This year, following the passage of the Patient Protection and Affordable Care Act, there has been plenty of focus on the safety of the ambulatory setting. There have been several developments in ASC safety this year, whether they have confirmed what is already known or shed light on persistent questions surrounding safety in healthcare. Here are some of the highlights from the year in safety.
1. SSIs few and far between, data shows
Researchers this year dug into government data archives and analyzed infection rate data for ambulatory surgery settings. While their results confirm the low infection rates most know to be true at their own facilities, the solid numbers on the trend were touted by the ASC industry.
The data showed that of ambulatory surgery patients, one-third and one-half of 1 percent of patients developed surgical site infections within 14 and 30 days of surgery, respectively. Nearly all of these patients required inpatient treatment for their postsurgical infections. Slightly more patients, between 2 percent and 4 percent depending on a 14- or 30-day timeframe, had an all-cause visit to a hospital after surgery.
While the infection rates are low, the researchers in the study concluded total adverse outcomes from infection might represent a significant proportion of adverse outcomes associated with ambulatory surgery and should therefore be taken seriously.
2. Top surgical errors stay the same
When it comes to surgery-related errors, not much has changed, according to data from The Joint Commission. The organization released ten years of data in its second quarter 2014 sentinel event root cause report. For perioperative complications, human factors/staffing-related concerns), communication, organizational priorities and clinical assessment remained the top contributory causes to sentinel events reported to the organization.
Another finding: In surgery, it’s possible retention of surgical items may be more of a team, rather than an individual problem, supporting the idea that the safety culture of a healthcare setting has a large influence on medical errors.
3. The FDA and DEA recognize shortfalls, sort of
The federal government spent the year shoring up its policies with regard to prescription drugs, device oversight and patient safety. The year was slightly controversial for both the Food and Drug Administration and the Drug Enforcement Administration. The FDA in particular has been known for less stringent policies in some senses during this particular administration.
However, the agency and its affiliates began tightening control of some areas, including opiates, for which abuse is on the rise in the United States. The DEA upped certain hydrocodone combinations to Schedule II as of October 2014. In response to the government’s opiate control problem, the agency also announced a drug return collection box program to be instituted at pharmacies nationwide.
With regards to the FDA’s warning about morcellation in April, the device remains popular among physicians, despite the agency’s cautions that its use may spread undetected cancer. The morcellation debate is also emblematic of a larger FDA problem, upon which a new study shed light this year: The FDA is not a very effective regulator of devices for patient safety. While the agency requires public data and follow-up studies for certain high-risk devices, the actual availability of the data and completion of studies is low, according to one report.
Showing its commitment to change, the FDA released its strategic priorities for 2014 through 2015, which include improving its regulatory and oversight duties in order to better promote patient safety.
4. Checklists aren’t a magic bullet, but they can help
While the security checklists provide is vital, engaging patients with a safety checklist may improve surgical safety and improve patient satisfaction, according to one study. To come to this conclusion, researchers monitored patient satisfaction and surgical team compliance to certain checklist items, such as allergy confirmation, surgical instrument count and surgical site confirmation. Compliance increased between 20 and nearly 80 percent for items on the checklist, after patients engaged with the checklist.
This information is related to another study published in the New England Journal of Medicine that suggests checklists are not enough to prevent surgical errors. Rather, training is vital to proper use of a surgical checklist.
5. How safe is the ASC, really?
Surgery in the ambulatory setting is safe — very safe. In the wake of comedienne Joan Rivers’ unfortunate demise following a routine endoscopic procedure, the American Association for the Accreditation of Ambulatory Surgery Facilities released statistics on mortality and infection rates in their centers from 15 years of data. According to AAAASF, mortality is 1 in 50,000 procedures, intraoperative mortality is 1 in 478,000 procedures and infection is 1 in 2,400 procedures, with no deaths attributable to infection.
Disturbingly, while conversations about safety culture occur “frequently” in 9 of 10 organizations, just 24 percent of patient safety professionals feel they have appropriate data to reduce patient harms, according to a survey from the National Patient Safety Foundation’s 2014 annual conference.
Finally, while safety is important to patients, it appears being heard, along with having a competent provider is what patients desire in their care.
More articles on accreditation:
ASCs that overcame disaster
Joan Rivers dies from "surgical complications"
Tool: Preparing for Ebola in the OR
1. SSIs few and far between, data shows
Researchers this year dug into government data archives and analyzed infection rate data for ambulatory surgery settings. While their results confirm the low infection rates most know to be true at their own facilities, the solid numbers on the trend were touted by the ASC industry.
The data showed that of ambulatory surgery patients, one-third and one-half of 1 percent of patients developed surgical site infections within 14 and 30 days of surgery, respectively. Nearly all of these patients required inpatient treatment for their postsurgical infections. Slightly more patients, between 2 percent and 4 percent depending on a 14- or 30-day timeframe, had an all-cause visit to a hospital after surgery.
While the infection rates are low, the researchers in the study concluded total adverse outcomes from infection might represent a significant proportion of adverse outcomes associated with ambulatory surgery and should therefore be taken seriously.
2. Top surgical errors stay the same
When it comes to surgery-related errors, not much has changed, according to data from The Joint Commission. The organization released ten years of data in its second quarter 2014 sentinel event root cause report. For perioperative complications, human factors/staffing-related concerns), communication, organizational priorities and clinical assessment remained the top contributory causes to sentinel events reported to the organization.
Another finding: In surgery, it’s possible retention of surgical items may be more of a team, rather than an individual problem, supporting the idea that the safety culture of a healthcare setting has a large influence on medical errors.
3. The FDA and DEA recognize shortfalls, sort of
The federal government spent the year shoring up its policies with regard to prescription drugs, device oversight and patient safety. The year was slightly controversial for both the Food and Drug Administration and the Drug Enforcement Administration. The FDA in particular has been known for less stringent policies in some senses during this particular administration.
However, the agency and its affiliates began tightening control of some areas, including opiates, for which abuse is on the rise in the United States. The DEA upped certain hydrocodone combinations to Schedule II as of October 2014. In response to the government’s opiate control problem, the agency also announced a drug return collection box program to be instituted at pharmacies nationwide.
With regards to the FDA’s warning about morcellation in April, the device remains popular among physicians, despite the agency’s cautions that its use may spread undetected cancer. The morcellation debate is also emblematic of a larger FDA problem, upon which a new study shed light this year: The FDA is not a very effective regulator of devices for patient safety. While the agency requires public data and follow-up studies for certain high-risk devices, the actual availability of the data and completion of studies is low, according to one report.
Showing its commitment to change, the FDA released its strategic priorities for 2014 through 2015, which include improving its regulatory and oversight duties in order to better promote patient safety.
4. Checklists aren’t a magic bullet, but they can help
While the security checklists provide is vital, engaging patients with a safety checklist may improve surgical safety and improve patient satisfaction, according to one study. To come to this conclusion, researchers monitored patient satisfaction and surgical team compliance to certain checklist items, such as allergy confirmation, surgical instrument count and surgical site confirmation. Compliance increased between 20 and nearly 80 percent for items on the checklist, after patients engaged with the checklist.
This information is related to another study published in the New England Journal of Medicine that suggests checklists are not enough to prevent surgical errors. Rather, training is vital to proper use of a surgical checklist.
5. How safe is the ASC, really?
Surgery in the ambulatory setting is safe — very safe. In the wake of comedienne Joan Rivers’ unfortunate demise following a routine endoscopic procedure, the American Association for the Accreditation of Ambulatory Surgery Facilities released statistics on mortality and infection rates in their centers from 15 years of data. According to AAAASF, mortality is 1 in 50,000 procedures, intraoperative mortality is 1 in 478,000 procedures and infection is 1 in 2,400 procedures, with no deaths attributable to infection.
Disturbingly, while conversations about safety culture occur “frequently” in 9 of 10 organizations, just 24 percent of patient safety professionals feel they have appropriate data to reduce patient harms, according to a survey from the National Patient Safety Foundation’s 2014 annual conference.
Finally, while safety is important to patients, it appears being heard, along with having a competent provider is what patients desire in their care.
More articles on accreditation:
ASCs that overcame disaster
Joan Rivers dies from "surgical complications"
Tool: Preparing for Ebola in the OR