Page 5 - brochure %283%29

GOAL 1: QUALITY CARE (QC)

Providing Quality Care (QC) is one of the most important goals of the Shoulder and Upper Limb Unit.

For 2016, our Quality Care (QC) goal included the following three objectives: (1) Ensure Surgical volumes meet or exceed Center of Excellence
designation guidelines; (2) Measure, report and improve outcomes data; and (3) Offer the full complement of surgical and non-surgical care.

QC Objective 1: Ensure Surgical Volumes Meet or Exceed Center of Excellence Designation Guidelines

Volume is one of the most important quality indicators and predictors of outcome. Research for shoulder surgeries, for example, has found that
lower volume is tied to increased surgical complications, length of stay, surgical time, and surgical cost. 1,2 Conversely, there is strong evidence that
a higher volume of the same types of surgeries reduces variability, readmissions, and results in better outcomes. 3

As a result, one of the key qualifiers for being designated a Center of Excellence (COE) is a minimum number of annual surgeries within a
subspecialty. The minimum recommended are 50 surgical cases per surgeon and between 150 - 200 surgeries for a Center. SUL’s number of
surgeries (439 cases) for our surgeons in 2016 in their subspecialty) exceed by a significant margin both the minimum volume recommendations
for Physician and for a Center. Table 1 below, further breaks down the Unit’s surgical volume:

Table 1: 2016 Shoulder and Upper Limb Surgeries: Volume and Demographics

Types of # Average Age % %
Cases Surgeries (years) Male/Female Inpatient

*Upper Limb includes elbow, wrist, hand. Some overlap with shoulder for a few cases that covered two areas of the upper limb.
**Several types of surgery that fall under SUL’s subspecialty because they are arthroscopic surgeries apply to the minimum volume needed – e.g., knee arthroscopy.

1 Kent T. Weinheimer, et. al., “Patient Outcomes as a Function of Shoulder Surgeon Volume: A Systematic Review”, Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 33, No 7
(July), 2017: pp 12731281-.
2 Birkmeyer JD, Siewers AE, Finlayson EV, et. al., “Hospital volume and surgical mortality in the United States”. N Engl J Med 2002; 346:1128–37.
3
Johannes Morche, et. al, “Relationship between surgeon volume and outcomes: a systematic review of systematic reviews” Systematic Reviews 2016 5:204.
The Shoulder and Upper Limb Unit