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ASC Quality Collaboration Quality Report
3rd 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 July 1, 2018 through September30, 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 1,600 ASCs -- including 993 multispecialty ASCs and 607 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 0.121 per 1000 admissions

Represents the experience of 1,915,145 ASC admissions seen at 1,576 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

1,463

1,566

1,574

1,576

Number of ASC Admissions Represented

1,942,646

1,823,379

1,995,575

1,915,145

Patient Fall Rate per 1000 ASC Admissions

0.111

0.119

0.096

0.121

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 0.023 per 1000 admissions

Represents the experience of 1,917,030 ASC admissions seen at 1,575 facilities between July 1 and September 30, 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

4Q2017

1Q2018

 2Q2018

 3Q2018

Number of Participating ASCs

1,463

1,567

1,573

1,575

Number of ASC Admissions Represented

1,942,646

1,823,572

1,993,951

1,917,030

Patient Burn Rate per 1000 ASC Admissions

0.022

0.018

0.015

0.023

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 0.881 per 1000 admissions

Represents the experience of 1,913,875 admissions seen at 1,574 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

1,465

1,561

1,572

1,574

Number of ASC Admissions Represented

1,944,458

1,816,049

1,992,946

1,913,875

Hospital Transfer/Admission Rate per 1000 ASC Admissions

1.012

0.945

0.944

0.881

Hospital Transfer/Admission Rate per 1000 ASC Admissions

0.955

1.012

0.945

0.944

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 0.023 per 1000 admissions

Represents the experience of 1,917,294 ASC admissions seen at 1,576 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

1,461

1,564

1,574

1,576

Number of ASC Admissions Represented

1,941,411

1,818,388

1,995,575

1,917,294

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

0.032

0.029

0.025

0.023

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 1,172,426 ASC admissions with antibiotics ordered seen at 968 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

1,150

937

966

968

Number of ASC Admissions Represented

1,500,770

1,090,584

1,180,248

1,172,426

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

98%

99%

98%

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 94%

Represents the experience of 890,817 ASC admissions with surgical site hair removal seen at 695 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

791

722

701

695

Number of ASC Admissions Represented

1,043,261

818,032

914,478

890,817

Percentage of ASC Admissions with appropriate surgical site hair removal

94%

97%

98%

94%

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 175,347 eligible ASC patients seen at 976 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

542

899

957

976

Number of Eligible ASC Patients Represented

79,689

169,602

181,019

175,347

Percentage of Eligible ASC Patients with Normothermia

98%

96%

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 0.46%

Represents the experience of 298,380 ASC cataract surgery patients seen at 821 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

739

711

690

821

Number of ASC Cataract Surgery Patients Represented

299,364

283,832

312,116

298,380

Percent of ASC Cataract Patients with Unplanned Anterior Vitrectomy

0.43%

0.47%

0.44%

0.46%

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 147,107 anterior segment surgery patients seen at 384 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

474

361

361

384

Number of Anterior Segment Surgery Patients Represented

142,392

128,930

148,503

147,107

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

0.10

0.09

0.12

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 0.97 per 1000

Represents the experience of 1,248,199 admissions seen at 1,067 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

992

1,006

1,058

1,067

Number of Admissions

1,284,647

1,126,411

1,304,709

1,248,199

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

0.71

0.83

0.86

0.97

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 0.44 per 1000

Represents the experience of 1,251,194 admissions seen at 1,067 facilities between July 1 and September 30, 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

4Q2017

1Q2018

2Q2018

3Q2018

Number of Participating ASCs

950

991

1,056

1,067

Number of Admissions

1,243,227

1,114,097

1,306,227

1,251,194

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

0.34

0.37

0.43

0.44

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.