While a recent article questioned the safety of ambulatory surgery centers (ASC), studies have shown that outpatient surgery centers generally are as safe as hospitals for many procedures. This is particularly true in California, due in part to the work of the Institute for Medical Quality (IMQ).
In 1996, California enacted requirements to protect individuals who undergo surgical procedures in outpatient surgery settings. First and foremost, these statutes require that any outpatient setting where anesthesia is used that is likely to cause loss of life-preserving protective reflexes be licensed by the state, accredited by an approved accrediting organization or certified for Medicare.
This means that any individual having a procedure performed in one of these facilities is assured a basic standard of care. Accreditation and Medicare certification standards can and do go beyond the basic requirements of California law to ensure quality care. These standards include assessing such systems as quality; infection control; practitioner credentialing, proctoring and peer review; personnel training and competency; medical records; equipment maintenance; medication management; and perioperative surgery, including patient selection, anesthesia risk assessment, monitoring, recovery, and discharge.
Further requirements mandate that the facility have a minimum number of appropriately trained individuals on site at any time there is a patient in the facility, and that these individuals have and are trained to use necessary emergency equipment.
In the past five years, according to the article, ASCs have 260 deaths on record, nationally. According to the Ambulatory Surgery Center Association, the number of procedures performed in the same timeframe, exceeds 200 million. In fact, health outcomes in ASCs either match or exceed that of hospitals.
Indeed, California regulations require a prompt review of any incident, both by the facility staff and by the accrediting agency, to determine if the facility and its staff are complying with accrediting standards of safety and quality. This also includes reviews of any transfers to an acute care hospital for patients that are admitted.
Accreditation certificates must also be posted in a manner visible to the public along with information about how to contact the accrediting organization. The law states that the accreditation report is a public document, available to any individual. This provides a layer of transparency for any potential patient who is contemplating having a procedure performed in that facility. The Medical Board of California website is available to members of the public who want to know more about the individual performing their procedure.
Review by an accrediting body is performed on initial application and at least every three years thereafter. The time interval for repeat review of an outpatient facility is the same as that mandated for a hospital setting.
Outpatient surgery settings (ambulatory surgery centers and office-based surgery facilities) are vital to the health care system. The clinicians who work in ASCs throughout the country work under regulations just as those who work in hospitals. Statutory protections that exist for patients in California ASCs, as noted above, are stringent.
Many physicians choose to practice in ASCs to benefit their patients. ASCs generally have lower infection rates and are less expensive than hospital care.
California has made strong efforts to protect the public and provide safe venues for outpatient surgery. IMQ is very proud to be an import part of this effort.
IMQ’s mission has always been to improve the quality of care for the people of California and beyond. Through the survey process, IMQ utilizes education, counseling, and direct involvement of practicing physicians to ensure this mission is fulfilled.
For more information about IMQ’s Ambulatory Accreditation Program, visit www.imq.org
Neal H. Shorstein, M.D., is chair of the IMQ Ambulatory Care Review Committee; Mindel Spiegel, M.D., is also a member of the committee.