A study of hospital postoperative complications concludes that, at best, teaching hospitals deliver no better quality of care than nonteaching hospitals. Researchers at the Agency for Healthcare Research and Quality's Center for Primary Care, Prevention, and Clinical Partnerships retrospectively studied data on a sample of 3,818 acute care hospitals in the National Inpatient Sample (database of U.S. community hospital discharge claims) from 1990-1996. The quality indicators examined were postoperative problems that usually can be prevented with adequate and quality nurse and medical staffing. These included deep vein thrombosis/pulmonary embolism (DVT/PE), pulmonary compromise, pneumonia, and urinary tract infection (UTI).
Amar V. Duggirala, D.O., Frederick M. Chen, M.D., M.P.H., and Peter J. Gergen, M.D., M.P.H., classified hospitals as major teaching, other teaching, and nonteaching. Major and other teaching hospitals had higher rates of postoperative DVT/PE and pulmonary compromise than nonteaching hospitals (0.51 and 0.42 vs. 0.35 and 1.01 and 0.94 vs. 0.77 per 100 major operation discharges, respectively). Hospital characteristics such as hospital bed size, rural or urban location, ownership, nurse staffing levels, percent of patients with Medicare or Medicaid, and geographic region were also considered. When these hospital characteristics were accounted for, only other teaching hospitals had higher rates of postoperative pulmonary compromise and UTI than nonteaching hospitals, and only major teaching hospitals had higher postoperative pneumonia rates than nonteaching hospitals.
These findings should not be seen as an indictment of teaching hospitals, caution the researchers. The findings do, however, raise concerns that medical students and residents may be learning the practice of medicine in settings that do not necessarily reflect the highest level of care. Teaching hospitals, especially major teaching hospitals, have a complex structure involving multiple levels of providers. The deleterious effects of multiple transfers of care to different providers in teaching hospitals may affect their rates of adverse events, conclude the researchers.
See "Postoperative adverse events in teaching and nonteaching hospitals," by Drs. Duggirala, Chen, and Gergen, in the July 2004 Family Medicine 36(7), pp. 508-513.
Reprints (AHRQ Publication No. 04-R058) are available from the AHRQ Publications Clearinghouse.
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