9.02.2009

Is the Doctor Experienced? It Doesn’t Matter Much in a Well-Organized ER

When it comes to saving your life, the overall organization of the trauma department matters more than the experience of the doctors.

That is the conclusion drawn by researchers in the trauma surgery program at Johns Hopkins in a study published in the journal Archives of Survery.

The doctors examined whether having more experienced staff on duty made a difference – and found it didn’t.


In a structured trauma program, there is no mortality difference between novice surgeons and their experienced trauma director. The organized trauma program and senior surgical mentoring overpower any influence of individual surgeon inexperience.


That validates lean concepts, which maintain that the process is more important that any one person.

The study’s conclusion is debatable, as noted in a report from ABC News.


The study did have some limitations, notably in its use of survival as the primary measure of experience. Dr. David Feliciano, a trauma surgeon at Emory University, in his invited commentary accompanying the article, noted that details of the most complex surgical cases and of how avoidable the deaths were in this study, would help to better answer the questions regarding experience.

"Mortality is also likely to be the factor least impacted by surgeon experience," West said, noting that the amount of blood transfused, number of complications, length of hospital stay, and number of infections would also help to better gauge experience.

Another weakness of the study comes from the numbers themselves, West said. A study that makes a conclusion based on a "lack of statistical significance" is weaker than a study that makes a conclusion based on the presence of one and would require either much larger numbers of patients or much greater differences between the groups than those present in this study to be meaningful.


Still, the study was strong enough to win publication in a peer-reviewed journal. And I believe this is another indicator of the value of applying lean principles to healthcare.

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