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Measuring the Quality of Orthopaedic Care at Cedars-Sinai
The Cedars-Sinai Orthopaedic Center continually monitors the care it provides to patients. Several factors are measured:
- Total volume of procedures. Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e. lower short-term and long term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways. In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel. Commitment to quality standards throughout the institution is also an important determinant of better outcomes.1,2 In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly-trained surgeons than by general surgeons.3
- The percentage of procedures that are performed on an outpatient basis. When a procedure can be done on a outpatient basis, the patient tends to heal more quickly with less pain and less interference with his or her daily activities.
- Average length of stay (ALOS): This refers to the average number of days a patient stays at Cedars-Sinai Medical Center after being admitted. The goal is to ensure that all patients are appropriately treated in the hospital for their respective conditions, and are not hospitalized longer than they need to be.
- Surgical Site Infections. A surgical site infection is an infection that occurs after surgery, in the part of the body where the surgery was performed. Many such infections involve the skin only, but some are more serious and in tissues under the skin or in an organ. These are called deep incisional and organ/space surgical site infections. We measure our performance by tracking the observed vs. expected rate of infection, as calculated by the California Department of Public Health and the Centers for Disease Control and Reporting National Healthcare Safety Network. To learn more, and view Cedars-Sinai performance for hip and knee replacement surgeries, click here.
The table below highlights the types of procedures done at the Cedars-Sinai Orthopaedic Center in terms of the categories defined above:
|Cedars-Sinai Orthopaedic Center, 2013 Outpatient Procedures||Total Procedures*||% Performed on an Outpatient Basis|
|Minimally invasive outpatient procedures including arthroscopies, knee ligament repair (ACL) and rotator cuff repair||927||100%|
|Hand, fingers and wrist repair including arthroplasties and carpal tunnel release||296||95%|
|Foot, ankle and toe procedures including foot fusion procedures, bunion procedures, hammertoe repair and Achilles tendon repair||570||96%|
The table below highlights procedures done in the hospital.
|Cedars-Sinai Orthopaedic Center, 2013 Inpatient Procedures||Total Procedures||Average Length of Stay for Inpatients||Average Length of Stay for Comparison Group|
|Hip replacement||704||2.6 days||3.1 days|
|Partial hip replacement||82||7.2 days||6.9 days|
|Knee replacement||743||3.2 days||3.1 days|
|Shoulder replacement||33||2.8 days||3.2 days|
Source: UHC Clinical DataBase/Resource ManagerTM, patients discharged in 2013. This data was accessed on March 20, 2014
UHC is an alliance of 120 academic medical centers and 301 of their affiliated hospitals representing the nation's leading academic medical centers. The majority of these facilities participate in the Clinical DataBase/Resource Manager.
1Bach PB, Ann Intern Med 2009; 150:729-30
2Greene FL, Ann Surg Oncol 2007; 15:14-15
3Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08