Quality Improvement in Ambulatory Surgery Centers: A Major National Effort Aimed at Reducing Infections and Other Surgical Complications

Kristina K Davis; Vrinda Mahishi; Robbie Singal; Richard D Urman; Melissa A Miller; Marcia Cooke; William R Berry

doi:10.14740/jocmr3603w

Quality Improvement in Ambulatory Surgery Centers: A Major National Effort Aimed at Reducing Infections and Other Surgical Complications

J Clin Med Res. 2019 Jan;11(1):7-14. doi: 10.14740/jocmr3603w. Epub 2018 Dec 3.

Authors

Kristina K Davis¹, Vrinda Mahishi¹, Robbie Singal², Richard D Urman³, Melissa A Miller⁴, Marcia Cooke¹, William R Berry²

Affiliations

¹ Health Research and Educational Trust (HRET), An Affiliate of the American Hospital Association, Chicago, IL, USA.
² Ariadne Labs, A Joint Center Between Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Division of Healthcare-Associated Infections, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, USA.

Abstract

Background: Surgical volume has shifted significantly from inpatient to outpatient settings, including free-standing ambulatory surgery centers (ASCs). Approaches to quality improvement (QI) and surveillance used in hospitals are not always appropriate to the ambulatory setting.

Methods: We recruited 665 ASCs in 47 US states to participate in an intervention to improve safe practice through implementation of a surgical safety checklist and infection control practices. Areas for partner contribution included recruitment, project development, content development and delivery, clinical subject matter expertise, data analysis, and facility coaching.

Results: Barriers to implementation and data collection were encountered during the project, requiring revisions to the implementation plan. Project activities, such as facility recruitment, data measurement, and implementation strategies were modified to meet ASC-specific needs. Several ASC-specific tools were designed.

Conclusions: The increasing number of patients being cared for in ASCs makes it essential to better understand how to implement quality improvement projects in that environment. Tailoring interventions to the ASC's unique needs is necessary.

Keywords: Ambulatory surgery center; Checklist; Implementation; Infection control; Quality improvement; Safety.