As part of ongoing efforts to promote safety in ambulatory surgery, ASCA is partnering with the Health Research & Educational Trust (HRET) of the American Hospital Association, the Harvard School of Public Health, the South Carolina Hospital Association and Westat on a national, multi-year patient safety initiative funded by the Agency for Healthcare Research and Quality (AHRQ). The overall aim of this project, an adaptation of AHRQ’s Comprehensive unit-based Safety Program (CuSP), is to reduce surgical site infections (SSI) and other complications of care in ambulatory surgery center settings through the effective implementation of a combination of clinical and cultural interventions. These interventions will include the World Health Organization (WHO) Safe Surgery Checklist; TeamSTEPPS teamwork and communication safety tools; and a survey on patient safety culture for ambulatory surgery, which will be developed in the coming months.

BACKGROUND

AHRQ, as part its work to support the US Department of Health and Human Services’ Healthcare-Associated Infections (HAI) National Action Plan, has supported HRET in the implementation and adoption of CUSP to reduce central-line associated blood stream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). AHRQ is now funding HRET and its partners to apply the principles and concepts that have been learned from these two HAI reduction efforts to the problem of infections and other surgical complications following ambulatory surgery.

BUILDING ON SUCCESS

The AHRQ ambulatory surgery safety project will build on lessons learned during a previous nationwide patient safety project, also funded by AHRQ, that reduced the rate of CLABSIs in intensive care units (ICUs) by 41%, according to the agency’s findings of the largest national effort to combat CLABSIs to date. The project used CUSP, which was developed by a team led by Dr. Peter Pronovost at Johns Hopkins, to achieve results that include preventing more than 2,100 CLABSIs, saving more than 500 lives and avoiding more than $36 million in health care costs, and involved hospital teams at more than 1,000 ICUs in 44 states over a four-year period. The Johns Hopkins Armstrong Institute for Patient Safety and Quality is also using CUSP in national initiatives to eliminate ventilator-associated pneumonia and SSIs in the inpatient setting.

The ambulatory surgery safety project will be incorporating the work from internationally renowned surgeon and author Atul Gawande, MD, and his Safe Surgery 2015 team at the Harvard School of Public Health. In 2007, WHO funded Dr. Gawande and his team to develop and test a checklist that surgical teams could complete in less than two minutes and use to promote adherence to 19 practices identified as critical for safe surgery. According to the report on the project published in the New England Journal of Medicine in 2009, testing on approximately 8,000 patients around the world led to an average reduction in infections of 50% and a reduction in all complications of 36%. Death rates dropped by almost half.

ASCA has been providing the WHO safe surgery checklist (among others) to ASCs across the country as part of its efforts to promote participation in the new quality reporting program that Medicare implemented this year. ASCA’s ongoing involvement with the ASC Quality Collaboration and the development of ASC quality measures also make this new project a good fit for ASCA and indicate some of the ways that ASCA can provide important information and support to the health professionals and organizations involved.

NEXT STEPS

The project will be phased in over a four-year period. Beginning with three pilot states early in the new year, the project will expand to 15 states by the fall of 2013, with a minimum of 10 ASCs in each state. The project will then expand to all 50 states, the District of Columbia and Puerto Rico. Ultimately, the goal of the AHRQ Safe Ambulatory Surgical Project is not only to create a successful process for reducing SSIs and other complications from surgery in ASCs, but also to ensure that the process is shared with, and used effectively by, ASCs throughout the country.

ASCA will work with our members to identify ASCs across the country that are willing to participate in both the initial and subsequent phases of the program. We will communicate more information about the project as we finalize the program design with other members of the national project team in the coming few months. We will ensure that this information is made available to you on the ASCA web site, as well as the national project web site currently under construction. ASCA looks forward to working with ASCs across the country on this exciting and important project.

William Prentice is the chief executive officer of the Ambulatory Surgery Center Association.

For more information about the association, call 703.836.8808 or go to www.ascassociation.org.