In addition to reporting on the surgical volume standard, hospitals are asked to report on practices that help to ensure surgical appropriateness.
For the cancer procedures (lung resection for cancer, esophageal resection for cancer, pancreatic resection for cancer, rectal cancer surgery) this includes having a multidisciplinary tumor board that prospectively reviews cancer cases or having national accreditation from the American College of Surgeons (applies to rectal cancer surgery only).
For the other procedures (carotid endarterectomy, mitral valve repair and replacement, open aortic procedures, bariatric surgery for weight loss), hospitals are asked to report on their implementation of a hospital-wide policy which includes processes aimed at monitoring surgical necessity and preventing overuse of surgical procedures. The questions are designed to identify the steps hospitals have taken to establish and ensure adherence to their own surgical appropriateness criteria.
For these procedures, hospitals are asked about their progress in developing surgical appropriateness criteria based on:
- Published guidelines and input from local surgeons
- Supporting and monitoring adherence to those criteria
- Communicating with surgeons, hospital leaders, and board members about adherence to the criteria
This subsection on surgical appropriateness will be publicly reported in 2019, but not scored against a standard this year.
This subsection is reported in two groups --High-Risk Surgery and Cancer Surgery-- on Leapfrog's Hospital Ratings Results page.