Comparing quality at an ambulatory surgery center and a hospital-based facility: preliminary findings.
OBJECTIVE
To measure the quality of outpatient surgery in an ambulatory surgery center (ASC) compared to a hospital-based facility (HBF) in a multidimensional manner.


METHODS
Cross-sectional survey based on chart review.


METHODS
Pediatric academic health center.


METHODS
A total of 486 cases were reviewed. Procedures were performed at either an ASC (n = 275) or an HBF (n = 211). Cases comprised four procedure types: ventilation tube insertion (ASC, n = 126; HBF, n = 108), dental rehabilitation (ASC, n = 89; HBF, n = 58), adenotonsillectomy (ASC, n = 37; HBF, n = 34), and ventilation tube insertion/adenoidectomy (ASC, n = 23; HBF, n = 11). Measures were developed for five categories: safety, patient-centeredness, timeliness, efficiency, and equitability. Performance was compared between facilities.


RESULTS
The ASC had no unexpected safety events (0/275) compared to nine events (9/211) at the HBF. Tonsil bleed rates were 0 percent (0/37) at the ASC compared to 5.9 percent (2/34) at the HBF. Patient satisfaction was similar between facilities (ASC, n = 64; HBF, n = 35). Differences in timeliness approached 30 percent. A total of 77 percent of ASC cases finished within the scheduled time compared to 38 percent at the HBF. Total charges were 12 to 23 percent less at the ASC. Patients treated at the ASC generally lived in wealthier neighborhoods.


CONCLUSIONS
Performance at the ASC generally exceeded that at the HBF. Future research should investigate how perioperative processes result in these quality differences. Health policy implications are discussed.
Grisel
Jedidiah
J
Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45229, USA. griselj@ucmail.uc.edu
Arjmand
Ellis
E
D003430:Cross-Sectional Studies; D006801:Humans; D010036:Otolaryngology / Q000592:standards*; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D017060:Patient Satisfaction; D010372:Pediatrics / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D013531:Surgicenters / Q000592:standards*