Among Rebounding Caseloads , Ambulatory Surgery Centers Continue to Champion Patient Safety and Quality
By Kelly M . Pyrek
Diverse experiences during the COVID-19 pandemic have led ambulatory surgery centers ( ASCs ) to continue to message to patients that they are continuing to navigate the challenges and striving to provide the best outcomes as the country emerges from the pandemic and contemplates how this public health crisis shapes all aspects – clinical , fiscal and supply chain – of healthcare delivery .
Lessons learned from the pandemic in ASCs often mirror those in acute-care settings .
“ Not every ASC had the same experience ,” emphasizes Terri Link , MPH , BSN , CNOR , CIC , CAIP , FAPIC , ambulatory education specialist with the Association of periOperative Registered Nurses ( AORN ). “ Some never closed , some continued to do elective surgery . COVID-19 brought to light that facilities are not prepared for emergency management , because emergencies went to the hospital setting and their involvement in disasters in some instances only includes staff moving to the hospital setting or a shelter for the community . Going forward , emergency preparedness that includes infectious disease outbreaks and pandemics will be part of their emergency preparedness plan along with other mass casualty events . ASCs are required to have an infection preventionist ( IP ) per CMS conditions of coverage , so one is in place , but I see a more concentrated focus on this position and their role in emergency preparedness . Facilities have learned what their vulnerabilities are , whether it is supply management , PPE , or their role in elective and urgent surgery when inpatient ORs are on hold . Some ASCs shared staff , including anesthesia providers tasked to be on intubation teams in the hospital setting . Some shared PPE , equipment early in the crisis . Using those identified vulnerabilities and performing a risk assessment that is specific to the facilities will be important .”
Pandemic-Driven Challenges in ASCs
An ASCA survey revealed that increased cancellations were just one of many difficulties that ASCs faced in 2020 . As Taira ( 2021 ) explains , “ Responses to ( ASCA ’ s ) 60-Second Survey also showed a majority of facilities experienced difficulty maintaining staffing , navigating changing regulatory requirements and acquiring personal protective equipment ( PPE ). In a previous survey from ASCA , the majority of respondents — 87.3 percent — reported ‘ some ’ to ‘ significant ’ issues with acquiring PPE , including having to pay more than normal to purchase . Despite these challenges , in past ASCA surveys facilities reported 100 percent compliance with universal masking and 98.1 percent compliance with social distancing and pre-operative patient screenings per recommendations from the Centers for Disease Control and Prevention ( CDC ).”
Despite the cancellation of non-emergency surgeries in acute-care hospitals as the COVID-19 pandemic ramped up , ASCs continued to perform essential outpatient surgeries safely , say advocates of this segment . A survey of more than 700 ASCs late last year confirmed those reports .
The survey , developed and conducted by the ASC Quality Collaboration ( ASC QC ), queried 709 ASCs in eight states Connecticut , Illinois , Louisiana , Massachusetts , Michigan , New Jersey , New York , Pennsylvania ) in March and April 2020 , reflecting cases of 84,446 patients . Only 16 of those patients tested positive for COVID-19 within 14 days after their procedures , an infinitesimally small infection rate of just 0.02 percent , noted the ASC QC , an independent , nonprofit organization established by leaders in the ASC community , accreditation organizations and professional associations to develop meaningful quality measures for ASCs . The survey also showed that only two of the 16 infected patients required hospitalization , primarily for respiratory issues , and no patients experienced cardiac issues , blood clotting or kidney failure . The survey included ASCs in three states — New York , New Jersey , and Louisiana — that were experiencing high rates of COVID-19 infection in the general population at the time .
“ COVID-19 has obviously affected all ASCs profoundly over the last year ,” confirms Kathy Wilson , RN , MHA , executive director of the ASC QC . “ The learning from this experience continues . ASCs throughout the country have worked diligently to comply with CDC as well as state and local guidelines and to adapt quickly as changes were made to those guidelines .”
Although infection rates in ASCs have traditionally been low , the pandemic underscored the need for ongoing vigilance against transmission of disease and the constant pursuit of quality improvement .
“ ASCs have always made infection prevention a high priority , but the COVID-19 pandemic allowed ASCs to demonstrate that the rigorous standards they already have in place are effective ,” emphasizes Bill Prentice , chief executive officer of the Ambulatory Surgery Center Association ( ASCA ). “ Two surveys — one conducted by the ASC Quality Collaboration and the other by ASCA — show that the number of patients who contracted COVID-19 after having surgery in an ASC during the pandemic was extremely small . Although neither survey attempted to
www . healthcarehygienemagazine . com • july 2021
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