Leapfrog Group finds room for patient safety improvement at surgery centers

In its first-ever report on patient safety in ambulatory surgical centers and hospital outpatient departments, the Leapfrog Group found there’s room for improvement.

Most outpatient surgery facilities still have a long way to go with improvements needed in patient safety practices such as ensuring hand hygiene and board certification of clinical staff, according to the report released today.

While the nonprofit safety group has graded the country’s hospitals based on patient safety and quality for almost two decades, given that the vast majority of surgeries in the U.S. are now performed in ambulatory and outpatient settings, it has turned its focus there.

“Today, more than 60% of surgical procedures take place in an outpatient environment,” Leah Binder, president and CEO of The Leapfrog Group, said in an announcement. “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.”   

RELATED: Leapfrog gives more than 1,000 hospitals a 'C' or worse for safety; infection control a hurdle for low-scoring facilities

The report was based on surveys completed by 321 ambulatory surgery centers and 1,141 hospital outpatient departments who voluntarily responded to The Leapfrog Group’s request for data.

Here are some of the report’s key findings:

• Gaps in the education, training and national certifications of clinicians were found in both ambulatory surgery centers and hospital outpatient departments. Both showed gaps in ensuring all providers performing surgery or anesthesia were board-certified, the group said. While nearly all surgery settings always have a clinician present who is certified in advanced cardiovascular life support who can perform life-saving actions if complications arise, fewer facilities have clinicians certified in pediatric advanced life support. The Leapfrog Group said parents should ensure a facility they choose for their child’s surgery has clinicians certified in providing pediatric advanced life support.
   
• There are gaps in communication with patients before and after procedures in both settings. Both can do better at proactively contacting patients by phone within 24 hours after discharge. Nearly all facilities did ensure patients have contact information after-hours following a procedure. Both settings could do better by providing patients with surgical and anesthesia consent forms before the day of their surgery so they can more carefully consider the risks and develop questions to ask their providers, The Leapfrog Group said.
   
• Hospital outpatient departments do a better job than ambulatory surgery centers in implementing best practices for patient safety. “All facilities that perform same-day surgery should be complying with best practices as identified by national organizations for infection prevention, hand hygiene, and medication safety,” the group said. However, very few ambulatory surgery centers have an antimicrobial stewardship program in place and are less likely to adopt practices such as monitoring for hand hygiene compliance. 

• Patients tended to give higher patient experience ratings to ambulatory surgery centers, but many facilities did not monitor those results. On the whole, patients reported their experience with ambulatory surgery centers to be more positive than those reported of hospital outpatient departments. The Leapfrog Group said both settings can benefit from increased participation in the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS), a survey to assess patient feedback.  

This year, The Leapfrog Group only publicly released the report that showed aggregate numbers but plans to release data on specific centers in the next round of surveys starting in 2020, as it currently does with hospitals.

Facilities that completed surveys this year received confidential benchmarking reports from The Leapfrog Group detailing their performance. Ambulatory surgery centers and hospital outpatient departments that did not complete a 2019 survey can still do so by November 30 and will receive an individual benchmarking report.