Ambulatory Surgery Centers (ASC) are adept at hiding problems. Just try to find death rates, numbers of transfers to hospitals, organ punctures, and surgical procedures required to correct errors. Nope — you won’t find those crucial bits of data for public view. Here is a link to statistics collected for “internal” review: Quality Reporting Program.
As with most health care entities the public expression of “quality” is “certification” — which means an outside reviewer thinks the organization has the right programs and procedures so nothing stands in the way of quality care. Likewise, nothing usually stands in the way of a student getting an A+ on a test — but A+ is not always the grade. As Confucius says: “there are always greater and lesser”.
So, as a patient, what should you look for; what questions should you ask?
- Is the ASC certified? If not, find another ASC.
- How many patients does the surgeon treat at the ASC — expect at least 10 per week.
- How often does the surgeon do the procedure you need at the ASC — expect at least 10 per month.
- Will you be sedated? — if so, make sure an anesthesiologist or nurse anesthetist will be monitoring you while sedated — if not — find a different ASC.
- How close is a hospital if you have one of those serious complications listed in the consent-for-surgery form? If an ambulance would take more than 10 minutes to get you to the hospital consider another ASC.
- If you have severe heart or lung problems (like a history of congestive heart failure or COPD) consider having your procedure at a hospital rather than at an ASC.
- Ask if a pre-op check list, like the one the World Health Organization recommends, is used for all surgeries — if not, quality is a questionable. If the surgeons says they don’t need a check list find a different surgeon. Keep this in perspective — every airplane pilot must follow a pre-flight checklist, is your surgery any less important?
- The person that comes with you needs to write down what the surgeons says after the procedure. Patients who have been sedated, even if they seem fully awake, will have impaired memory for many hours. Have the person with you write down what was found at surgery — what is the diagnosis and what are the specific instructions.
- Absolutely avoid late afternoon surgery — because you will be shipped to the hospital for minor complications — the ASC will close and they don’t have staff to provide care after closing.