Sep 2, 2009

Study: Surgeon Experience Doesn’t Impact Patient Deaths

Here's some evidence of the importance of care teams to improve care rather than the work and effort of individual heroes that I found on the WSJ Health Blog. How would the system of care change if the team of trauma surgeons was expanded to include all members of the surgical team (anesthesiologists, nurses, etc.)?

hospitalWhether a trauma surgeon is a novice or experienced makes no difference on patients’ likelihood of survival, according to a recent study published in the Archives of Surgery. Instead, it appears that the overall system of care is more important.

We caught up with Elliott Haut, first author of the study and an assistant professor of surgery at Johns Hopkins, to discuss his findings. Here is an edited excerpt of the conversation.

Surgeons’ years of experience didn’t have an impact on patient mortality. Why is that?

I think there probably are very specific cases where very experienced surgeons do make a difference. But when you look at it as a whole — thousands and thousands of patients treated by different kinds of surgeons — it’s the system that makes the difference.

It doesn’t put [a veteran surgeon] out of a job. You need an experienced person to set up the system. It just means that we as a group of trauma surgeons need to have a system in place to treat all the patients in the same way, with evidence-based guidelines.

What defines the “structured program” that seems to be so important to patient outcomes?

At Johns Hopkins, we have a trauma attending surgeon. They’re going to show up with full team of residents. We have dozens of algorithms in our trauma manual that are given to our trauma residents. It helps guide you through some of the simpler things.

That senior, experienced trauma surgeon is an excellent mentor for junior people. We meet [as a trauma team] every morning at 7 a.m. We review every single trauma patient, go over what happened to them, what tests were done, vital signs, if the patient had surgery, what operation it was. It’s the real-time judgment and mentoring. All these pieces play a role; it’s not clear what’s the most important.

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