Benchmarking your ASC's transfer rates and examining data that explains why patients are transferred can help lower rates and increase the number of cases that stay in your surgery center. David Kelly, administrator of Samaritan North Surgery Center in Dayton, Ohio, discusses six steps his ASC took to benchmark transfer rates and improve flawed processes that led to frequent transfers.
1. Benchmark transfer rates against other centers once a month. According to Mr. Kelly, ASC committees should examine benchmarking data once a month in order to spot damaging trends. One month of troubling statistics may not necessitate changes, but three months should raise a red flag. In the case of transfer rates, his center's patient care committee saw that "month after month after month, out of all the centers, our transfer rates were the highest," he says. "The ASC Association benchmark for transfer rates is less than one per month, and ours was 3.3."
2. Look at data on why cases are transferred. If your center discovers a trend in high transfer rates, Mr. Kelly recommends examining data to determine why cases are transferring. At Samaritan North Surgery Center, the patient care committee looked at data on the patients most frequently transferred and found that smokers and patients with obesity, sleep apnea and chronic obstructive pulmonary disease made up the highest percentage of transfers.
3. Compare transfer rates to ASA scores. According to Mr. Kelly, his center found that high transfer rates correlated with high American Society of Anesthesiologists Physical Status scores. The ASA Physical Status classification system measures the fitness of patients prior to surgery, with "one" being a normal healthy patient and "six" being a brain-dead patient whose organs are being removed for donor purposes. Mr. Kelly found that the center's high ASA scores were significantly higher than the ASC benchmark [found where? If explained earlier, not necessary to explain again here], meaning the center was treating more acute patients. Sicker patients likely meant more transfers.
4. Examine the last year of transfers through different lenses. Once Mr. Kelly understood that his center treated a higher percentage of sick patients than the average ASC, his committee decided to look more closely at transfer data based on different categories. "We looked at transfers for the past year by surgeon, by anesthesia provider, by the nurses that cared for the patient, by how long the patient was in the PACU, by time of day in the PACU, by the patient's co-morbidities and by what kind of procedure it was," he says.
By examining this data, he says his center discovered several surprising trends. The staff had expected more cases to be transferred on Thursdays and Fridays, but the data showed more Monday transfers than any other day. Similarly, the staff expected shoulder surgeries to prompt the most transfers, when in fact urology cases were the highest.
5. Review and change your processes. Once the ASC's staff members understood the reasons behind high transfer rates, they began to alter processes to lower the rates. "We decided to be more diligent in the pre-admission testing process, and we expanded our interview questions to include more questions about lung issues," he says. Because late afternoon cases represented a high number of transfers, the staff decided to schedule cases with a high potential for transfer in the morning, to allow the patient a longer time to recover.
The committee also discovered that the ASC's PACU monitors showed a different O2 saturation level than the portable monitors. The discrepancy in those readings meant the center could do another study to determine why the difference existed and ensure that O2 readings were accurate.
6. Examine the impact of high transfer rates on other issues. Mr. Kelly says that benchmarking is important because often one issue will uncover "10 more issues" to be addressed. For example, since Mr. Kelly's ASC keeps patients overnight, the center benchmarks the number of patients that stay overnight and the profitability of overnight cases every month. The center decided to address high transfer rates by keeping some of those patients overnight, which increased overnight stays and physician satisfaction.
The committee also discovered during data examination that the center was waiting too long to transfer cases once they knew the patient would need an additional level of care. "Things weren't necessarily going to get better, but we were keeping them in the PACU forever and then making the decision to transfer," Mr. Kelly says. "That kept our employees staying later into the evening." By understanding how delayed transfers affected overtime, the ASC could be vigilant about identifying patients needing a transfer and completing the transfer quickly.
Read more about benchmarking:
-Critical ASC Mistake: Benchmarking Externally But Not Internally
-Critical ASC Mistake: Benchmarking Against Dissimilar Facilities