Oh damn. Here we go again.
We have a mountain of evidence, that small hospitals are providing far worse outcomes, even if you factor in transport times to larger facilities. They don’t have the equipment(from blood, to imaging, interventional radiology, etc.), the qualification(you won’t find a interdisciplinary surgical team like you find in a larger centre)and the experience(you need to have a certain case load to keep your skills up) to handle cases with higher severity.
Of course people feel like the “good old hospital” close by would “save their life”, but the times where a small surgeon saves a life are long gone. (And realistically they fucked up more than enough cases back then as well. We have started to gather evidence about that since the 50ies).
In that case multiple people fucked up. There is zero evidence that the uterus rupture wouldn’t have happened if she was an inpatient - or that she would have survived if she was an inpatient in that small hospital.
What do you mean with blood to imaging.
Even my small 120 bed hospital in the black forest has a CT, and an MRI.They also have their own laboratory for blood analysis, and can teleconsult specialists in the University Hospital 24/7 if a Stroke Patient should be transferred to them
Also in this case the University Hospital fucked up the case too.
So yes, bigger hospitals have better outcomes in certain areas, this is not a good example for this point.
And it’s also convenient to be better in stats with care concentrated on bigger hospitals when you measure outcomes only starting at the hospital door
If you need 1-2 hours to reach the hospital in Denmark with an acute myocardial infarction (it’s an example our previous health minister loved), then the cases still alive when reaching it might be not the worst ones, because they died already on the way there
We have a mountain of evidence, that small hospitals are providing far worse outcomes, even if you factor in transport times to larger facilities.
Do you per chance have interesting sources you recommend? I feel this must very much depend on the distance.
Sorry for the late reply.
Here are some leads - not all of these studies are truely “rockstars”, but they will lead you into the right direction if you follow their citations.
Myocardial Infarction: Searcy R, Patel R, Drossopoulos P, Arora S, Stouffer GA. Rural-urban disparity in survival and use of PCI in patients who develop STEMI while hospitalized for a non-cardiac condition. Curr Probl Cardiol. 2025 Mar;50(3):102979. doi: 10.1016/j.cpcardiol.2025.102979. Epub 2025 Jan 10. PMID: 39800089
Sasaki K, Koeda Y, Yoshizawa R, Ishikawa Y, Ishida M, Itoh T, Morino Y, Saitoh H, Onodera H, Nozaki T, Maegawa Y, Nishiyama O, Ozawa M, Osaki T, Nakamura A. Comparing In-Hospital Outcomes for Acute Myocardial Infarction Patients in High-Volume Hospitals Performing Primary Percutaneous Coronary Intervention vs. Regional General Hospitals. Circ J. 2023 Sep 25;87(10):1347-1355. doi: 10.1253/circj.CJ-23-0188. Epub 2023 Aug 10. PMID: 37558468.
Stroke/Traumatic brain injury: Quantifying Improved Outcomes, Cost Savings, and Hospital Volume Changes From Optimized Emergency Stroke Transport. (2022). Stroke,53 (12), 3644–3651. https://doi.org/10.1161/strokeaha.122.039172
Tepas JJ 3rd, Pracht EE, Orban BL, Flint LM. High-volume trauma centers have better outcomes treating traumatic brain injury. J Trauma Acute Care Surg. 2013 Jan;74(1):143-7; discussion 147-8. doi: 10.1097/TA.0b013e3182788b5a. PMID: 23271089.
Saposnik G, Baibergenova A, O’Donnell M, Hill MD, Kapral MK, Hachinski V; Stroke Outcome Research Canada (SORCan) Working Group. Hospital volume and stroke outcome: does it matter? Neurology. 2007 Sep 11;69(11):1142-51. doi: 10.1212/01.wnl.0000268485.93349.58. Epub 2007 Jul 18. PMID: 17634420.
Tsai SHL, Goyal A, Alvi MA, Kerezoudis P, Yolcu YU, Wahood W, Habermann EB, Burns TC, Bydon M. Hospital volume-outcome relationship in severe traumatic brain injury: stratified analysis by level of trauma center. J Neurosurg. 2020 Mar 13;134(3):1303-1315. doi: 10.3171/2020.1.JNS192115. PMID: 32168482.
Trauma: Tang A, Chehab M, Ditillo M, Asmar S, Khurrum M, Douglas M, Bible L, Kulvatunyou N, Joseph B. Regionalization of trauma care by operative experience: Does the volume of emergent laparotomy matter? J Trauma Acute Care Surg. 2021 Jan 1;90(1):11-20. doi: 10.1097/TA.0000000000002911. PMID: 32925573.
Nathens AB, Jurkovich GJ, Maier RV, Grossman DC, MacKenzie EJ, Moore M, Rivara FP. Relationship between trauma center volume and outcomes. JAMA. 2001 Mar 7;285(9):1164-71. doi: 10.1001/jama.285.9.1164. PMID: 11231745.
Let me know if you need more info on a specific field.