Raising the Safety Standards in Ambulatory Surgery Centers
Ambulatory surgery centers (ASC) are increasing in numbers as more of the U.S. population is undergoing routine surgeries to take care of common health issues. ASCs offer reasonably healthy patients the opportunity to get their issue resolved without the need to step foot into a hospital and undergo surgery in a setting that can be expensive, and feel impersonal.
But ASCs are not without their risks no matter how well they minimize the potential for patient adverse outcomes. Here's a look at the ambulatory surgery center of today, why they're gaining in popularity, and the risks that physicians and patients face at an ASC.
What Is an Ambulatory Surgery Center (ASC)?
An ambulatory surgery center, also known as a surgicenter, is a highly regulated healthcare facility that is equipped and staffed to handle same-day outpatient surgeries and preventative procedures, which are typically performed in a hospital setting. Lower cost, convenience, and the ability to achieve the same positive patient outcomes that can be obtained at a hospital all contribute to ASCs' rise in popularity.
What Kinds of Procedures Are Typically Performed at an ASC?
A wide variety of procedures are typically performed at an ASC. Most procedures performed at ASCs are treatments for chronic conditions and quick procedures that don't require hospitalization afterward. They include surgeries approved by private insurance, Medicare, and elective procedures like plastic surgery. Some of the most common procedures performed at an ASC include:
- Ear, nose, and throat procedures
- Orthopedic surgery
- Plastic surgery
- Eye surgery
- Urology procedures
- Gastrointestinal procedures
Ambulatory surgery centers cannot accommodate patients on an emergency basis and are not designed to handle the needs and requirements of a patient in an emergency.
Why Are ASCs Becoming More Popular With Physicians and Patients?
Flexibility for physicians and surgeons
Physicians and surgeons enjoy the additional flexibility and control offered in an ambulatory surgery center. Additionally, the staff manages fewer patients for pre-operative preparation. The surgeon also usually has more control over the tools, materials, and necessary medical devices to be used in the procedure and can readily prevent a last-minute substitution. And fewer patients in recovery means that medical staff are able to monitor the patient closely and intervene quickly in the event of a complication.
A personalized care environment for patients
From the patient's perspective, receiving care at an ASC feels more personal. Patients often report feeling a stronger connection with their physician because fewer barriers are preventing direct access to them. This more intimate setting eases patient-to-clinical staff communication, ultimately creating a perception that the patient received a higher quality of care and concern from the staff.
One of the most-cited reasons why patients and physicians are turning to the ASC for routine surgeries is cost. It's estimated that ASCs across the country reduce healthcare costs by more than $38 billion a year. Over $5 billion of that number is directly attributable to lower deductible and coinsurance payments for patients. Patients frequently have out-of-pocket costs for their medical care and will avoid or delay going through a procedure at a hospital as a result.
The costs for the same procedure at an ASC are almost always lower for the patient and enable them to undergo a necessary surgery without going heavily into debt.
What Are Some of the Top Safety Issues ASCs Face?
As ASCs continue increasing in popularity, maintaining safety and quality should stay top of mind. Here are a few areas that deserve special attention:
Infection control and prevention
Even though the risk of developing a surgical site infection (SSI) at an ASC tends to be lower than at a hospital, results from a recent U.S. Department of Health and Human Services' Office of Inspector General (OIG) report found that infection control remains a top issue for some ambulatory surgery centers. During the study, states cited 55% of all nondeemed ASCs with one or more infection control deficiency, like ensuring that surgical equipment is sanitized correctly, for example.
Off-site surgery centers' approachable and casual feel are part of what makes them so appealing to patients and staff; however, there should be nothing casual about an ASC's infection control and prevention approach. "Office grade" clean isn't good enough. The Center for Disease Control (CDC) recommends in its guide to Infection Prevention in Outpatient Settings, staffing, or contracting regularly available associates who specialize in infection prevention. These individuals can manage the facility's infection prevention program and help develop policies that are tailored to the facility.
Learn more about how the right EVS partner can help you address the reality and perception of clean to keep your patients and staff safe, without overdoing it.
As ambulatory surgery centers become more popular, they expand the services they offer in order to cover more patient needs. However, as they grow, they expose themselves to risks that are more commonly seen at the hospital level. This doesn't mean that ASCs will lose their status as a quality alternative to surgery in a hospital setting so much as ASCs need to recognize the increased risk and take steps to minimize their potential for occurrence.
Ambulatory surgery centers are required to maintain a patient transfer agreement with a local hospital if an emergency arises in order to comply with federal and state regulations across the U.S. This agreement is a safety net for a patient who is undergoing a surgical procedure at an ASC, and failure to maintain the agreement can result in an adverse outcome for the patient. While ASCs can and do keep resuscitation equipment at hand, sometimes a patient can present with a problem that far outstrips the facility's ability to handle the situation. An emergency care agreement with a nearby hospital can save a patient's life when staff and equipment at the ASC are unable to do so.
The core reason for the existence of ASCs is the ability to perform routine surgeries in an outpatient setting and offer a high level of patient service before, during, and after the surgery. Expanding upon the range of the surgeries provided is a natural step in the growth of the ASC, but the expansion needs to be done in a safe and measured fashion. Some ASCs have gone forward with providing complex surgeries only to demonstrate that they are not well-equipped to handle an emergency.
Conflict of interest
Hospitals are increasingly entering into ASC ventures, ASCs are predominately owned by physicians and operate independently of hospitals. Federal law allows physicians to refer patients to their own surgery centers, which means more significant financial incentives. Some experts worry that these financial incentives, especially for more complicated procedures, will lead physicians to approve high-risk patients for off-site surgery because of the financial rewards. While this is in no way reflective of all ASCs, all owners should enforce a rigorous patient selection process.
The ASC Can Be a Model for Surgeries of the Future
The ASC is here to stay as an alternative to the hospital surgical suite. As the role of the ASC expands, so must oversight of the services it provides to maintain its status as a low-cost, full-service outpatient surgical center. Maintaining balance, and infectious disease oversight will keep the ASC well-positioned for the decades to come.