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Do More Hospital Resources Equal Better Care?

Thu, 11/07/2013 - 9:13am
Skeptical Scalpel

For surgical patients, the answer is "Yes."

A recent study from England found that mortality rates for patients admitted with high-risk general surgery diagnoses were significantly lower in National Health Service Trust hospitals that used more CT scans and ultrasounds and had more ICU beds.

During the first decade of this century, nearly 368,000 patients were admitted as emergencies to English hospitals with surgical diagnoses carrying mortality rates in excess of 5 percent.

The diseases were bowel obstruction, liver/biliary conditions, hernias with obstruction or gangrene, peritonitis, gastrointestinal ulcers, perforated diverticulitis, bowel ischemia and miscellaneous diagnoses.

The 30-day risk-adjusted in-hospital mortality rate for the eight illnesses was 15.5% with a range of 9.2% in low-mortality hospital trusts (LMHTs) to 18.2 percent in high mortality hospital trusts (HMHTs). An operation was performed in 37.4 percent of patients, and 14.9 percent were readmitted within 28 days.

Three factors significantly differentiated LMHTs from HMHTs:

  • LMHTs had 20 ICU beds per 1000 beds vs. 14 for HMHTs, p = 0.017.
  • LMHTs performed 24.6 CT scans per bed per year vs. 17.2 for HMHTs, p < 0.001.
  • LMHTs performed 42.5 ultrasounds per bed per year vs. 30 for HMHTs, p < 0.001.
Some limitations of the study included the fact that it was based on administrative data. There was no way to determine if the increased use of imaging or availability of ICU beds had a direct effect on patients admitted with emergency surgical diagnoses. Also, variables such as delays in surgery or competence of surgeons could not be investigated.
 
Despite its limitations, this study is provocative.
 
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