More on Quality and Safety

Improvements needed across outpatient and ambulatory surgery settings, Leapfrog report shows

Among the gaps for both types of facilities are a lack of best practices for patient care and inadequate monitoring of board certifications.

Jeff Lagasse, Associate Editor

There are gaps in the education, training and national certifications of clinicians in both ambulatory surgical centers and hospital outpatient departments, according to a new report published by The Leapfrog Group.

In its inaugural report, Same-Day Surgery in the U.S.: Findings of Two Inaugural Leapfrog Surveys, Leapfrog gathered data on several important areas of outpatient care including basic facility information; medical, surgical and clinical staff; volume and safety procedures; patient safety practices; and patient experience.

While the report itself is available to the public, individual facilities that completed the surveys received confidential benchmarking reports illustrating their performance. Beginning with the 2020 Surveys, HOPD and ASC Survey Results will be publicly reported by facility on The Leapfrog Group's website. Results will be published in a way that allows consumers, purchasers, and payers to compare ASC and HOPD performance side by side.


Both ASCs and HOPDs showed gaps in ensuring all providers performing surgery or anesthesia were board certified, the report found. And while nearly all ASCs and HOPDs always have a clinician present who is certified in Advanced Cardiovascular Life Support (ACLS) and can perform life-saving actions if complications arise, fewer facilities have clinicians certified in Pediatric Advanced Life Support (PALS). Parents, the report said, should be aware of this gap and ensure the facility they choose for their child's care has PALS-certified clinicians prior to scheduling a procedure.

It was also revealed that ASC and HOPD patients may experience gaps in communication before and after procedures. Encouragingly, nearly all ASCs and HOPDs ensure that patients know who to contact after-hours following their procedure if needed, though both types of facilities could do better at proactively contacting patients by phone within 24 hours after discharge.

In both ASCs and HOPDs, most facilities are providing patients with surgical and anesthesia consent forms the day of the surgery. Patients would benefit from having this information in advance so they can more carefully consider the risks and develop questions to ask their providers.

ASCs lag behind HOPD counterparts in implementing best practices for patient safety, the surveys showed. 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.

Very few ASCs have an antimicrobial stewardship program in place and are also less likely to adopt practices such as monitoring for hand hygiene compliance. ASCs have many opportunities in the future to demonstrate improvement in this area, such as reporting to the CDC's National Healthcare Safety Network to report infection rates.

Meanwhile, patients tend to give higher patient experience ratings to ASCs -- but not enough ASCs monitor it. On the whole, patients reported their experience with ASCs to be more positive than that reported of HOPDs, though there are fewer ASCs participating in the standard patient experience survey.

Both ASCs and HOPDs can benefit from increased participation in the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey, the tested and validated instrument for assessing patient feedback.


The preliminary findings are based on data voluntarily submitted by 321 ASCs and 1,141 HOPDs across the country that had responded either to the Leapfrog ASC Survey or the Leapfrog Hospital Survey by August 31. Both surveys remain open for late submissions through November 30.

Similar to Leapfrog's other public reporting programs, the surveys were developed with guidance from Leapfrog's national Expert Panel and the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine. They include standardized, evidence-based measures of care specific to places that perform ambulatory and outpatient procedures.


The new Leapfrog report is the first since "Safety in Numbers"report, which found that the vast majority of participating hospitals do not meet its minimum hospital or surgeon volume standards for safety, nor do they have adequate policies in place to monitor for appropriateness.

Of the eight high-risk procedures assessed, open abdominal aortic aneurysm repair and esophageal resection for cancer are the two procedures where the fewest hospitals met the volume standard for patient safety (less than 3% fully meeting for each). The procedure for which hospitals were most likely to meet the safety standard was bariatric surgery for weight loss (38%).


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

Twitter: @JELagasse

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