A new way to effectively track patient safety in the outpatient setting

In recent years, outpatient procedure growth in the United States has been astronomical. For many hospitals and health systems, this growth in the number of outpatient procedures has occurred while the number of inpatient surgeries has either been flat or declined.

Despite these trends, safety in the ambulatory setting has been a blind spot for many quality teams. During a recent Becker's Hospital Review webinar sponsored by 3M Health Information Systems, three experts on outpatient safety discussed how a new methodology can be used to monitor, measure and improve patient safety:

  • Danielle Bowen Scheurer, MD, chief quality officer, Medical University of South Carolina (MUSC) in Charleston, S.C.
  • Sandeep Wadhwa, MD, global chief medical officer, 3M Health Information Systems
  • Miki Patterson, PhD, NP, product owner, 3M Health Information Systems 

Five key takeaways from the discussion:

  1. National quality rankings have traditionally focused on the inpatient setting. Many quality metrics concentrate on potentially preventable complications in the inpatient environment, such as hospital-acquired infections. Yet, the majority of care today is delivered outside the walls of the hospital. "These are important reasons to understand the patient experience in the ambulatory space," Dr. Bowen Scheurer said. "We must encourage rankings to get into the business of ambulatory complications."

  1. 3MTM Ambulatory Potentially Preventable Complications (AM-PPCs) grouping software is shedding new light on outpatient procedures. Developed to address patient safety and quality oversight gaps for procedures performed in hospital outpatient departments or ASCs, 3M’s new methodology system brings a safety lens to the outpatient care setting and helps measure outcomes in an area that previously lacked transparency.

    3M AM-PPCs software analyzes 2,900 procedures and 1,500 complications to surface potentially preventable complications directly or plausibly related to a procedure. "The definition of an ambulatory potentially preventable complication is a harmful event like sepsis, infection or bleeding after an elective procedure that's performed in an ambulatory care setting," Patterson said.

  1. Actionable data can be used to support safer outpatient procedures. With 3M AM-PPCs, organizations can analyze data by service line, identify opportunities and develop action plans aimed at improving quality outcomes. As an example, the top orthopedic procedure performed in the hospital outpatient setting is total knee arthroplasty, which has a 2.8 percent complication rate per 3M AM-PPC analysis. "Many of these patients return to the emergency room or hospital for anemia, but the surgeons may never find out about it,” Dr. Patterson said. “If we know that patients are coming in after a procedure with anemia, a UTI or another infection, we can examine all of our processes. We can also look at patients pre-operatively and proactively evaluate what medications they're taking. If patients are educated preoperatively about different symptoms to look for, they can call the office sooner — before complications become more serious."

  1. MUSC has woven 3M AM-PPCs into its safety infrastructure. To ensure that patients receive appropriate care across the complete spectrum of care settings, MUSC implemented Integrated Centers of Clinical Excellence (ICCE) into its service lines. Each ICCE has a quality safety manager or director who conducts data analysis and works closely with other ICCE leaders and operational partners. "They think about care in a longitudinal way, not just in isolated areas," Dr. Bowen Scheurer said. "Now they are craving more ambulatory data."

    MUSC quality leaders partner with the ICCEs so these clinical leaders understand how complications are related to outpatient procedures. Working together, the quality and clinical leaders ensure that teams are following processes to prevent complications, like medication reconciliation and chlorhexidine gluconate bathing. "We review KPIs every week, identify barriers to success and escalate those through the quality team,” Dr. Bowen Scheurer said. “By revising workflows and standard operating procedures, and incentivizing teams for success, we are weaving ambulatory potentially preventable complications into our existing infrastructure and closing gaps."

  1. Ambulatory procedure safety data can empower patients and revolutionize value-based care. Payers, patients and ranking systems all have a vested interest in ambulatory safety. "Many times, when patients are deciding where to go for a procedure, they rely on word of mouth,” Dr. Wadhwa said. “Objective data, however, can lead to better decision-making. We're pleased that US. News & World Report recently announced that it will incorporate 3M AM-PPCs software into the analysis of this year’s Best Hospitals Specialty rankings for orthopedics and urology."

    Dr. Wadhwa also believes that 3M AM-PPC data will play an important role in value-based contracts. Payers will be able to evaluate which providers to include in a narrow network. Health systems will also be able to negotiate from a stronger position. "Knowing your total cost of care and how you are performing on potentially preventable events can transform your negotiation position in these increasingly downside risk relationships," Dr. Wadhwa said. "Having insight into your performance relative to others will become very important."

To learn more about 3M AM-PPCs, click here.

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