Comparing quality at an ambulatory surgery center and a hospital-based facility: Preliminary findings
Received 26 March 2009; received in revised form 12 August 2009; accepted 9 September 2009.
Abstract
Objective
To measure the quality of outpatient surgery in an ambulatory surgery center (ASC) compared to a hospital-based facility (HBF) in a multidimensional manner.
Study Design
Cross-sectional survey based on chart review.
Setting
Pediatric academic health center.
Subjects and Methods
A total of 486 cases were reviewed. Procedures were performed at either an ASC (n = 275) or an HBF (n = 211). Cases comprised four procedure types: ventilation tube insertion (ASC, n = 126; HBF, n = 108), dental rehabilitation (ASC, n = 89; HBF, n = 58), adenotonsillectomy (ASC, n = 37; HBF, n = 34), and ventilation tube insertion/adenoidectomy (ASC, n = 23; HBF, n = 11). Measures were developed for five categories: safety, patient-centeredness, timeliness, efficiency, and equitability. Performance was compared between facilities.
Results
The ASC had no unexpected safety events (0/275) compared to nine events (9/211) at the HBF. Tonsil bleed rates were 0 percent (0/37) at the ASC compared to 5.9 percent (2/34) at the HBF. Patient satisfaction was similar between facilities (ASC, n = 64; HBF, n = 35). Differences in timeliness approached 30 percent. A total of 77 percent of ASC cases finished within the scheduled time compared to 38 percent at the HBF. Total charges were 12 to 23 percent less at the ASC. Patients treated at the ASC generally lived in wealthier neighborhoods.
Conclusion
Performance at the ASC generally exceeded that at the HBF. Future research should investigate how perioperative processes result in these quality differences. Health policy implications are discussed.
aDepartment of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH
bDepartment of Otolaryngology, Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Corresponding author: Jedidiah Grisel, MD, Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, 231 Albert B. Sabin Way, Cincinnati, OH 45229
No sponsorships or competing interests have been disclosed for this article.
ABSTRACT