which might indicate a problem. Later in the process, internal benchmarking helps you track performance over time. For example, you might use a chart or a graph to record the number of cases cancelled in pre-op. These cancellations can be a problem for you because they disrupt your schedule and affect your patients, the responsible adult compan- ions who accompany patients to your ASC on the day of surgery, those who provide care for your patients once they return home and a host of other process activities. Your own data might indicate a change in cancellations week to week or month to month and show consistent- ly higher cancellations than you desire. Do these cancellations occur more fre- quently with particular surgeons or spe- cialties? Were cancellations due to pa- tients who did not follow preoperative instructions, failed to arrive on time or failed to be accompanied by a respon- sible adult companion? Once you col- lect the data, you can more thoroughly determine what actions you can take to reduce cancellations. How do you know that you have done as much as you can to reduce cancella- tions? Do other ASCs have this prob- lem? How much of a problem is it for your ASC when compared to others? Are you about the same? Better? Worse? That is where external benchmark- ing can provide information to help you decide what to target as a QAPI activity, and once that decision is made, what to set as a reasonable goal for improve- ment. The example of cases cancelled provided above is one data element in ASCA Benchmarking. The external benchmarking source helps you under- stand how much room for improvement you have or how good you can expect to get on a particular measurement be- cause you can see how others performed on the measure. Another example might come to your attention through a staff comment or an adverse event. Vitrectomy is a known complication of cataract surgery, but how often does
Knowing where you stand on certain key
performance indicators (KPIs) can help you dedicate your resources to improving performance and outcomes and demonstrate your results.”
— Sandra J. Jones, CASC Ambulatory Strategies Inc.
it occur at your surgery center? How often does it occur per 1,000 cataract surgeries in any location in the US or abroad? Reports from specialty groups conducting research on complications are available on vitrectomies and other cataract surgery complications. Other specialty groups, such as gastroenter- ology, anesthesiology, orthopedic sur- gery and ear, nose and throat (ENT) also publish reports or journal articles that contain valuable data that will help you compare processes and per- formance to others. In internal benchmarking, some pro-
cesses, such as performing a time out, will
require 100 percent compliance,
while others might never reach 100 per- cent. Consult external benchmarks to help you pinpoint a reasonable goal, such as 87 percent compliance on hand hygiene.
Sources for External Benchmarks You might need to consult several sourc- es before you find the right external benchmark for you. And, the more detail that you can get about the measurement, the better. Are you measuring the same
thing in the same way? Specialty web sites and journals contain research re- ports that can help you get the informa- tion you need. The Centers for Disease Control and Prevention (CDC) reports statistical findings on various topics, as do the Association of PeriOperative Registered Nurses (AORN) and the As- sociation for Professionals in Infection Control and Epidemiology (APIC). You will want to learn the precise definition of any measure you see in these reports to determine if it matches what you in- tend to measure.
ASCs that are part of corporations
might have ready access to benchmarks from their sister ASCs, but freestanding centers also can get statistics by teaming up with similar facilities. At our surgery centers, we have reviewed supply use and cost by CPT code for some high volume surgical procedures such as knee arthroscopy or tonsillectomy and ad- enoidectomy (T&A), comparing center to center and doctor to doctor. Currently, we are working with several orthopedic surgery centers to share data on the in- terval between start of anesthesia and cut time for shoulder cases since this inter- val impacts patient safety, cost and the scheduling of staff and cases.
Act on the Results A lot of centers simply collect data and benchmarks and never take the next step of evaluating the information to deter- mine if there is an opportunity to im- prove, and, if so, take action. Even fairly modest variations might
deserve action. For example, if your in- fection rate is 1.5 percent per 1,000 cas- es versus an external benchmark show- ing 1 percent, this variance indicates an opportunity for improvement. The next step will be determining what exactly is causing the higher rate. Share your data with members of your governing board. Ask them for suggestions on additional data to collect or areas to research. In- volve them in reviewing your findings and discussing an action plan. It is im-
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