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Ann Thorac Surg 2000;70:1001
© 2000 The Society of Thoracic Surgeons

Correspondence

Reply

Gerald L. Early, MDa, Shauna R. Roberts, MDa

a Kansas University Medical Center, 3901 Rainbow Blvd, Suite 1232, Kansas City, KS, 66160, USA

To the Editor

We appreciate the comments by Urschel and Urschel on our work [1] and look forward to seeing their report on volume–outcome relationships in noncardiac thoracic surgery.

We have shown that excellent results can be obtained in a low-volume program with a peak annual volume of 181 cardiac cases. We concluded that the knowledge required to obtain these results is readily available and agree that a high level of surgeon involvement is necessary (at least in the early phases of a new program). It is of interest that in the other low-volume programs noted by Urschel and Urschel the surgeons moved to different centers, and they felt that it was difficult "for surgeons to shoulder the burden of patient care in low-volume hospitals indefinitely." We believe that they are correct but suspect that the burden is significant in high-volume centers as well.

It may be that it is not just the clinical burden that becomes too heavy for the surgeons who leave. The greater burden can be maintaining a commitment to quality in the systems in which they work. Although economic incentives are seductive, failure to honor the financial and ethical value of quality care (recognizing that that includes cost-effective care) can be disastrous. In addition, it is erroneous to assume that quality can persist without commitment. We believe that if any of us allow quality care to be degraded for purely economic or frivolous reasons we become deeply impoverished, and this played a powerful role in our decision to move.

References

  1. Early G.L., Roberts S.R. Excellence and low case volume. Ann Thorac Surg 2000;69:146-150.[Abstract/Free Full Text]




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