#Volume reset david professionalNevertheless, a discussion board of the American College of Surgeons quickly filled with dozens of postings, almost all bristling at the idea of external organizations imposing volume standards on surgery, arguing instead for quality-based standards, and taking particular offense at the portrayal of low-volume surgeons as hobbyists who are motivated by professional autonomy and pride to continue performing rare procedures despite the clinical and economic consequences. Proponents of the Pledge have presumably calculated that starting with such an easily achievable policy could be the thin end of the wedge for broader efforts to centralize complex surgery. (The Pledge is silent on the question of performing complex surgery in independent small and rural hospitals.) If volume-based distribution of surgery cannot be accomplished in this context, then it's probably not going to happen anywhere. Of all the possible approaches to restricting surgical care to high-volume hospitals, perhaps the least controversial ought to be a decision by a large metropolitan academic hospital system that its most complex elective surgery should be performed by the providers and hospitals that do the most of a given procedure. News & World Report as part of its Best Hospitals for Common Care rankings, was predictably hostile - and completely out of proportion to the modest ambition of the Pledge. The reaction of surgeons to the Pledge, which was widely promoted in U.S. The annual volume thresholds range from 10 per hospital and 5 per surgeon for carotid stenting to 50 per hospital and 25 per surgeon for hip and knee replacement. The Pledge, promoted by long-time advocates of quality improvement such as John Birkmeyer and Peter Pronovost, challenges other large health systems to join them in restricting the performance of 10 surgical procedures - including gastrointestinal, cardiovascular, and joint-replacement surgeries - to hospitals and surgeons who perform more than a minimum number. On May 18, 2015, leaders at three hospital systems - Dartmouth–Hitchcock Medical Center, the Johns Hopkins Hospital and Health System, and the University of Michigan Health System - publicly announced a “Take the Volume Pledge” campaign to prevent certain surgical procedures from being performed by their surgeons who perform relatively few of them or at their hospitals where relatively few such procedures are performed. David Urbach on a plan to concentrate certain surgical procedures among the physicians and hospitals that perform the most of them. The most trusted, influential source of new medical knowledge and clinical best practices in the world. #Volume reset david licenseInformation and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. #Volume reset david trialNEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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