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High-Volume Hospitals Have Better Ventilation Outcomes

Lower mortality rates independent of academic status of facility

THURSDAY, July 6 (HealthDay News) -- Hospitals with a high volume of patients have lower mortality rates among critically ill patients who receive mechanical ventilation compared with low-volume hospitals, according to a study published in the July 6 issue of the New England Journal of Medicine.

Jeremy M. Kahn, M.D., of the University of Washington in Seattle, and colleagues analyzed data on 20,241 non-surgical patients who received mechanical ventilation at 37 acute care hospitals.

Among mechanical ventilation patients in both the hospitals and in the hospitals' intensive care units, higher patient volumes were associated with improved survival. Patients at hospitals with 400 or more patients requiring mechanical ventilation each year (the top quartile by volume) had 37 percent lower adjusted odds of death compared to their counterparts in hospitals in the lowest quartile, which received 150 or fewer mechanical ventilation patients a year.

The in-hospital mortality rate for patients in the lowest quartile volume hospitals was 34.2 percent versus 25.5 percent for those in the highest quartile hospitals.

The authors cite a range of possible reasons why high-volume hospitals generate better outcomes. They may have better practices such as lower nurse-to-patient ratios and multidisciplinary care teams, for example. "More-experienced as opposed to less-experienced clinicians may be better at recognizing and treating the complications of critical illness," they write.

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