The Etiology of Improved Outcomes at High Volume Centers Learning Theory and the Case of Implant Flashing.

Increased volume has been shown to be associated with improved outcomes for many orthopaedic procedures. For individual surgeons, the concepts of learning curves and volume effects have been well established in the literature. For institutions, high-volume hospitals have also been shown to have better outcomes for orthopaedic procedures such as total joint replacements. However, exactly how hospital volume mediates this improvement is not well understood. Learning theory states that learning occurs as a result of accumulated experience, not based on time. We compared our institution's curve representing our implant flashing rates to other institutional data sets that exhibit learning and continuous quality improvement, including airline near misses, coal mining accidents, and others. Development of expertise is based on volume and rate of errors, and therefore higher volume is conducive to faster learning.