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Improving quality of care at ASCs is the goal of the new patient safety program, a joint venture between the AAOS and the HRET.
Courtesy of Brandon McQueen\iStock\Thinkstock

AAOS Now

Published 7/1/2014
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Howard Mevis

AAOS Participating in ASC Quality Improvement Program

The AAOS is working with the Health Research and Educational Trust (HRET) of the American Hospital Association to undertake a special 1-year program designed to improve quality of care at ambulatory surgery centers (ASCs). The pilot program focuses on improving patient safety and reducing postoperative infections to zero. The Agency for Healthcare Research and Quality (AHRQ) is funding the program.

“Participating in this program aligns with other AAOS patient safety programs. We see synergies between our work with TeamSTEPPS training to improve communications in the operating room (OR) and this program on patient safety,” noted project leader Dwight W. Burney III, MD. William J. Robb III, MD, chair of the AAOS Patient Safety Committee, and Paul Levin, MD, are working with Dr. Burney on the project.

To qualify for the program, at least 4,000 surgeries must be performed at the ASC annually. The case mix must include arthroscopy, arthroplasty, and other open procedures. The ASC must be owned or co-owned by an orthopaedic surgeon or a practice group.

The year-long, voluntary program begins Sept. 8, 2014; 9 to 12 ASC participants will be selected by July 31.

According to Dr. Burney, the project will have three phases. “Phase 1 includes selection, orientation, and initial data gathering. Phase 2 is an educational program developed by HRET, in collaboration with the Harvard School of Public Health (HSPH). Phase 3 is a 6-month implementation and data gathering period for the sites.”

During phase 3, Drs. Burney, Levin, and Robb will be advising the study sites on quality improvement and team building. The activity culminates with final data reporting.

Data reporting
Each participating site will complete several data reporting activities. “We begin with a survey to determine the safety culture in the ASC. All ASC staff complete the same survey at the end of the program to compare attitudinal changes,” noted Mital Mehta, RN, BSN, MBA, the national project coordinator at HRET. Using a specially prepared survey tool developed by HRET, the participating sites will collect benchmark and ongoing data on items such as the following:

  • wrong side, site, patient, procedure, implant
  • hospital transfer/admission
  • hospitalization or emergency department visit within 48 hours of discharge from the ASC
  • reoperation within 48 hours of discharge from the ASC
  • surgical site infection (SSI)
  • other infections (non-SSI)

Data will be collected on more than 30 orthopaedic procedures identified by HRET as being performed in ASCs. The procedures range from arthroscopy (knee, shoulder, ankle, and wrist) and arthroplasty to selected fracture fixation procedures and repair of other soft-tissue injuries, such as ganglion cyst removal and carpal tunnel release.

Educational program
The education program developed by HRET and HSPH for the pilot project includes sessions for orthopaedic surgeons, anesthesiology staff, nurses, physician assistants, and others working in patient care.

“We use the webinar format to teach each topic,” said Ms. Mehta. She identified the following educational programs for the participating ASCs:

  • data collection measures
  • infection prevention techniques leading to zero harm
  • ASC cleaning, disinfection, and sterilization
  • sterile processing
  • using and personalizing the preoperative and OR checklist
  • building a team, communicating, and coaching
  • observation

Dr. Burney would like each of the participating ASCs to complete one or more TeamSTEPPS workshops at the beginning of the program to improve communication in the OR. “We want OR staff to recognize the importance of speaking up when they see the potential for an error,” he said.

Getting under way
“We are pleased to be a national partner with HRET on this AHRQ safety program for ambulatory care,” said Dr. Robb. “About 10 other organizations are involved in the program, but the AAOS is the only surgical specialty society. Orthopaedic surgeons are being asked to take leadership roles in teamwork and team communication to improve the patient safety culture in their practices, hospitals, and, with this program, ASCs, too.”

If the pilot cohort of orthopaedic ASCs proves successful, AAOS and HRET will determine if a larger, second cohort might be undertaken beginning in late 2015.

Howard Mevis is director of the AAOS department of electronic media, evaluation programs, course operations, and practice management. He can be reached at mevis@aaos.org