In its first report of outpatient settings, the Leapfrog Group found some ambulatory surgery centers and hospital outpatient departments fail to follow quality practices.
The organization found 1 in 3 centers didn't have physicians or nursing staff who were all board-certified, according to the findings published Tuesday.
The Leapfrog Group received voluntary information from 321 ambulatory surgery centers and 1,141 hospital outpatient departments as part of its inaugural inclusion of these settings on its website that currently only displays data on safety of care at hospitals.
It decided to expand surveys to outpatient settings considering the proliferation of same-day procedures happening in the setting and a dearth of quality information available to consumers and employers.
"Over 60% of surgeries take place in an outpatient and ambulatory setting, and yet there is very little publicly available data about their quality and safety," said Leah Binder, CEO of the Leapfrog Group. "We believe purchasers and consumers deserve to have this information to make informed decisions."
The low number of board-certified physicians and nurse anesthetists may be due to recently graduated clinicians going through the certification process at the time of the survey, according to Dr. Lee Fleisher, chair of Leapfrog's technical expert panel and chair of anesthesiology and critical care at the University of Pennsylvania Health System.
Another reason may be because they don't have to work in the hospital setting, and therefore don't need hospital privileges, physicians and nurses "potentially might not be staying up to date on the latest information" and don't get recertified, he said.
Leapfrog asked the centers for information about medical staff, volume of procedures, safety practices and patient experience. The centers offer procedures in at least one of 10 specialties including gastroenterology, urology, and obstetrics and gynecology.
They survey found not all ambulatory surgery centers and hospital outpatient departments provide surgery consent materials before the day of surgery. Just 14% of ambulatory surgery centers provided the information one to three days before the surgery, while just 20.7% of hospital outpatient departments do so.
"Many times on the day of surgery, the patient might be nervous so it's really best you have some advance time to review the information and ask questions," said Missy Danforth, vice president of healthcare ratings at the Leapfrog Group.
Additionally, some outpatient providers fail to call the patient within 24 hours after the procedure. Just 77.6% of ambulatory surgery centers said they call the patient within the time frame while 86.2% of hospital outpatient departments said they do.
Calling patients within 24 hours of discharge allows them to ask questions about their symptoms as well as offers a learning opportunity for the centers to address potential complications, Fleisher said.
The report also found gaps in hand-hygiene monitoring. Nearly all respondents use direct observation to gauge hand hygiene, but few use electronic monitoring. Further, only 81% of ambulatory surgery centers and 78% of hospital outpatient departments provide regular feedback to leadership on hand-hygiene results.
"Given the amount of direct observation that is being reported, we would hope the regular feedback of these results are being shared more regularly," Danforth said.
Akin Demehin, director of quality policy at the American Hospital Association, said the new data from the Leapfrog Group is "one source of information among many" patients can use to make care decisions.
He urges patients to "augment" what they find from the Leapfrog Group and speak with their clinicians about concerns. The AHA has been critical of the Leapfrog Group's hospital patient safety grades.
There are few measures that the CMS applies to outpatient surgery settings. The findings show the need for "more actionable outcomes data" from these settings, according to Bill Prentice, CEO of the Ambulatory Surgery Center Association.
Of the 321 ambulatory surgery centers that participated in the survey, 38% were jointly owned by physicians and a management company. Twenty-nine percent were owned by only doctors and 18% were jointly owned by physicians and a hospital.
The results from the survey will be publicly available to patients starting in spring 2020, Binder said. Ambulatory surgery centers and hospital outpatient departments can submit surveys until Nov. 30.
Correction: An earlier version of this story misstated how many medical staff are board-certified and the specialties the centers offer. These errors have been corrected.
