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Report: Low-Volume Hospitals Pose Heightened Risk to Patient Safety?

Our Seattle medical malpractice lawyers ask if low-volume hospitals pose heightened risk to patient safety.

An analysis by U.S. News and World Report concluded that patients at “low-volume hospitals” face higher mortality rates and increased complications as compared to patients at busier facilities because the medical staffs at low-volume hospitals do not perform enough procedures to maintain their skills. Low-volume hospitals are those that do not see the high number of patients treated by other facilities.

The magazine cited the example of Sterling Regional Medical Center, a 25-bed hospital in Colorado, where the death rate for elective knee replacements is 24 times the national average and three times the national average for hip replacements. While larger hospitals perform hundreds of these procedures each year, Sterling performed only 29 hip and 52 knee surgeries between 2010 and 2012, according to the report.

The analysis by U.S. News and World Report showed it is not just tiny hospitals that have an increased risk. At the 331-bed Lawnwood Regional Medical Center and Heart Institute in Florida, the death rate for hip replacement surgery is nine times the national average. The risk of dying for heart bypass patients at 316-bed Jersey City Medical Center in New Jersey was four times the national average.

The report chronicled how Dr. John Birkmeyer, a surgeon who researches the effect of patient volume, used the U.S. News and World Report data to determine that as many as 11,000 deaths nationally might have been prevented from 2010 through 2012 if patients who went to the lowest-volume 20% of the hospitals had instead gone to the highest volume hospitals on the list. He based the findings on five common procedures and conditions – hip replacement, knee replacement, heart bypass surgery, heart failure and chronic obstructive pulmonary disease (COPD).

The U.S. News and World Report analysis identified hospitals that operated on or treated 25 or fewer traditional Medicare inpatients from 2010 through 2012 for several procedures and conditions; these are the so-called “ultra-low-volume hospitals.” At these hospitals, the death risk for knee-replacement patients was double the national average and the facilities had a 25 percent higher rate of readmission because of post-discharge complications. Hip-replacement patients had a 77 percent higher risk of death and a 25 percent higher risk of readmission.

U.S. News and World Report’s findings for ultra-low-volume hospitals also include:

  • 1,071 performed 10,686 hip replacements, an average of 3.3 per year per hospital.
  • 608 performed 6,707 knee replacements, an average of 3.7 per year.
  • 124 performed basic heart bypass surgery on 1,538 patients, an average of 4.1 per year.
  • 254 hospitals performed heart bypass surgery involving valve replacement or repair on 3,203 patients, an average of 4.2 per year.
  • 396 hospitals treated 4,626 cases of heart failure, an average of 3.9 per year.
  • 558 hospitals treated 7,174 cases of chronic obstructive pulmonary disease, an average of 4.3 per year.

Patients at low-volume hospitals face other negative outcomes. The analysis showed that patients need to come back more often after a joint replacement for revision surgery because of infection or mechanical failure. The one-year revision rates at the lowest-volume hospitals are nearly 20 percent for knee replacement patients and 20 percent higher for hip replacement patients.

The attorneys of Morrow Kidman Tinker Macey-Cushman, PLLC, are committed to patient safety and represent patients who have been harmed by preventable medical errors in Seattle and across Washington. Schedule a free consultation by calling us or contacting us online.