Benchmarking sounds simple: You compare data and processes from one organization with data and processes from similar organizations. It can help you determine where your facility stands in relation to its peers, find weaknesses and cull ways to improve. But many facilities find it difficult to collect data consistently and find a relevant peer group to which to compare results. In this article, we'll examine three benchmarking systems successfully implemented by three facilities.

Surgical Outcomes Information Exchange (SOIX)
We've built an additional internal quality-improvement program.
    Vicki Parada, RN

We started using the Surgical Outcomes Information Ex-change (SOIX) system in 2000 to fulfill a Joint Commission requirement that we start benchmarking. Now, we've tailored the SOIX system to our facility and used it to build an internal quality-improvement program. Here's what we did.

We collect monthly the medical records and the post-procedure phone call notes from our highest-volume procedures, organized by CPT code. The Web-based SOIX system includes pre-set indicators for each code; for example, the indicators for cataract surgery include length of surgery and incidence of post-op complications. The areas for data entry on the Web site are highlighted, making numbers easy to input.

We submit our data online, and SOIX averages the data with that from 100 freestanding surgery centers that are also members. They then generate reports showing how our facility stacks up. We can access our reports via the Web with a code, and SOIX sends us quarterly written reports that we give to our administration.

When we first started using SOIX, we entered data on every procedure, which was very time consuming. SOIX suggested we enter 20 percent of our highest-volume procedures - about 650 cases a month in GI, orthopedics, ophthalmology and urology (130 cases for each CPT code). If we enter less than 20 percent of any code, SOIX will compile our numbers but won't compare them.

This can still be useful. When we wanted to see how our pain management methods for certain orthopedic procedures were working, for example, we came up with several indicators in addition to the ones SOIX already had for those CPT codes. Instead of benchmarking this data against other facilities, SOIX tabulated it for us, allowing us to track our progress.

Even if your benchmarking system isn't SOIX, I suggest that you ensure a clinical person (preferably an RN) enters the data and that you use the system at least six months before deciding whether to keep it. A nurse can analyze the op reports and enters data with a more critical eye and a sense of what the facility hopes to learn in the report. It took us about six months to determine what data we wanted to enter and how to make the reports most relevant to our facility.

Potential users of SOIX should be aware they won't be able to collect data from procedures not on SOIX's CPT code list (i.e. strabismus surgery and certain pain management procedures). But overall, SOIX has been invaluable for benchmarking, and the company has been helpful in the installation and modification of the system to fit our facility's needs.

Ms. Parada is the quality assurance representative at the Monroeville Surgery Center in Pittsburgh, Pa.

FASA Outcomes Monitoring Project
Benchmarking data against about 300 licensed freestanding facilities.
    Dawn McLane, RN

Our freestanding, physician-owned, multispecialty facility performs about 9,000 cases a year, and one of our biggest challenges is benchmarking. We've used several benchmarking systems, but the FASA Outcomes Monitoring Project (OMP) has been by far the most valuable.

Before we started using OMP, we collected data on many clinical performance indicators, including transfers to the hospital, infection rate, patient satisfaction and physician satisfaction. FASA offers benchmarking data on 22 of the same indicators. Further-more, FASA has the most surgery centers to benchmark data against: about 300 licensed freestanding facilities, some of which are like ours.

OMP is closely integrated with our information system. We collect data daily for each case with the Source Medical (SIS) system. To submit data to FASA, we simply run reports on each of the 22 indicators and use them to fill out the written OMP surveys. We submit data and get written reports from FASA quarterly.

FASA and Source Medical are improving the system, and soon, we'll be able to click on a desktop icon and run the re-ports for each indicator instead of running them separately.

I've learned to ask if what I'm seeing makes sense. For example, when we first started using the OMP, we discovered that our rates for post-discharge complications and infections were above the FASA benchmark. We discovered we had sometimes duplicated information from the patient and the physician, and patients sometimes reported non-surgical site infections. We modified our procedure and found we were below FASA benchmarks.

I hope that FASA will expand the financial benchmarks to include AR days, medical supply cost per case and personnel cost per case. But the OMP has been invaluable for quality improvement, as a report card and for helping us meet requirements for state licensure, Medicare certification and AAAHC accreditation.

Ms. McLane is the executive director of the Allied Physician's Surgery Center, LLC, in South Bend, Ind.

Everyday Giving Excellence (EDGE)
Data anytime on 14 indicators with 12 to 14 actions each.
    Ouida Klock, RN

Our facility is a limited partnership that joined Johnson City's two competitive orthopedic practices, the local hospital system and United Surgical Partners International (USPI) in a three-way joint venture. One of the biggest benefits of the USPI network is the use of the network's benchmarking system, Everyday Giving Excellence (EDGE). We've been using EDGE since it became available on the Web about two years ago. Here's how it works.

With EDGE, 14 benchmarking indicators are compiled for 56 facilities in the network. For each of these indicators, we collect data for 12 to 14 actions. For example, the wrong-site surgery benchmark includes asking the patient which extremity will be operated on and having a "surgical pause" in the OR. Fulfillment of these actions is marked on an operative site verification form, which travels with the patient throughout surgery. We enter data from the operative verification forms into EDGE input screens monthly. EDGE tabulates the data and benchmarks it against other facilities in the network.

EDGE is convenient: We can go to the Web site and see data anytime. Nurses or business of-fice staff enter data, depending on the indicator. USPI is working on ways to add indicators to customize reports. EDGE has improved our safety practices, such as OR site verification, and it has helped us fulfill our quality-improvement and benchmarking requirements for JCAHO accreditation.

Ms. Klock is the administrator of the Mountain Empire Surgery Center in Johnson City, Tenn.