For patients, a glimpse into data on the quality and safety of surgery centers

They may be more appealing and convenient because they’re located in the neighborhood with better hours and more parking. They also may be less costly because they lack the high overheard of big hospitals. But those booming same-day surgery centers have patient safety issues of their own.

Their doctors and nurses may not be as well-trained as patients might find at big hospitals or academic medical centers, with 1 in 3 centers not having staff who were all board-certified, according to the Leapfrog Group, a consortium of big companies and other major health care users focused on patient concerns.

Leapfrog has issued — to its considerable credit — its first safety and quality study of the facilities, also finding that, “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,” Modern Healthcare, an industry news source, reported.

The health information website added:

“[S]ome 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 … The report also found gaps in hand-hygiene monitoring [a basic test of how health care facilities safeguard patients, especially from health care acquired infections]. 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.”

These may not seem like dramatic or game-changing findings by Leapfrog. But they are an important start in providing public insight into care in a rising area of the health café industry.

“Today, more than 60% of surgical procedures take place in an outpatient environment,” Leah Binder, president and CEO of The Leapfrog Group, commented in a news release. “Despite this increasing shift towards same-day procedures, surprisingly little information about the safety and quality of these settings is available to the public. That’s why Leapfrog made the commitment this past year to expand our ratings to include same-day surgery.”

Preliminary findings in this national report were based on data voluntarily submitted by 321 surgical centers and 1,141 hospital outpatient facilities across the country. This survey, as with well-known Leapfrog information gathered on hospitals,  was developed with guidance from the group’s national Expert Panel and the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine.

In my practice, I see the harms that patients can suffer while seeking medical services, whether in hospitals or the ever-expanding array of new facilities, including urgent, emergency, and ambulatory surgical centers, as well as hospital outpatient outposts. News reports suggest an urgent need for lawmakers and regulators to step up the oversight of non-hospital treatment facilities. As the Leapfrog survey alone suggests, the facilities are taking on increasingly demanding, complex, and time-consuming procedures in medical specialties including, surgery, gastroenterology, urology, and obstetrics and gynecology. They operate under varied and not always clear ownership and regulation, depending, for example, where they are located.

Big hospitals and academic medical centers — which have stood up, spun off, and still keep a hand in many satellite care centers — have fought a pitched battle, and continue to do so, against patient advocates’ efforts to get regulators to not only watchdog the safety and quality of treatment facilities but to make information on their efforts to do so public and comprehensible.

Patients already run a gauntlet of sorts, trying to research and choose doctors and hospitals that they can access and afford, and who will provide them safe, efficient, and quality care. To try to make the hospital-selection process less daunting, federal officials, for example, have tried to weigh key safety and quality measures and to roll them up into a single, easy-to-understand letter grade. Our law firm carries on its site some of this important hospital data. It is worth noting that hospitals continue to dispute the accuracy and fairness of their ratings, and federal officials keep trying to figure ways to improve them. The ratings, of course, offer just a start for informing patients about their choices — and we have lots of work to not only make them as informative and useful as possible but also to ensure that all medical care giving facilities hew to the highest safety and quality standards for patients’ sake.