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ASC Quality Collaboration Quality Report
1st Quarter 2016

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 January 1, 2016 through March 31, 2016: Ambulatory Surgery Center Association; Ambulatory Surgical Centers of America (ASCOA); AmSurg; ASD Management; Covenant Surgical Partners; HCA Ambulatory Surgery Division; Practice Partners in Healthcare, Inc; Regent Surgical Health, Surgical Care Affiliates (SCA); Surgery Partners-Symbion; United Surgical Partners International (USPI) and Visionary Enterprises, Inc. This quarter's data has been collected from 1,527 ASCs -- including 999 multispecialty ASCs and 528 single specialty ASCs -- representing every state.

This report presents aggregated performance data for ASC facility-level quality measures developed by the ASC Quality Collaboration:

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 0.123 per 1000 admissions

Represents the experience of 1,832,988 ASC admissions seen at 1,516 facilities between January 1 and March 31, 2016

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

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

1,445

1,393

1,418

1,516

Number of ASC Admissions Represented

1,718,786

1,766,053

1,814,500

1,832,988

Patient Fall Rate per 1000 ASC Admissions

0.130

0.099

0.122

0.123

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 0.016 per 1000 admissions

Represents the experience of 1,828,185 ASC admissions seen at 1,512 facilities between January 1 and March 31, 2016

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

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

1,444

1,386

1,419

1,512

Number of ASC Admissions Represented

1,720,605

1,757,478

1,815,421

1,828,185

Patient Burn Rate per 1000 ASC Admissions

0.017

0.020

0.024

0.016

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 1.067 per 1000 admissions

Represents the experience of 1,822,138 admissions seen at 1,509 facilities between January 1 and March 31, 2016

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

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

1,439

1,390

1,417

1,509

Number of ASC Admissions Represented

1,714,539

1,759,696

1,814,226

1,822,138

Hospital Transfer/Admission Rate per 1000 ASC Admissions

1.022

1.002

0.998

1.067

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 0.028 per 1000 admissions

Represents the experience of 1,831,786 ASC admissions seen at 1,515 facilities between January 1 and March 31, 2016

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

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

1,443

1,386

1,414

1,515

Number of ASC Admissions Represented

1,716,295

1,758,518

1,811,245

1,831,786

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

0.030

0.027

0.035

0.028

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 1,456,928 ASC admissions with antibiotics ordered seen at 1,266 facilities between January 1 and March 31, 2016

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

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

1,167

1,080

1,120

1,266

Number of ASC Admissions Represented

1,278,487

1,217,580

1,408,548

1,456,928

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 1,238,620 ASC admissions with surgical site hair removal seen at 1,090 facilities between January 1 and March 31, 2016

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

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

949

902

949

1,090

Number of ASC Admissions Represented

1,035,647

1,006,608

1,169,262

1,238,620

Percentage of ASC Admissions with appropriate surgical site hair removal

97%

97%

96%

96%

Hair Removal

 

Normothermia

Maintaining body temperature within a normal range (normothermia) is important in patients who have general, spinal or epidural anesthesia lasting 60 minutes or more at the time of surgery. Normothermia helps reduce the risk of surgical complications, including the risk of developing an infection at the surgical site.

The percentage of eligible ASC patients that are normothermic within 15 minutes of arrival into the Post Anesthesia Care Unit (PACU) is displayed below. Higher percentages are better.

Percentage of eligible ASC patients with normothermia 97%

Represents the experience of 609,196 eligible ASC patients seen at 570 facilities between January 1 and March 31, 2016

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

Data Summary: Normothermia

Reporting Period

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

347

489

526

570

Number of Eligible ASC Patients Represented

327,091

500,254

622,594

609,196

Percentage of Eligible ASC Patients with Normothermia

98%

94%

98%

97%

Normothermia

 

Unplanned Anterior Vitrectomy

An unplanned anterior vitrectomy is a potential complication of cataract surgery.

The percentage of ASC cataract surgery patients that experienced an unplanned anterior vitrectomy in ASC cataract surgery patients is shown below. Lower rates are better.

Percent of ASC cataract surgery patients with unplanned anterior vitrectomy 0.50%

Represents the experience of 1,061,419 ASC cataract surgery patients seen at 931 facilities between January 1 and March 31, 2016

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

Data Summary: Unplanned Anterior Vitrectomy

Reporting Period

2Q2015

3Q2015

4Q2015

1Q2016

Number of Participating ASCs

631

909

947

931

Number of ASC Cataract Surgery Patients Represented

639,082

978,944

1,095,907

1,061,419

Percent of ASC Cataract Patients with Unplanned Anterior Vitrectomy

0.69%

0.48%

0.43%

0.50%

Unplanned Anterior Vitrectomy

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.