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ASC Quality Collaboration Quality Report
2nd 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 April 1, 2016 through June 30, 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; United Surgical Partners International (USPI) and Visionary Enterprises, Inc. This quarter's data has been collected from 1,488 ASCs -- including 957 multispecialty ASCs and 531 single specialty ASCs -- representing every state except Vermont and West Virginia.

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 0.104 per 1000 admissions

Represents the experience of 1,891,933 ASC admissions seen at 1,476 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

1,393

1,418

1,516

1,476

Number of ASC Admissions Represented

1,766,053

1,814,500

1,832,988

1,891,933

Patient Fall Rate per 1000 ASC Admissions

0.099

0.122

0.123

0.104

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 0.011 per 1000 admissions

Represents the experience of 1,897,033 ASC admissions seen at 1,480 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

1,386

1,419

1,512

1,480

Number of ASC Admissions Represented

1,757,478

1,815,421

1,828,185

1,897,033

Patient Burn Rate per 1000 ASC Admissions

0.020

0.024

0.016

0.011

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 1.008 per 1000 admissions

Represents the experience of 1,887,715 admissions seen at 1,474 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

1,390

1,417

1,509

1,474

Number of ASC Admissions Represented

1,759,696

1,814,226

1,822,138

1,887,715

Hospital Transfer/Admission Rate per 1000 ASC Admissions

1.002

0.998

1.067

1.008

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 0.027 per 1000 admissions

Represents the experience of 1,893,117, ASC admissions seen at 1,478 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

1,386

1,414

1,515

1,478

Number of ASC Admissions Represented

1,758,518

1,811,245

1,831,786

1,893,117

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

0.027

0.035

0.028

0.027

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 1,475,520 ASC admissions with antibiotics ordered seen at 1,194 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

1,080

1,120

1,266

1,194

Number of ASC Admissions Represented

1,217,580

1,408,548

1,456,928

1,475,520

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 1,295,981 ASC admissions with surgical site hair removal seen at 1,050 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

902

949

1,090

1,050

Number of ASC Admissions Represented

1,006,608

1,169,262

1,238,620

1,295,981

Percentage of ASC Admissions with appropriate surgical site hair removal

97%

96%

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 96%

Represents the experience of 537,596 eligible ASC patients seen at 474 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

489

526

570

474

Number of Eligible ASC Patients Represented

500,254

622,594

609,196

537,596

Percentage of Eligible ASC Patients with Normothermia

94%

98%

97%

96%

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 0.52%

Represents the experience of 974,153 ASC cataract surgery patients seen at 1,107 facilities between April 1 and June 30, 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

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

909

947

931

1,107

Number of ASC Cataract Surgery Patients Represented

978,944

1,095,907

1,061,419

974,153

Percent of ASC Cataract Patients with Unplanned Anterior Vitrectomy

0.48%

0.43%

0.50%

0.52%

Unplanned Anterior Vitrectomy

 

Toxic Anterior Segment Syndrome (TASS)

Toxic anterior segment syndrome (TASS) is a potential complication of anterior segment eye surgery.

The frequency of TASS is shown below as a rate per 1000 anterior segment surgery patients. Lower rates are better.

Rate of Toxic Anterior Segment Syndrome (TASS) 1.01 per 1000

Represents the experience of 367,410 anterior segment surgery patients seen at 314 facilities between April 1 and June 30, 2016

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

Data Summary: Toxic Anterior Segment Syndrome (TASS)

Reporting Period

3Q2015

4Q2015

1Q2016

2Q2016

Number of Participating ASCs

n/a

n/a

414

314

Number of Anterior Segment Surgery Patients Represented

n/a

n/a

487,720

367,410

Rate of Toxic Anterior Segment Syndrome per 1000 Anterior Segment Surgery Patients

n/a

n/a

0.26

1.01

Data Summary: Toxic Anterior Segment Syndrome (TASS)

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.