The vast majority of participating hospitals do not meet The Leapfrog Group's minimum hospital or surgeon volume standards for safety, nor do they have adequate policies in place to monitor for appropriateness, according to a new report from the independent national healthcare watchdog organization.
The report analyzes eight high-risk procedures to determine which hospitals and surgeons perform enough of them to minimize the risk of patient harm or death, and whether hospitals actively monitor to assure that each surgery is necessary. Rural hospitals are particularly challenged in meeting the standards.
"Safety In Numbers" summarizes findings from the 2018 Leapfrog Hospital Survey, submitted by over 2,000 hospitals nationwide. This is the first year Leapfrog reported the new surgical standard by hospital, assessing whether both hospitals and surgeons met volume standards, and whether hospitals monitored for surgical necessity.
WHAT'S THE IMPACT
The eight high-risk procedures highlighted in the report were selected based on an intensive review of hundreds of studies conducted over the past decade, as well as guidance from Leapfrog's National Inpatient Surgery Expert Panel. From this the group set evidence-based standards for the minimum number of procedures each hospital and surgeon should perform.
Of the eight high-risk procedures assessed, open abdominal aortic aneurysm repair and esophageal resection for cancer are the two procedures where the fewest hospitals met the volume standard for patient safety (less than 3% fully meeting for each). The procedure for which hospitals were most likely to meet the safety standard was bariatric surgery for weight loss (38%).
The other procedures were lung resection for cancer, pancreatic resection for cancer, rectal cancer surgery, lung resection for cancer and carotid endarterectomy.
The analysis also shows significant variation between urban and rural hospitals, with urban hospitals outperforming rural hospitals across all eight high-risk procedures. For five of the eight procedures, no rural hospitals are fully meeting Leapfrog's volume standard.
Achieving minimum volume standards is key to avoiding unnecessary and unneeded surgeries, the report found. To that end, Leapfrog encouraged hospitals to have an appropriateness policy in place, which includes processes aimed at monitoring surgical necessity and preventing overuse of surgical procedures. For all but one high-risk procedure assessed, less than one-third of reporting hospitals indicate that they have a surgical appropriateness policy in place.
ON THE RECORD
"It's clear from this report that patients should be very careful before they choose a hospital for one of these high-risk procedures," said Leah Binder, president and CEO of The Leapfrog Group. "Beyond the disturbing findings in this report, patients should worry even more about hospitals that decline to report this information at all, because candor and transparency is the necessary first step to improvement. We are confident that health system leaders will use these findings productively, in this case by concentrating volume in the most appropriate setting, and monitoring appropriateness better."