AAAHC Institute releases benchmarks
Latest report covers 4 procedures
The AAAHC Institute for Quality Improvement has released its July to December 2012 benchmarking reports for knee arthroscopy, cataract surgery, low back injection, and colonoscopy. The best performers in each category have shared their tips and best practices.
“The AAAHC Institute strives to help ambulatory surgery centers in their mission to provide the highest levels of safety and patient satisfaction, and these reports allow us insights into best practices,” said Naomi Kuznets, PhD, senior director and general manager of the AAAHC Institute.
The reports include data such as pre-procedure, procedure and discharge time comparisons, intra-operative complications, non-routine procedures, anesthesia, wrong-site surgery prevention, and patient outcomes. Highlights of the studies include the following:
• Knee arthroscopy.
Virtually all knee arthroscopies are performed in the ambulatory setting. The July-December 2012 clinical study of the procedure, the latest in a series conducted since 2000, includes results from 41 organizations that perform more than 9,190 procedures annually. Among the findings:
— Procedure times. Median pre-procedure time was 88 minutes. The range was 60 to 135. Organizations with the shortest pre-procedure times attributed their results to calling their patients the day before the procedure to remind them of their appointment time and making sure they understand the pre-procedure requirements.
Average procedure times ranged from 13 to 81 minutes. The median was 28. Median discharge time was 75 minutes. The range was 35 to 141. Organizations with the shortest discharge times attributed their results to having patients leave the operating room as they are waking up so their comfort level can be assessed as soon after the procedure as possible.
— Patient outcomes. Seventy-five percent had to wait less than one month from scheduling to the time of the procedure. Eighty-nine percent indicated they were able to schedule their procedures as soon as they wanted. Ninety-nine percent said they had an adequate understanding of the procedure. One hundred percent said they experienced little or no discomfort during the procedure.
Ninety-nine percent said they were comfortable post-discharge. One hundred percent said they received written discharge instructions. Ninety-nine percent said they would recommend the procedure to a friend or relative.
• Cataract extraction with lens insertion.
Cataract and lens operations are the number one outpatient surgical procedure and account for about one-half of all low vision cases in adults over age 40. The AAAHC Institute has conducted clinical studies on this procedure since 1999. Key July-December 2012 clinical findings reported by 92 organizations that perform more than 170,000 cataract surgeries annually include:
— Procedure times. The median pre-procedure time, defined as patient check-in to start of the procedure, was 81 minutes. The range was 30 to 137 minutes. Organizations with the shortest pre-procedure times use processes that include pre-arrival review of patient information. Average procedure times, defined as the time the procedure starts; i.e., incision, to the time the procedure has ended (dressing on), ranged from six to 34 minutes. The median was 14 minutes.
The median discharge time, defined as end of the procedure until patient meets discharge criteria, was 21 minutes. The range was 4 to 64. Organizations with the shortest discharge times attributed their results to practices such as having the physicians’ offices provide discharge instructions to patients at the time of procedure scheduling.
— Patient outcomes. Eighty-nine percent had to wait less than one month from scheduling to the time of the procedure. Ninety-six percent indicated that they were able to schedule their procedures as soon as they wanted. Ninety-nine percent said they had an adequate understanding of the procedure. Ninety-eight percent said they were comfortable during the procedure, and 99% said they were comfortable post-discharge.
Ninety-four percent reported that their vision was better post-surgery. Ninety-nine percent reported that their physicians rated their eyesight as better (98%) or the same (1%) post-surgery. Ninety-four percent returned to normal activities of daily living within one week of the procedure. Ninety-nine percent said they would recommend the procedure to friends or relatives with cataracts.
• Low back injection.
More than 1.5 million low back injections (LBI) for the treatment of pain or mobility problems are given each year, and that number is expected to rise as the population ages. This report is the sixth study of this procedure in the ambulatory setting conducted by the AAAHC Institute. This 2012 study included information from 31 organizations that perform a combined total of more than 64,890 LBI procedures annually. Findings include:
— Procedure times. Median pre-procedure time, which is the time from when the patient checks in to the time the needle is inserted, was 43 minutes. The range was 10 to 85 minutes. Organizations with the shortest times attributed their results to processes including contacting the patient to prepare for the procedure prior to the procedure day. Average procedure times ranged from three to 25 minutes. The median was seven.
Median discharge time was 22 minutes. The range was one minute to 42 minutes. Organizations with the shortest discharge times attributed their results to not using or using low levels of sedation, or controlling the type and amount of medication administered.
— Patient outcomes. Ninety percent had to wait less than one month from scheduling to the time of the procedure. Ninety-three percent indicated they were able to schedule their procedures within a reasonable time. Ninety-nine percent said they had an adequate understanding of the procedure.
Eighty-five percent reported that they were performing their usual daily activities. Eighty percent indicated that their pain had improved. Fifty percent had reduced their pain medications.
• Colonoscopy.
Nearly 60% (3.7 million) of colonoscopies to detect colorectal cancer are performed in ambulatory settings. The AAAHC Institute has been studying this procedure since 2001. Key July-December 2012 clinical findings from 100 organizations that perform more than 353,300 colonoscopies annually include:
— Procedure times. The median pre-procedure time, from patient check-in to insertion of the scope, was 59 minutes. The range was 17 to 129 minutes. Organizations with the shortest times use processes including preparing the patients and paperwork prior to arrival and having staff familiar with and dedicated to admissions. Average procedure times, from “scope in” to “scope out,” ranged from nine to 29 minutes. The median was 16 minutes. Procedure time might vary with the complexity (number of findings, biopsies, removals) of the colonoscopy.
The median discharge time was 40 minutes. The range was 15 to 75 minutes. Organizations with the shortest times attributed their results to well-trained anesthesia providers and the use of midazolam and propofol or propoful alone.
— Patient outcomes. Eighty-one percent had to wait less than one month from scheduling to the time of the procedure. Ninety-seven percent indicated that they were able to schedule their procedures as soon as they wanted. One hundred percent said they had an adequate understanding of the procedure. Seventy-seven percent said they experienced little or no discomfort during their bowel preparation. Ninety-nine percent said they experienced little or no discomfort during their procedure.
Ninety-eight percent said they were comfortable post-discharge. One hundred percent said they received written discharge instructions. Ninety-nine percent said they would recommend the procedure to a friend.
Organizations that participated in the AAAHC Institute studies all were volunteers, and most were accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). Organizations are invited to participate through the AAAHC Institute website and, when possible, through mailing to members of relevant specialty societies. To order copies of the reports or for more information, please visit the AAAHC Institute online at http://www.aaahc.org/en/institute.
Latest report covers 4 proceduresYou have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content