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• April 2008 Issue
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• New tools to promote ASC Quality

Working toward standardizing quality of care measures for ambulatory surgery centers (ASCs) has been the driving force behind the ASC Quality Collaboration, a group of ASC industry stakeholders interested in ensuring that ASC quality data is measured and reported in a meaningful way. 

"Until recently ASCs have not had a cohesive, standardized method for collecting quality of care data, but that is changing," explained Donna Slosburg, BSN, LHRM, CASC, executive director of the ASC Quality Collaboration (ASC QC).

Slosburg works closely with ASC QC members, including representatives from companies and organizations such as AORN, The Joint Commission, Accreditation Association for Ambulatory Health Care, the American College of Surgeons, Ambulatory Surgery Foundation and several ASC management companies. Formed in 2006, the ASC QC has worked together to develop five ASC quality measures that were endorsed by the National Quality Forum last November.

"We needed a way to demonstrate the quality of care provided by ASCs. These measures address aspects of care that all ASCs can measure to improve quality," Slosburg said.

"The key is asking the right questions," stressed Beverly Kirchner, RN, BSN, CNOR, CASC, a member of AORN's board of directors who serves on the ASC QC. "Many ASCs measure outcomes, but there is currently no standard for what is measured, which means data cannot easily be compared between ASCs. With these NQF-endorsed measures we can all start measuring the same data and work to improve quality across the board. "

Tools for quality improvement
When the ASC QC first considered the idea of developing standardized outcomes and process measures for ASCs, they looked to several organizations and programs with established quality measures, including The Joint Commission, the Surgical Care Improvement Project (SCIP) and the Agency for Healthcare Research and Quality (AHRQ), to determine what measures had already been established, Slosburg said

"We could not find quality measures that were specifically relevant to clinical practice in an ASC, so we were determined to develop our own," she explained.
The ASC QC looked at common quality measures currently being collected among ASC organizations and identified ten measures important to standardized ASC quality reporting. These measures were then developed and submitted for possible national endorsement to the NQF, a voluntary consensus standard setting organization established to standardize healthcare quality measurement and reporting, for possible national endorsement.

"This application process was very rigorous," Slosburg said. "NQF requires evidence that supports usability, feasibility and scientific acceptability before it is endorsed."

After a lengthy review process NQF endorsed five of the quality measures the ASC QC submitted. The measures include:

• Patient Burn
• Prophylactic IV Antibiotic Timing
• Patient Fall in the ASC
• Wrong site, Side, Patient, Procedure or Implant
• Hospital Transfer/Admission

"It was such a feeling of accomplishment to see these measures through to NQF endorsement, but we needed a way to help ASCs implement the measures," acknowledged Slosburg.

Implementing quality measurement
To help ASC staff implement the NQF-endorsed quality measures, the ASC QC developed the ASC Quality Measures Implementation Guide, an educational tool with research, references and detailed explanations for each quality measure. The document includes the rationale and clinical guidelines for gathering measurement data that were included in the application to NQF. It also includes frequently asked questions developed in responses to issues raised by ASCs across the country who have been working with the ASC QC to pilot the measures.

"Before you start measuring data you need to educate your staff to help them understand what these quality measures are and why they need to be addressed. This implementation guide is the educational tool ASCs need to communicate this critical information to ASC staff," stressed Kirchner.

The implementation guide, available to the public from the ASC QC Web site, includes introductory information about ASC QC, NQF and the specific measures. Each measure is described in detail, beginning with the specific definitions and how to collect the information for each measure, Slosburg explained.

For example, in the measure for patient burn the measure type, intent, numerator/denominator, inclusions/exclusions, data sources and definitions are outlined in a table.

Source: ASC Quality Measures Implementation Guide

Specifically, the language for the parameters for inclusion or exclusion of patients is outlined in detail, so that facilities know when a patient burn should be counted, Slosburg pointed out.

The guide also includes the rationale and clinical practice guidelines to help facilities understand why they need to collect data on the measure, she added. For example, in the implementation guide the prophylactic IV antibiotic timing information includes evidence on the incidence of surgical site infection.

"This can be a complicated measure to collect data for, but the rationale and clinical practice guidelines can help facilities educate staff as to the importance of antibiotic timing," Slosburg acknowledged.

Beyond internal quality improvement and external benchmarking, she says implementing the measures will also help ASCs in meeting future Medicare requirements for quality reporting.

Outlook on ASC quality measurement
Quality improvement is something all ambulatory surgical centers need to focus on to begin collecting data that the Centers for Medicare and Medicaid (CMS) will require beginning Jan. 1, 2009, as part of the Tax Relief and Health Care Act of 2006.

Currently the ASC QC is working with CMS to provide input on the development of required CMS quality measures for ASCs, but "the final word on ASC reporting is still being written," stressed Kim Wood, MD, who serves as one of the co-chairs of the ASC Quality Collaboration. "Regardless of the methodology CMS implements as the way for us to begin reporting measures by their statutory deadline of Jan. 1, 2009, ASCs will need to have established processes in place to gather this information."

Members of the ASC QC agree that ASCs need to be collecting data now, and the NQF-endorsed measures provide a framework to do this in a standardized way that may be similar to what CMS will require.

"Be proactive with these measures—don't wait until the last minute to learn what they entail," said Becky Small, RN, CNOR, who serves on the ASC QC. "These are quality outcomes that will let you look at numbers to determine if you need to improve quality processes."

"Implementing a culture of quality monitoring is critical, and it's my experience that ASCs are already doing this," acknowledged David Shapiro, MD, also co-chair of the ASC Quality Collaboration. "These NQF-endorsed ASC quality measures are just the next step in an evolutionary process that will allow for standardized quality measurement in ASCs, which ultimately means improved care for our patients."

Additional Resources