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ASC Quality Collaboration Quality Report
4th Quarter 2013

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, 2013 through December 30, 2013: Ambulatory Surgery Center Association; Ambulatory Surgical Centers of America (ASCOA); AmSurg; Healthcare Facilities Accreditation Program (HFAP); Health Inventures; HCA Ambulatory Surgery Division; Nueterra; Regent; Surgical Care Affiliates (SCA); Symbion and United Surgical Partners International (USPI).

This quarter's data has been collected from 1,430 ASCs -- including 942 multispecialty ASCs and 488 single specialty ASCs -- representing every state except Maine, North Dakota, and Vermont. ^Please note 1Q2013 and 2Q2013 reports have been updated to reflect additional data.

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 0.139 per 1000 admissions

Represents the experience of 1,656,440 ASC admissions seen at 1,415 facilities between October 1 and December 30, 2013

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

1Q2013^

2Q2013^

3Q2013

4Q2013

Number of Participating ASCs

1,379

1,358

1,344

1,415

Number of ASC Admissions Represented

1,492,571

1,550,159

1,511,888

1,656,440

Patient Fall Rate per 1000 ASC Admissions

0.127

0.124

0.124

0.139

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 0.026 per 1000 admissions

Represents the experience of 1,651,862 ASC admissions seen at 1,411 facilities between October 1 and December 30, 2013

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

1Q2013^

2Q2013^

3Q2013

4Q2013

Number of Participating ASCs

1,379

1,358

1,343

1,411

Number of ASC Admissions Represented

1,492,571

1,550,159

1,511,301

1,651,862

Patient Burn Rate per 1000 ASC Admissions

0.030

0.025

0.024

0.026

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 1.124 per 1000 admissions

Represents the experience of 1,656,153 admissions seen at 1,405 facilities between October 1 and December 30, 2013

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

1Q2013^

2Q2013^

3Q2013

4Q2013

Number of Participating ASCs

1,365

1,347

1,345

1,405

Number of ASC Admissions Represented

1,489,291

1,545,735

1,528,596

1,656,153

Hospital Transfer/Admission Rate per 1000 ASC Admissions

1.109

1.077

1.132

1.124

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 0.029 per 1000 admissions

Represents the experience of 1,654,861 ASC admissions seen at 1,414 facilities between October 1 and December 30, 2013

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

1Q2013^

2Q2013^

3Q2013

4Q2013

Number of Participating ASCs

1,366

1,358

1,344

1,414

Number of ASC Admissions Represented

1,485,941

1,550,159

1,513,201

1,654,861

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

0.034

0.031

0.026

0.029

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 1,336,265 ASC admissions with antibiotics ordered seen at 1,181 facilities between October 1 and December 30, 2013

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

1Q2013^

2Q2013^

3Q2013

4Q2013

Number of Participating ASCs

1,135

1,122

1,285

1,181

Number of ASC Admissions Represented

1,165,376

1,181,570

1,454,207

1,336,265

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 98%

Represents the experience of 1,155,036 ASC admissions with surgical site hair removal seen at 1,034 facilities between October 1 and December 30, 2013

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

1Q2013^

2Q2013^

3Q2013

4Q2013

Number of Participating ASCs

974

955

962

1,034

Number of ASC Admissions Represented

1,012,513

1,005,313

1,019,887

1,155,036

Percentage of ASC Admissions with appropriate surgical site hair removal

99%

99%

99%

98%

Hair Removal

 

^ Please note 1Q2013 and 2Q2013 reports have been updated to reflect additional data.

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.