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ASC Quality Collaboration Quality Report
4th Quarter 2018

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 October 1, 2018 through December 31, 2018: Ambulatory Surgery Center Association; Ambulatory Surgical Centers of America (ASCOA); AmSurg; California Ambulatory Surgery Association; 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 1,609 ASCs -- including 999 multispecialty ASCs and 610 single specialty ASCs -- representing every state except Vermont.

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 0.118 per 1000 admissions

Represents the experience of 2,085,527 ASC admissions seen at 1,592 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

1,566

1,574

1,576

1,592

Number of ASC Admissions Represented

1,823,379

1,995,575

1,915,145

2,085,527

Patient Fall Rate per 1000 ASC Admissions

0.119

0.096

0.121

0.118

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 0.017 per 1000 admissions

Represents the experience of 2,085,035 ASC admissions seen at 1,591 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

1,567

1,573

1,575

1,591

Number of ASC Admissions Represented

1,823,572

1,993,951

1,917,030

2,085,035

Patient Burn Rate per 1000 ASC Admissions

0.018

0.015

0.023

0.017

Patient Burn

 

All Cause 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 0.873 per 1000 admissions

Represents the experience of 2,085,048 admissions seen at 1,593 facilities between October 1 and December 31, 2018

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

Data Summary: All Cause Hospital Transfer/Admission

Reporting Period

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

1,561

1,572

1,574

1,593

Number of ASC Admissions Represented

1,816,049

1,992,946

1,913,875

2,085,048

Hospital Transfer/Admission Rate per 1000 ASC Admissions

0.945

0.944

0.881

0.873

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 0.021 per 1000 admissions

Represents the experience of 2,085,035 ASC admissions seen at 1,591 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

1,564

1,574

1,576

1,591

Number of ASC Admissions Represented

1,818,388

1,995,575

1,917,294

2,085,035

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

0.029

0.025

0.023

0.021

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 1,286,593 ASC admissions with antibiotics ordered seen at 991 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

937

966

968

991

Number of ASC Admissions Represented

1,090,584

1,180,248

1,172,426

1,286,593

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

99%

98%

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 98%

Represents the experience of 955,585 ASC admissions with surgical site hair removal seen at 683 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

722

701

695

683

Number of ASC Admissions Represented

818,032

914,478

890,817

955,585

Percentage of ASC Admissions with appropriate surgical site hair removal

97%

98%

94%

98%

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 98%

Represents the experience of 201,346 eligible ASC patients seen at 1,013 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

899

957

976

1,013

Number of Eligible ASC Patients Represented

169,602

181,019

175,347

201,346

Percentage of Eligible ASC Patients with Normothermia

96%

97%

96%

98%

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 0.42%

Represents the experience of 319,835 ASC cataract surgery patients seen at 803 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

711

690

821

803

Number of ASC Cataract Surgery Patients Represented

283,832

312,116

298,380

319,835

Percent of ASC Cataract Patients with Unplanned Anterior Vitrectomy

0.47%

0.44%

0.46%

0.42%

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) 0.07 per 1000

Represents the experience of 153,385 anterior segment surgery patients seen at 370 facilities between October 1 and December 31, 2018

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

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

361

361

384

370

Number of Anterior Segment Surgery Patients Represented

128,930

148,503

147,107

153,385

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

0.09

0.12

0.07

0.07

Data Summary: Toxic Anterior Segment Syndrome (TASS)

 

All Cause Emergency Department Visit Within One Day of Discharge

Patients undergoing ambulatory surgery are expected to recover at home following discharge. An emergency department visit within one day of discharge is an unexpected event.

The frequency of ASC admissions experiencing an emergency department visit within one day of discharge is shown below as a rate per 1000 admissions. Not all conditions requiring an emergency department visit result from the care the patient received in the ASC, nor can all medical conditions requiring an emergency department visit following discharge be anticipated in advance. Therefore, some level of emergency department visits following discharge is to be expected.

All Cause Emergency Department Visit Within One Day of Discharge 0.74 per 1000

Represents the experience of 1,358,260 admissions seen at 1,061 facilities between October 1 and December 31, 2018

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

Data Summary: All Cause Emergency Department Visit Within One Day of Discharge

Reporting Period

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

1,006

1,058

1,067

1,061

Number of Admissions

1,126,411

1,304,709

1,248,199

1,358,260

Rate of Emergency Department Visits Within One Day per 1000 ASC Admissions

0.83

0.86

0.97

0.74

Data Summary: All Cause Emergency Department Visit Within One Day of Discharge

 

All Cause Unplanned Hospital Admission Within One Day of Discharge

Patients undergoing ambulatory surgery are expected to recover at home following discharge. An unplanned hospital admission within one day of discharge is an unexpected event.

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

All Cause Unplanned Hospital Admission Within One Day of Discharge 0.35 per 1000

Represents the experience of 1,352,089 admissions seen at 1,056 facilities between October 1 and December 31, 2018

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

Data Summary: All Cause Unplanned Hospital Admission Within One Day of Discharge

Reporting Period

1Q2018

2Q2018

3Q2018

4Q2018

Number of Participating ASCs

991

1,056

1,067

1,056

Number of Admissions

1,114,097

1,306,227

1,251,194

1,352,089

Rate of Unplanned Hospital Admissions Within One Day per 1000 ASC Admissions

0.37

0.43

0.44

0.35

Data Summary: All Cause Unplanned Hospital Admission Within One Day of Discharge

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.