This past year, the Hospital for Special Surgery in New York City was ranked number one in orthopedics by U.S. News & World Report. The hospital was started 150 years ago as an orthopedic hospital, says Thomas Sculco, MD, surgeon-in-chief and chairman of the department of orthopedic surgery at the Hospital for Special Surgery, and orthopedics is the major surgical specialty of the hospital. Dr. Sculco travels around the world speaking about the hospital's excellence in orthopedics, most recently returning from a trip to China.
Dr. Sculco discusses six ways hospitals can build top orthopedic departments.
1. Focus resources on the orthopedic department. The Hospital for Special Surgery has a commitment to orthopedic surgery, which means the hospital is focused on providing resources for treating musculoskeletal conditions and injuries. A large amount of attention and resources is focused on the clinical care, research and education of orthopedic surgery. The hospital's orthopedic department is twice the size of most hospitals, with 87 full time orthopedic surgeons who perform approximately 25,000 surgeries annually, says Dr. Sculco. "The volume we do here is tremendous," he says. "We are a very focused center."
2. Constantly evaluate results and create practice guidelines. To ensure surgeons have the best outcomes possible, surgeons at the Hospital for Special Surgery are always looking at the results of their procedures and examining points in the process that might need improvement, says Dr. Sculco. When a weak spot is pinpointed in the process, the surgeons and medical staff work to correct it. "Our goal is always to work to be better," he says. "We collect data from our surgeries and create guidelines, which we share internationally."
The Hospital for Special Surgery also has registries in 30 different areas, including joint replacements, which allows the surgeons to track patients and compile information for research projects. The hospital recently created the Center for Musculoskeletal Outcomes and Patient Oriented Research. One of the center's initial activities will be to lead the development of an International Consortium of Orthopedic Registries, along with Kaiser Permanente and the FDA.
3. Work toward becoming a referral center for complex cases. Because of the reputation for treating complex cases, the Hospital for Special Surgery has become a referral center. This means other surgeons who aren't confident about treating complex or unique cases often refer their patients to the hospital for treatment, says Dr. Sculco. These patients often include complex joint replacement and revision joint replacement, trauma and spinal surgery. Surgeons at the hospital have extensive experience in treating complex cases in specific subspecialties rather as well as general orthopedic cases. The constant referrals from other physicians also increase the patient volume at the hospital.
4. Build a strong residency and fellowship program. The hospital recently expanded the education initiatives to allow more medical students to spend a year doing research on location at the hospital, says Dr. Sculco. The hospital also has a fellowship program for 37 fellows, 25 percent of which are international. The residency is also very competitive, and after graduation, most of the surgeons who complete residencies at the hospital go into academic positions. "The volume and complexity of what we do is very attractive to residents and fellows as well as the research infrastucture," says Dr. Sculco.
5. Provide research time and facilities for the surgeons. The high clinical volume at the hospital allows surgeons to conduct research and compile information on a large number of cases, says Dr. Sculco. The National Institutes of Health funds a significant amount of the research done at the hospital, which allows surgeons to spend half of their time in clinical practice and the other half in research. The hospital also has its own journal where researchers can publish their findings. The journal is internally funded, says Dr. Sculco, so there isn't an outside influence on the study outcomes.
6. Coordinate grand rounds for all specialists to discuss cases. The hospital holds grand rounds where the specialists from different departments are able to come together and discuss cases. The ability to collaborate efforts between specialists ensures that everyone is on the same page and updated on the treatment for complex cases. Additionally, quality and patient safety issues which may arise in these cases are studied and corrected. Every year, the hospital publishes complex case studies and provides information about the management of these cases to the orthopedic community, says Dr. Sculco.
Learn more about the Hospital for Special Surgery.
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- Hospital for Special Surgery Creates Musculoskeletal Outcomes and Research Center