Watchdog Group Surveys Outpatient Surgery Facilities for Safety and Quality

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By Christopher Cheney

For the first time, The Leapfrog Group has collected patient safety and quality information about ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPD).

Leapfrog has been collecting patient safety and quality data about hospital inpatient facilities for years. With more than 60% of surgical procedures now possible to perform at ASCs and HOPDs, the Washington, DC-based watchdog organization decided to expand collection of data to these same-day surgery settings.

The data was reported recently in a report based on two surveys. A new survey collected data this year from 321 ASCs. In an expanded Leapfrog Hospital Survey, data was collected this year from 1,141 HOPDs. “Both surveys were developed with guidance from national experts and include standardized, evidence-based measures of care specific to places that perform ambulatory and outpatient procedures,” the report says.

The surveys generated several key data points, including the following:

  • Life support: All ASCs and HOPDs reported having a board-certified clinician for advanced cardiovascular life support present while adult patients undergo procedures and recovery. However, fewer of the facilities reported always having a board-certified clinician present for pediatric advanced life support: 89% of ASCs and 96% of HOPDs. “This displays a potential gap in ability to perform life-saving actions if complications arise for pediatric patients,” the report says.
  • Surgery board certification: Leapfrog found that 1 in 3 same-day surgery facilities do not have 100% board-certification among surgical professionals.
  • Anesthesia board certification: Nearly 30% of ASCs reported that not all providers administering anesthesia are board certified. Nearly 20% of HOPDs reported that not all providers administering anesthesia are board certified. “Though 71% of ASCs and 83% of HOPDs report that all individuals who administer anesthesia are board-certified, there is still significant room for improvement,” the report says.
  • Surgery consent materials: Relatively few ASCs and HOPDs provided surgery consent materials to patients before the day of surgery. Consent materials were provided to patients at least three days prior to surgery at 17% of ASCs and 21% of HOPDs. Consent materials were provided to patients one to three days prior to surgery at 14% of ASCs and 21% of HOPDs. Consent materials were provided to patients the same day as surgery at 65% of ASCs and 49% of HOPDs. “Providing consent materials prior to the day of the procedure gives patients the opportunity to adequately consider the risks involved,” the report says.
  • Anesthesia consent materials: ASCs and HOPDs reported similar data for provision of anesthesia consent materials to patients. Anesthesia consent materials were provided to patients at least three days prior to surgery at 8% of ASCs and 10% of HOPDs. Consent materials were provided to patients one to three days prior to surgery at 8% of ASCs and 12% of HOPDs. Consent materials were provided to patients the same day as surgery at 80% of ASCs and 71% of HOPDs.
  • Antimicrobial stewardship: Only 18% of ASCs reported they had adopted antimicrobial stewardship programs. “ASCs are encouraged to adopt a program to promote the appropriate use of antimicrobials (including antibiotics), which can in turn improve patient outcomes, reduce microbial resistance, and ultimately decrease the spread of infections,” the report says. Although data was not available for HOPDs, 93% of acute care hospitals have reported having antimicrobial stewardship programs.

Interpreting the data

Erica Mobley, director of operations at The Leapfrog Group, told HealthLeaders that the survey result on antimicrobial stewardship at ASCs was “certainly a concern.”

“Antibiotic and antimicrobial use in ASCs is different from that administered in other healthcare environments, which is why Leapfrog chose to include this safety protocol on its survey. Many resources and toolkits have been developed to help ASCs with implementing an antimicrobial stewardship program, and we are confident this number will grow in the future,” she said.

The findings that 11% of ASCs and 4% of HOPDs do not always have a clinician present who is certified to provide advanced life support for pediatric patients is also concerning, Mobley said. “If unexpected complications arise, these facilities may not be well-equipped to care for pediatric patients. … Parents should inquire about the availability of clinicians certified in pediatric advanced life support prior to scheduling a procedure for their child.”

When selecting an ASC or HOPD for a surgical procedure, patients should consider the presence of board-certified clinicians performing procedures and administering anesthesia, she said.

“Board certification is a voluntary process separate from licensure. Medical professionals who pursue it demonstrate a desire to grow their skillset to keep pace with the latest advancements in their specialty. Consumers considering their options for surgery should inquire whether the healthcare team consists of board-certified individuals to inform their decision of where they seek treatment. In some cases, the absence of board-certified clinicians may mean that experts who have the skillset to treat true complications are not present in the facility.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.