Hospital-based, acute care after ambulatory surgery center discharge

Abstract

Background As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. However, this may underestimate patient’s acute care needs after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Methods Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or surgical procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. Results We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1/1,000 discharges (95% CI, 1.1–1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8/1,000 discharges (95% CI, 31.6–32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median=1.0/1,000 discharges [25th–75th percentile=1.0–2.0]), while substantial variation existed in adjusted hospital-based, acute care rates (28.0/1,000 [21.0–39.0]). Conclusions Among adult patients undergoing ambulatory surgery center care, hospital transfer at discharge is a rare event. In contrast, the hospital-based, acute care rate is nearly 30-fold higher, varies across centers, and may be a more meaningful measure for discriminating quality.

Factors Associated with Hospital Admission after Outpatient Surgery in the Veterans Health Administration

“…; Fox et al. ). In recognition of these studies, the CMS postoperative 0‐ to 7‐day admission measure was explicitly designed to “improve transparency, inform patients and providers, and foster quality improvement” (CMS ).…”

“…; Fox et al. ; CMS ). While this rate is lower than inpatient surgical readmissions in the VA (Rosen et al.…”

Thirty-Day Acute Health Care Resource Utilization Following Outpatient Anterior Cruciate Ligament Surgery

“…Although the Centers for Medicare & Medicaid Services (CMS) requires outpatient surgery facilities to report any hospital transfer event, 1 this requirement is limited and may fail to capture the majority of adverse outcomes following discharge after the initial surgery. [2][3][4] Beginning in 2018, CMS 1 announced that the 7-day risk-standardized hospital visit rate following outpatient colonoscopy will be used for reimbursement payment. This quality-of-care metric will be expanded to other common surgical procedures in the future to fulfill CMS's pledge to tie payments for medical care to quality.…”

Outpatient surgical practices in otorhinolaryngology

“…Ancak kurumumuzda gerçekleştirilen günübirlik cerrahi girişimlerin tüm cerrahi girişimlere oranı literatür bilgileri ile karşılaştırıldığında belirgin olarak düşük seyretmektedir. [18][19][20] Bunun en önemli nedeni ülkemizdeki sağlıkla ilgili düzenlemelerin günübirlik cerrahiyi teşvik edici olmamasıdır. Oysa günübirlik cerrahi uygulamaların artışı ile toplumsal sağlık harcamalarının birçok basamağında azalma sağlanırken, hasta memnuniyeti de artırılabilir.…”

“…[21,22] Günübirlik cerrahi olarak planlamasına karşın, çeşitli neden ya da komplikasyonlar nedeniyle cerrahi uygulama sonrası aynı gün ya da izleyen günlerde hastaneye yatış gerekebilir. Fox ve ark.nın [19] çalışmasında, günübirlik cerrahi sonrası ortalama hastaneye yatış oranı binde 1.1 olarak saptanırken, hastaneye beklenmeyen başvurunun ise binde 21 ile 39 arasında değiştiği belirlenmiştir. Branşımız ile ilgili bir başka çalışmada ise günübirlik cerrahi sonrası 1106 hastadan 74'ünün (%0.7) hastaneye yatırılması gerekmiş ve en sık yatış gerektiren cerrahi girişimler sırasıyla, boyun biyopsisi, fonksiyonel endoskopik sinüs cerrahisi ve panendoskopi olarak öne çıkmıştır.…”