The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review

Abstract

BackgroundOver recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes—for any procedure—is unclear.Methods and findingsWe conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions.ConclusionsMore and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.

Miscarriage Treatment–Related Morbidities and Adverse Events in Hospitals, Ambulatory Surgery Centers, and Office-Based Settings

“…ASCs and office-based settings. 11,12 Our estimates of miscarriage treatment-related events, including the more than 6% retained products of conception, are in the range of other estimates. [24][25][26][27][28][29][30][31] The rates of miscarriage treatment-related events are notably higher than published rates of abortion-related events.…”

“…9,10 A small body of research has compared safety of different procedures across ASCs and office-based settings and has not found consistent differences. 11,12 Research on safety of miscarriage treatment across facility types has been done primarily with small samples 5 and has not directly compared safety in two outpatient settings -ASCs v. office-based settings. The ASC vs.…”

Association of Facility Type With Procedural-Related Morbidities and Adverse Events Among Patients Undergoing Induced Abortions

“…The QIC indicated that the exchangeable correlation structure was a better fit for the data than the independent correlation structure (QIC of 307274.59 for exchangeable v. 307277.23 for independent). In adjusted analyses, there were not significant differences in abortion-related events (the primary outcome) [aOR 0.97, 95% CI 0.81 -1.17, adjusted incidence rate 3.25% v. 3.33%, adjusted difference -0.08%, 95% CI -0.58% -0.43%] between ASCs and office-based settings [See Table 3 Table 3] There were no substantive differences in the sensitivity analyses using different definitions of abortion-related morbidities and adverse events and 24 This study reinforced that there are low rates of abortion-related morbidities and adverse events after abortion, with major events occurring in only one-third of one percent of cases. This study also confirmed that there are low rates of abortion-related morbidities and adverse events in both ASCs and office-based settings.…”

Admitting privileges and hospital‐based care after presenting for abortion: A retrospective case series

“…There is limited evidence about the impact of hospital admitting privileges on patient safety for procedures in outpatient settings in general and for abortion patients specifically . This is because adverse events from abortion are rare and large detailed datasets are required to make quantitative estimates.…”

“…1 There is limited evidence about the impact of hospital admitting privileges on patient safety for procedures in outpatient settings in general and for abortion patients specifically. 9 This is because adverse events from abortion are rare 5 and large detailed datasets are required to make quantitative estimates. The few studies that have examined hospital admitting privileges in relation to patient safety have used reports of adverse events from office-based surgery procedures and lack consistent denominators.…”