Op-Ed: We Need More Information on Surgical Safety in Outpatient Departments, Ambulatory Centers

Linda Schwimmer | October 23, 2019 | Opinion
New survey is a good start toward helping consumers determine which facilities are most committed to safety and quality
Linda Schwimmer

At the Quality Institute, we have long called for greater transparency on quality at outpatient surgery settings, including hospital outpatient departments and ambulatory surgery centers. We saw the great need for independent, consumer-friendly data about the safety of care in these settings since our earliest days.

The need for this information has increased as more surgeries are being done in these outpatient settings. Indeed, some health plans are designed to incentivize patients, when appropriate, to seek out these lower-cost settings, rather than hospitals. According to the state Department of Health, there are 296 ambulatory surgery centers in New Jersey. Nationally, 60% of surgeries are now performed in outpatient rather than inpatient settings.

But there’s very little public information for consumers to determine which of these outpatient settings are most committed to safety and quality. That is why we are thrilled that The Leapfrog Group expanded its safety survey to examine outpatient centers — and that the organization has released, for the first time ever, a national report that looks at surgery beyond hospital walls. Leapfrog began collecting safety and quality data on outpatient centers through a voluntary survey that started in early 2019, and hospital outpatient surgery departments began reporting similar data through a new section to the existing Leapfrog Hospital Survey.

This initial report — out yesterday — does not yet provide data for individual centers or states. But in 2020, the public report will include more specific information, such as surgical volumes and performance on facility-specific measures.

Troubling findings nationally

The report is a good start and documents some troubling findings nationally — as well as some positive aspects of outpatient centers. First, here are the measures that give us insight on how we can improve the nation’s outpatient centers:

  • More than one in three providers performing procedures in ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs) are not board certified. Additionally, just 71% of providers in ASCs and 83% in HOPDs who perform anesthesia are board-certified. Certainly, there is an opportunity for improvement here.
  • Pediatric life support certification is not universal: 88% of ASCs and 96% of HOPDs with pediatric patients reported always having a clinician present with this certification. This is important information for parents to check before scheduling procedures at a center.
  • Fewer than one in five ASCs have adopted an antimicrobial stewardship program. In comparison, at the inpatient level 93% of hospitals are in compliance with the program.

Here is some more positive news from the report:

  • Ninety-five percent of participating ASCs are accredited by a national organization.
  • Almost all ASCs and HOPDs have a clinician present who is certified for adult life support.
  • Nearly 100% of both ASCs and HOPDs make sure that patients know where to call to contact someone if there is a problem after the procedure and the center is closed. (Unfortunately, only 77% of ASCs and 86% of HOPDs follow up directly with patients by phone within 24 hours of their discharge.)

Leapfrog will use data collected from the surveys, in addition to published literature and guidance from its panel of national experts, to inform the development of additional safety standards in the future.

Step up and participate

New Jersey had strong participation from ASCs and HOPDs in this first outpatient setting survey – and those that did not participate still have until November 30 to respond to the 2019 survey. At the Quality Institute, we are calling on all outpatient centers in our state to participate in the survey and to be transparent about their quality and safety. We want to see that same drive toward safety and quality among outpatient facilities that we have seen among hospitals that participated in Leapfrog.

I know some people may assume that state or federal inspection data is readily available and, therefore, wonder why we need Leapfrog to collect and report this information. But from our work on this issue, we found that this is not the case. First, inspections absent a specific complaint are generally conducted about every four years, which means that it may not be timely data for consumers seeking a location for their procedure. A lot can change for better or worse over such a long period of time. Moreover, many inspections are conducted for the federal government by private accreditors and, unfortunately, that information is not publicly available. Finally, the inspection information posted on the New Jersey Department of Health website is often incomplete and is not consumer friendly to access or understand.

That is why Leapfrog is the right organization to step in. Leapfrog has almost 20 years experience collecting safety and quality data and making it available to employers and consumers in a meaningful and actionable way. As the regional leader for Leapfrog in New Jersey, we’ve seen how publicly reporting quality data drives improvements — such as reduced infection ratios and lower cesarean section rates. We look forward to bringing that same level of transparency and quality improvement to outpatient settings as more care occurs beyond the hospital walls.