Use of Triggers to Detect Adverse Events After Outpatient Orthopedic Surgery at a Single Ambulatory Surgery Center

Orthopedics ◽  
2022 ◽  
pp. 1-6
Author(s):  
Daniel B. Calem ◽  
Dylan P. Horan ◽  
Matthew T. Taylor ◽  
Richard M. McEntee ◽  
David I. Pedowitz ◽  
...  
2020 ◽  
Vol 27 (6) ◽  
pp. 956-963 ◽  
Author(s):  
Samuel S. Ahn ◽  
Robert W. Tahara ◽  
Lauren E. Jones ◽  
Jeffrey G. Carr ◽  
John Blebea

Purpose To present a new outcomes-based registry to collect data on outpatient endovascular interventions, a relatively new site of service without adequate historical data to assess best clinical practices. Quality data collection with subsequent outcomes analysis, benchmarking, and direct feedback is necessary to achieve optimal care. Materials and Methods The Outpatient Endovascular and Interventional Society (OEIS) established the OEIS National Registry in 2017 to collect data on safety, efficacy, and quality of care for outpatient endovascular interventions. Since then, it has grown to include a peripheral artery disease (PAD) module with plans to expand to include cardiac, venous, dialysis access, and other procedures in future modules. As a Qualified Clinical Data Registry approved by the Centers for Medicare and Medicaid Services, this application also supports new quality measure development under the Quality Payment Program. All physicians operating in an office-based laboratory or ambulatory surgery center can use the Registry to analyze de-identified data and benchmark performance against national averages. Major adverse events were defined as death, stroke, myocardial infarction, acute onset of limb ischemia, index bypass graft or treated segment thrombosis, and/or need for urgent/emergent vascular surgery. Results Since Registry inception in 2017, 251 participating physicians from 64 centers located in 18 states have participated. The current database includes 18,134 peripheral endovascular interventions performed in 12,403 PAD patients (mean age 72.3±10.2 years; 60.1% men) between January 2017 and January 2020. Cases were performed primarily in an office-based laboratory (85.1%) or ambulatory surgery center setting (10.4%). Most frequently observed procedure indications from 16,086 preprocedure form submissions included claudication (59%), minor tissue loss (16%), rest pain (9%), acute limb ischemia (5%), and maintenance of patency (3%). Planned diagnostic procedures made up 12.2% of cases entered, with the remainder indicated as interventional procedures (87.6%). The hospital transfer rate was 0.62%, with 88 urgent/emergent transfers and 24 elective transfers. The overall complication rate for the Registry was 1.87% (n=338), and the rate of major adverse events was 0.51% (n=92). Thirty-day mortality was 0.03% (n=6). Conclusion This report describes the current structure, methodology, and preliminary results of OEIS National Registry, an outcomes-based registry designed to collect quality performance data with subsequent outcome analysis, benchmarking, and direct feedback to aid clinicians in providing optimal care.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Wesley D. Peters ◽  
Peter J. Adamson ◽  
Cory Janney ◽  
Vinod K. Panchbhavi

Category: Ankle; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: There is a growing trend to perform surgical procedures at freestanding ambulatory surgical centers. No literature exists evaluating the rate of adverse events and overall safety of foot and ankle outpatient surgeries at a freestanding ambulatory surgery center (ASC). Methods: A retrospective review of all foot and ankle cases performed over a two year period at a single freestanding ASC. A total of 313 cases were performed. Adverse events are state-reported events that cause harm or lead to additional treatment. Using state-reported adverse events criteria and previous literature from hand and upper-extremity cases, we categorized our adverse events into seven categories: 1) infection requiring intravenous abx or return to the operating room, 2) postoperative transfer to a hospital, 3) wrong-site surgery, 4) retention of a foreign object, 5) postoperative symptomatic thromboembolism (DVT), 6) medication error, and 7) bleeding complications. Results: The overall rate of adverse events was 3.5% with 11 events identified over the two year period. There were a total of 10 infections and 1 symptomatic DVT. There were no cases that resulted in transfer to a hospital, hospital admission after discharge, medication error, bleeding complications, wrong-site procedures, or retained foreign bodies. Conclusion: Outpatient foot and ankle procedures are not without complications, but the overall rate of complications postoperatively is farly low (3.5%). Overall, foot and ankle surgeries can be performed safely in an outpatient setting at an ASC.


1995 ◽  
Vol 112 (5) ◽  
pp. P76-P76
Author(s):  
Charles R. Taylor

Educational objective: To establish an ambulatory surgery center for an ENT practice.


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