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34 In Europe, minimal volume standards are currently under consideration.
Especially hospitals not complying with minimum volume standards should be analysed why such procedures are performed.
In these cases the minimum volume standards affect far less centralised procedures.
Moreover, some volume standards are increasingly hard to meet because of secular changes in healthcare practice.
All minimum volume standards are valid for entire hospitals rather than for individual hospital departments.
Considering the potential of minimum volume standards to improve the quality of care, the German legislation decided in 2002 to use annual minimum volume standards as a quality assurance measure in the hospital sector.
In fact, hospital quality reports are the first extensive, comparable and accessible data source detailing Germany's hospital performance on the introduced minimum volume standards but available only since 2004, the same year these minimum volume standards were introduced.
For all three minimum volumes the number of hospitals complying with the minimum volume standards remained constant or increased slightly.
For more than a decade, there is an ongoing debate for minimal volume standards for pancreatic resections.
These international experiences with introducing minimum volume standards for esophagectomies and pancreatectomies can help understanding the differing development in Germany.
It might be helpful to address as well the hospital perspective to achieve stricter compliance with minimum volume standards.
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