uses final hospital data from the 2019 Leapfrog Hospital Survey, the flagship initiative of The Leapfrog Group. More than 2,100 hospitals participated in the 2019 Survey, representing 70% of U.S. hospital beds.
The eight surgeries included in the Survey were identified by Leapfrog's National Inpatient Surgery Expert Panel as procedures for which there is a strong volume-outcome relationship. The Expert Panel relied on published research and evidence to advise on minimum hospital and surgeon volume standards for each procedure.
Of the eight high-risk procedures assessed in the report, esophageal resection for cancer and pancreatic resection for cancer are the two procedures where the fewest hospitals met the volume standard for patient safety -- fewer than 3% and 8%, respectively. The procedure for which hospitals were most likely to meet the safety standard was bariatric surgery for weight loss (48%). The analysis also shows that while many rural hospitals are abstaining from performing these procedures, those that continue to do so are not likely to meet the volume standards.
Equally important to achieving minimum volume standards is avoiding unnecessary and unneeded surgeries. In this regard, survey findings show that 70% of reporting hospitals have enacted protocols to ensure appropriateness for cancer procedures. For other high-risk procedures, hospital compliance to ensuring appropriateness ranged from 32-60%, depending on the procedure.
THE LARGER TREND
An October 2019 retrospective literature study in JAMA that found the estimated cost of waste in the U.S. healthcare system due to overtreatment or low-value care ranged from $75.7 billion to $101.2 billion. Overall, the estimated cost of waste in the healthcare system ranged from $760 billion to $935 billion, accounting for approximately 25% of total healthcare spending.