An interesting study in the July 6 issue of The New England Journal of Medicine confirms what many physicians and patients have suspected: experience leads to quality. The study looked at over 20,000 patients with respiratory failure (inadequate or stopped breathing) in 37 different hospitals. The patients all required mechanical ventilation, meaning they were connected to a machine (a ventilator) that assisted their breathing until their respiratory problem improved. The study compared the number of these patients who survived their hospitalization to each hospital’s patient volume (the number of patients admitted to the hospital). The study took into account differences in illness severity and other differences between patients.

The patients admitted to the largest hospitals survived most frequently. A patient admitted to a hospital that was in the bottom 25% of hospital volume had a 34.2% chance of dying during the hospitalization. In the busiest 25% of hospitals, the average in-hospital mortality was 25.2%. That suggests that for every 11 patients with respiratory failure, one additional in-hospital death will occur in the least busy hospitals compared to in the busiest hospitals. That’s a surprisingly big difference.

Since this wasn’t a randomized study (meaning patients weren’t told which hospital to go to) the results may be potentially biased, so we should be cautious. The authors speculate about why busier hospitals may have better outcomes:

High-volume hospitals may improve outcomes by implementing a broad range of best practices, including higher nurse-to-patient ratios, multidisciplinary care teams. Clinicians at high-volume hospitals may also gain experience in the care of the critically ill, which could translate into improved rates of survival. More experienced as opposed to less experienced clinicians may be better at recognizing and treating the complications of critical illness or may be better at translating evidence into practice.

The bottom line is that experience translates to quality.

The Beverly Hills area is served by several hospitals, and I am frequently asked what I think about specific medical centers. This study further informs my initial opinion. Larger hospitals, like Cedars-Sinai Medical Center, have the care protocols, the information infrastructure, and the experienced specialists to provide better outcomes than small hospitals.