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Leapfrog reports: Reporters can check ambulatory surgery center and hospital outpatient quality data; next year by facility Date: 10/23/19

Joyce Frieden

By Joyce Frieden

Many ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) are following the correct patient safety protocols, but there is still much room for improvement, according to a report released Tuesday by The Leapfrog Group.

“Today, more than 60% of surgical procedures take place in an outpatient environment,” said Leah Binder, Leapfrog Group president and CEO, in a statement. “Despite this increasing shift towards same-day procedures, surprisingly little information about the safety and quality of these settings is available to the public. That’s why Leapfrog made the commitment this past year to expand our ratings to include same-day surgery.”

The Leapfrog Group is a 19-year-old nonprofit focused on patient safety and quality issues. The group surveyed 321 ambulatory surgery centers and 1,141 hospital outpatient departments about their patient safety practices.

The researchers looked at board certification and found that in both ASCs and HOPDs, 65% of all individuals performing procedures were board certified. Focusing only on clinicians performing anesthesia, 83% of those in HOPDs and 71% of those in ASCs were board certified.

“Patients should be informed that they should ask if their anesthesiologists and surgeons are either board certified or board eligible,” Dr. Lee Fleisher, an anesthesiologist at the University of Pennsylvania, in Philadelphia, and chair of Leapfrog’s Ambulatory Surgery Center/Hospital Outpatient Department Expert Panel, said in a phone call with reporters. “[Otherwise], experts who are available to treat true complications may not be present in the facility.”

The survey also asked about hand hygiene. While nearly all ASCs and HOPDs used direct observation to see whether hospital staff was following good hand hygiene practices, no ASCs and only 6% of HOPDs were using electronic monitoring. This is unfortunate, since facilities are limited in the number of direct observations they can perform, said Missy Danforth, vice president for health care ratings at The Leapfrog Group.

Researchers looked at antimicrobial stewardship and found that although most hospitals have a stewardship program in place, only 18% of ASCs do. Life support was another area in which ASCs underperformed HOPDs: while both types of facilities had clinicians certified in adult advanced cardiovascular life support (ACLS) while adults were recovering in their facility, 89% of ASCs had clinicians certified in pediatric life support during pediatric patients’ recovery, compared with 96% of HOPDs.

Patient experience was another survey focus; here, ASCs performed a little better on some measures compared with their HOPD counterparts. For example, 87% of ASC patients gave those facilities the highest possible overall rating, versus 83% of HOPD patients. In addition, 86% of ASC patients surveyed said they would recommend the facility to others, versus 82% of HOPD patients. However, fewer ASCs were distributing patient satisfaction surveys, something that Leapfrog officials hope will improve in coming years.

In terms of ownership, 38% of participating ASCs represented a joint venture among physicians and a management company, while 29% were owned by either a single physician or multiple physicians, and 18% were owned by a combination of physicians and/or a hospital joint venture. The remaining 15% had other ownership structures.

The Leapfrog Group plans to continue performing the surveys next year, and will release results for individual facilities rather than just aggregate results in July 2020, according to Binder. Then reporters will be able to look up specific ASCs and HOPDs in their regions to compare those facilities’ measures of quality and patient safety.

Joyce Frieden is the news editor at MedPage Today.