Patient Safety in Today's ASCs

Patient satisfaction with ambulatory surgery centers (ASCs) is generally high and infection rates are low, but the overall landscape of patient safety in surgery centers could still be improved. Physicians are performing more complex procedures and this could increase the risk to patient safety, according to the American Association of Orthopaedic Surgeons (AAOS).

“Patients may not receive adequate preoperative medical evaluation and clearance by their primary care physician for some of the more complex procedures,” AAOS researchers claim.¹ “This brings to light the importance of careful, uniformly-applied privileging standards, and highlights the importance of ASCs being recertified/reaccredited on a regular basis to ensure oversight of performance.”

According to AAOS research, there are characteristics of ASC physicians against whom claims were made, and they differ somewhat from the claims made against hospital-based physicians. The ASC physicians were older, and a significantly higher percentage was male and board certified than the hospital-based group.

Of all ASC specialties, the most professional liability claims have been against plastic surgeons.¹ They had more than twice the number of claims than the second highest specialty, which is ophthalmology. Obstetrics and gynecology was third and orthopedics was fourth.

AAOS researchers bring up the concern that in a few instances, safe harbor laws may decrease patient safety in ASCs. “ASC safe harbor laws require that physician investors perform one-third of their total procedures at the ASC,” they write. “Such physicians may feel pressure to do inappropriate cases at the ASC in order to meet this quota.”

Safe harbor laws don’t lead to patient danger, says Roger Pence, BBA, MHA, administrative consultant president of FWI Healthcare.

“In the vast majority of the situations, most ASCs just send a letter asking their surgeons to confirm they meet the one-third rule, without any other means of proof or documentation,” Pence says. “Thus, the practitioners have little burden to perform extra cases to meet the quota. As Medicare continues to expand the ASC procedure list, new procedures allow for increasing the ASC’s volume and enabling physicians to meet the rule. The critical component is the importance of the utilization review process at the center. Are appropriate procedures being performed on the correct patients in the right facility?”

Maintenance

One of the first steps toward keeping patients safe is making certain the building is well maintained, and the equipment as well. Administrators should develop specific procedures of checking and documenting the maintenance of the building and equipment including rescue exits, fire extinguishers, and storage of anesthetic gases.¹