As the healthcare industry continues to shift more procedures to an outpatient setting, it is critical to ensure comparable outcomes to their inpatient counterpart while continuing to improve patient care. According to the American Hospital Association, 80 percent of surgeries in 1981 were performed on an inpatient basis. As of 2011, that number had shrunk to 25 percent.
In addition, healthcare analytics firm Sg2’s 2015 growth forecast report predicted surgeries performed in an outpatient setting will grow by 19 percent between 2015 and 2025, while the number of inpatient procedures will be reduced by 4 percent. It is important to note, however, that it is not only the quantity of outpatient procedures increasing, but also the variety as well. Research and consulting firm The Advisory Board Company found that the percentage of healthcare facilities performing total joint knee replacements in an outpatient setting has been on the rise in recent years. In the first quarter of 2012, less than 10 percent of institutions surveyed performed this procedure in an outpatient setting. By the first quarter of 2014, that rate had risen to nearly 25 percent. So what is causing this migration of all types of procedures toward outpatient surgical settings? According to Sg2, payment models, payment penalties and increasing pressure for quality outcomes are all primary reasons for this increasing trend.
As ambulatory surgery centers continue to deliver patient-centered medical care in a highly efficient and accessible manner, it will be imperative to measure the success of not only total joint knee replacements, but also all procedures that begin to be performed in an outpatient setting. The tracking and recording of data will be instrumental in justifying these procedures being performed on an outpatient basis. It is critical to assess outcomes on an inpatient versus outpatient basis, and measure whether the results of these procedures vary by setting type or even provider. Below are three key metrics to track to ensure an ASC is prepared for and properly handling total joint knee replacements and other traditionally inpatient procedures:
Surgical site infection rate
According to the Centers for Disease Control and Prevention, surgical site infections (SSIs) are the most common healthcare-associated infections (HAIs), accounting for 31 percent of all HAIs in 2010. The good news, however, is that ASCs have an SSI rate of nearly half their inpatient counterpart; while nearly 9 patients per 1,000 developed an SSI in 2010, within ASCs only, that number fell to 4.8 per 1,000. Tracking the rate of SSIs developed in an ASC is critical to not only ensure patient and staff safety, but also to determine the health of the center’s daily operations. Has the facility’s SSI rate been increasing or decreasing recently? If so, does this trend correlate with a new specialty or surgical procedure being introduced, or perhaps a new nurse or physician hire? Determining an ASC’s SSI frequency is a critical part of measuring the center’s readiness for more complex, acute procedures.
Return to surgery rate
Another key metric to track is the rate at which patients return to an operating or procedure room prior to or within 48 hours of discharge. According to the Ambulatory Surgery Center Association, measuring and recording this statistic on a monthly basis helps ASC leaders and staff identify strengths and weaknesses in patient care, implement cost-saving initiatives, and improve compliancy standards. This will also help comparable outcome testing between inpatient vs. outpatient settings. What problems, if any, arise from performing procedures in an outpatient facility, and how can they be mitigated? How can centers improve daily operations to introduce more procedures safely and successfully? Gathering this data is key to expanding an ASC’s capability to serve its community and provide accessible care to its patients.
Hospital readmission rate
Hospital readmission rate is generally defined as patients returning to the hospital within 30 days of their procedure. The Centers for Medicare and Medicaid estimates that the Medicare hospital readmission rate was at 18.4 percent in 2012. This rate is the final data point to measure to ensure an ASC is ready for new cases and performing with results that are equal to or better than those from an inpatient setting. It is important that while an ASC works to collect and measure this data, its staff also effectively communicates with and reassures patients that the outpatient setting is appropriate for their procedure. In addition, we recommend having a nurse follow up with patients in the days and weeks after their procedure to not only briefly survey their condition, but also to better engage the patient via phone call, email or text to continue learning ways to refine daily operations and improve the overall patient experience. For more information about transferring traditionally inpatient procedures to an outpatient setting, contact firstname.lastname@example.org.