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ASC Quality Collaboration Quality Report
3rd Quarter 2014

This public report of ambulatory surgical center (ASC) quality data has been made possible through the voluntary efforts of participants in the ASC Quality Collaboration. The following organizations agreed to collect and submit clinical quality data reflecting patient admissions* from July 1, 2014 through September 30, 2014: Ambulatory Surgery Center Association; Ambulatory Surgical Centers of America (ASCOA); AmSurg; HCA Ambulatory Surgery Division; Regent Surgical Health, Surgical Care Affiliates (SCA); Symbion and United Surgical Partners International (USPI).

This quarter's data has been collected from 1,488 ASCs -- including 968 multispecialty ASCs and 520 single specialty ASCs -- representing every state except Vermont.

This report presents aggregated performance data for six ASC facility-level quality measures developed by the ASC Quality Collaboration and endorsed by the National Quality Forum:

This data and the accompanying information do not present all there is to know about the quality of ASCs. Patients are encouraged to discuss these quality indicators with their local ASC staff and their physician.

The data presented here has been self-reported by participating organizations and has not been independently validated by the ASC Quality Collaboration.

Questions or comments regarding this report may be directed to Donna Slosburg, Executive Director, ASC Quality Collaboration at donnaslosburg@ascquality.org.

 

Patient Fall in the ASC

Falls are an important issue for patients having outpatient procedures or surgery because virtually all patients receive sedatives, anesthetics and/or pain medications as a routine part of their care. The use of these medications increases the likelihood of a fall.

The frequency of ASC admissions experiencing a fall while in the confines of participating ASCs is shown below as a rate per 1000 admissions. Lower rates are better.

Rate of patient falls in the ASC 0.119 per 1000 admissions

Represents the experience of 1,656,931 ASC admissions seen at 1,471 facilities between July 1 and September 30, 2014

The data trends for this measure over the last four quarters are presented below in both tabular and graphical formats.

Data Summary: Patient Fall in the ASC

Reporting Period

4Q2013

1Q2014

2Q2014

3Q2014

Number of Participating ASCs

1,415

1,533

1,484

1,471

Number of ASC Admissions Represented

1,656,440

1,609,607

1,693,782

1,656,931

Patient Fall Rate per 1000 ASC Admissions

0.139

0.135

0.138

0.119

Patient Fall in the ASC

 

Patient Burn

Burns are an important issue for patients having outpatient procedures or surgery because the equipment and supplies routinely used in providing these types of services can increase the risk that a patient will experience an unintended burn.

The frequency of ASC admissions experiencing a burn, regardless of severity, while in the care of participating ASCs is shown below as a rate per 1000 admissions. Lower rates are better.

Rate of patient burns 0.015 per 1000 admissions

Represents the experience of 1,657,959 ASC admissions seen at 1,472 facilities between July 1 and September 30, 2014

The data trends for this measure over the last four quarters are presented below in both tabular and graphical formats.

Data Summary: Patient Burn

Reporting Period

4Q2013

1Q2014

2Q2014

3Q2014

Number of Participating ASCs

1,411

1,530

1,484

1,472

Number of ASC Admissions Represented

1,651,862

1,608,080

1,699,952

1,657,959

Patient Burn Rate per 1000 ASC Admissions

0.026

0.017

0.018

0.015

Patient Burn

 

Hospital Transfer/Admission

ASCs provide surgical services to patients not requiring hospitalization. Therefore, ASCs screen patients referred to their facilities to ensure they can be safely cared for as an outpatient.

The frequency of ASC admissions experiencing a transfer or admission to a hospital upon discharge from participating ASCs is shown below as a rate per 1000 admissions. Not all conditions requiring a hospital transfer or admission result from the care the patient received in the ASC, nor can all medical conditions requiring a hospital transfer or admission be anticipated in advance. Therefore, some level of hospital transfer or admission is expected.

Rate of hospital transfers/admissions 1.082 per 1000 admissions

Represents the experience of 1,652,578 admissions seen at 1,468 facilities between July 1 and September 30, 2014

The data trends for this measure over the last four quarters are presented below in both tabular and graphical formats.

Data Summary: Hospital Transfer/Admission

Reporting Period

4Q2013

1Q2014

2Q2014

3Q2014

Number of Participating ASCs

1,405

1,520

1,480

1,468

Number of ASC Admissions Represented

1,656,153

1,598,313

1,695,907

1,652,578

Hospital Transfer/Admission Rate per 1000 ASC Admissions

1.124

1.140

1.113

1.082

Hospital Transfer

 

Wrong Site, Side, Patient, Procedure, Implant

Wrong site, wrong side, wrong patient, wrong procedure and wrong implant events are a concern for patients having outpatient procedures or surgery. There are steps that can be taken to help prevent errors such as surgery performed on the wrong part of the body or the wrong side of the body.

The frequency of ASC admissions experiencing a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event while in the care of participating ASCs is shown below as a rate per 1000 admissions. Lower rates are better.

Rate of wrong site, side, patient, procedure, implant events 0.033 per 1000 admissions

Represents the experience of 1,654,393 ASC admissions seen at 1,467 facilities between July 1 and September 30, 2014

The data trends for this measure over the last four quarters are presented below in both tabular and graphical formats.

Data Summary: Wrong Site, Side, Patient, Procedure, Implant

Reporting Period

4Q2013

1Q2014

2Q2014

3Q2014

Number of Participating ASCs

1,414

1,528

1,483

1,467

Number of ASC Admissions Represented

1,654,861

1,608,144

1,699,211

1,654,393

Rate of Wrong Site, Side, Patient, Procedure, Implant per 1000 ASC Admissions

0.029

0.029

0.024

0.033

Wrong site

 

Prophylactic IV Antibiotic Timing

Prevention of surgical wound infections is an important issue for patients having outpatient procedures or surgery. In cases where the physician has determined that an antibiotic should be given to help prevent a surgical wound infection, giving the antibiotic at the right time is important. Research indicates that antibiotics given too early, or after the surgery begins, are not as effective.

The percentage of ASC admissions having an order for an antibiotic to help prevent surgical wound infection that received the antibiotic in the appropriate timeframe is displayed below. Higher percentages are better.

Percentage of ASC admissions with antibiotics ordered who received antibiotics on time 99%

Represents the experience of 1,315,788 ASC admissions with antibiotics ordered seen at 1,219 facilities between July 1 and September 30, 2014

The data trends for this measure over the last four quarters are presented below in both tabular and graphical formats.

Data Summary: Prophylactic IV Antibiotic Timing

Reporting Period

4Q2013

1Q2014

2Q2014

3Q2014

Number of Participating ASCs

1,181

1,286

1,238

1,219

Number of ASC Admissions Represented

1,336,265

1,293,150

1,364,562

1,315,788

Percentage of ASC Admissions with antibiotic ordered who received antibiotic on time

99%

99%

99%

99%

Prophylactic

 

Appropriate Surgical Site Hair Removal

Prevention of surgical wound infections is an important issue for patients having outpatient procedures or surgery. In certain cases, properly preparing the patient for surgery requires the removal of body hair in the area where the surgery will be done. Removing body hair with electric clippers or hair removal cream reduces the likelihood of a surgical wound infection. Removing body hair by shaving with a razor may increase the likelihood of a surgical wound infection.

The percentage of ASC admissions that had body hair removed with electric clippers or hair removal cream is displayed below. Higher percentages are better.

Percentage of ASC admissions with appropriate surgical site hair removal 96%

Represents the experience of 1,151,110 ASC admissions with surgical site hair removal seen at 1,068 facilities between July 1 and September 30, 2014

The data trends for this measure over the last four quarters are presented below in both tabular and graphical formats.

Data Summary: Appropriate Surgical Site Hair Removal

Reporting Period

4Q2013

1Q2014

2Q2014

3Q2014

Number of Participating ASCs

1,034

1,324

1,074

1,068

Number of ASC Admissions Represented

1,155,036

1,082,262

1,165,280

1,151,110

Percentage of ASC Admissions with appropriate surgical site hair removal

98%

98%

98%

96%

Hair Removal

For more detailed information on these measures, please review the implementation guide found on the home page of the ASC Quality Collaboration website at www.ascquality.org.

* For purposes of this quality report, "admission" is defined as completion of registration upon entry into the ASC. This term is used in order to be consistent with the measure specifications.