Abstract
BackgroundOver recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes—for any procedure—is unclear.Methods and findingsWe conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions.ConclusionsMore and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.
Highlights
The Institute of Medicine’s seminal reports, To Err is Human (1999) and Crossing the Quality Chasm (2002) brought national attention to concerns about patient safety in the health care system and led to efforts to study and improve safety across health care facility settings, primarily in hospitals [1, 2]
More and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability
No significant difference for Ambulatory Health Care (AAAHC) accredited vs. non-accredited ambulatory surgery centers (ASCs)
Summary
As of 2006, an estimated 53 million surgical and nonsurgical procedures were performed annually on an outpatient basis [3] This migration of care raised important questions about patient safety and has led to efforts to study and improve patient experience in non-hospital health care settings as well. There has been increased attention to patient experience and outcomes in outpatient settings by academic researchers, professional associations, state legislatures, payors and private accrediting organizations. The question of differential risk by outpatient setting has primarily been raised within the field of cosmetic/plastic surgery, following public concerns about patient safety in offices in the 1990s and subsequent efforts to address concerns through state office-based surgery laws, facility accreditation, mandated reporting of adverse events, and quality improvement activities. The extent to which facility requirements have an impact on patient outcomes—for any procedure—is unclear
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
