Procedure Time: A Quality Indicator

I've been a practicing interventional radiologist for 13 years. In that time I have watched my procedure times decrease without any increase in complication. Actually, the complication rate has also decreased over time. One would expect both of these things to happen with increasing experience in any field.  Such experiences make it apparent that procedure time is a quantifiable quality indicator.

It is said that it takes 10,000 hours to become expert at anything. While some may wish to debate that assertion, I can state with certainty that I have spent at least 10,000 hours in my field. In the field of medicine, 10,000 hours of "practice" becomes quite meaningful. Now, this is not a bragging rights issue. I am not writing this blog to showcase how wonderful I am. In fact, I have a friend/colleague who can perform a TIPS in less than 30 minutes! To calibrate you, that procedure routinely takes many interventionalists two hours to perform. (My time is under 45 minutes but that 30 minute time can't be beat.)

In light of the above, it seems logical that the recent move towards pay for quality should include technical expertise, and I'm sure it does. I'm also not trying to critique the finer points of any particular legislation. A quantifiable measure of quality is procedure time. So it makes sense to use it as such. The caveat however is that, as procedure time decreases, complication rate cannot increase. Complication rate increases would of course negate the quality benefit of improving procedure times.

Many healthcare workers develop a sense of who is the "go to person" for each patient care need. There can be a quality difference between doctors in a given specialty because everyone has differing levels of technical expertise, knowledge and clinical acumen.

So it makes sense that one group of doctors, for example, might excel at research while another set of doctors may excel at technical procedures. And other doctors may excel at making a diagnosis from seemingly unrelated signs and symptoms. 

Obviously not every field is quantifiable. But the more procedure-oriented fields, such as surgery or interventional radiology, are quantifiable in this respect.  Take time to delve into this topic a bit and determine for yourself whether it matters to you that the doctor who is about to remove your gallbladder can do so in less time than another doctor and with the same or fewer frequency of complications. Or whether you would prefer that the interventional radiologist can place a dialysis catheter or an IVC filter in less than five minutes without a hitch.

Being intimately connected to the field of medicine, I can say categorically it would matter to me.