Are ambulatory surgical facilities the future?

The role of outpatient vascular interventions during COVID-19 and beyond

Note: This is one in a series of articles exploring the wide range of interventional radiology practice settings, from academic centers to office-based laboratories (OBLs). Watch for more articles in this series in IRQ and tune in to the Kinked Wire podcast for episodes dedicated to the topic. The views and opinions of IRQ authors are not necessarily those of the Society of Interventional Radiology.

The COVID-19 global pandemic has continued to test all levels of the healthcare system—not just the effectiveness of medical personnel, but also the effectiveness of healthcare structures and organization.1 The ICU bed shortages and the moratorium on most surgeries affected patients and facilities alike, along with the ever-changing temporary measures and lack of PPE.2 Throughout the pandemic, ambulatory surgical facilities (ASFs) allowed patients access to essential care while providing a safe environment, implemented new technologies and offered a much-needed avenue of relief for overburdened larger facilities, which created a blueprint for the future role of ASFs.

COVID-19 response

Due to the nature and urgency of most vascular procedures, the COVID-19 pandemic required that qualified and licensed freestanding vascular centers such as ASFs operate to relieve the burden on area hospitals. ASFs who followed CDC and state guidance were able to continue operating and help treat critical, non-COVID-related cases. For example, a dialysis patient whose vascular access was clotted was still able to be treated and receive restoration of open access flow without inconveniences or decreased quality of care. ASFs also donated their surplus stock of PPE materials to local hospitals. In addition, many ASFs were fully equipped to provide readiness overflow of essential surgeries (urgent and emergent) closely tied or correlated to the typical procedures offered and performed at the facility, aided by having qualified vascular and IR surgeons on staff.

As evidenced by ASFs, there are resources available within the healthcare system to meet the demands for proper care during a pandemic. But unfortunately, many facilities across the country were not able to provide much needed support and were instead required to limit practices and surgeries in order to focus on financial survival modifications.5

As evidenced by ASFs, there are resources available within the healthcare system to meet the demands for proper care during a pandemic.

The demands of the pandemic stretched the resources of many U.S. hospitals beyond capacity.6 It is important to note that a majority of data relate directly to hospitals and their infrastructure, seemingly leaving out the various medical practices and institutions that do still contribute to society’s healthcare needs, despite size. Furthermore, instead of reducing surgical procedures, rules and regulations should be implemented that enable qualified and equipped facilities, such as ASFs, with the authorization to collaborate with surrounding medical organizations and reduce the overflow of non-critical care cases. This would allow hospitals to focus their full attention and resources on critically ill patients.4

ASFs and educational opportunities

Due to guidelines that required limited capacity and allowed essential workers in a facility, trainees and education were adversely affected.7 The rapid response by freestanding outpatient ASFs to implement telehealth and telemedicine services shows how vascular medicine trainees can absorb comparative educational training from an ASF performing similar procedures as seen in the operative rooms. ASFs may even be the solution to alternative educational training, as the Society for Vascular Surgery recently released new regulations for vascular trainees, including varied approval for clinical time incorporating advanced educational opportunities such as “check-ins” and “E-visits.”8 Implementation of these suggested educational possibilities opens the door for proving further usage of ASFs during a pandemic aside from procedural duties.

Telehealth and telemedicine

Over the past year, implementation, use and relaxed regulations have made telehealth and telemedicine truly a “frontline” response.9 It has been illustrated that telemedicine use in response to the COVID-19 pandemic increased from fewer than 100 visits per day to over 2,200 visits per day over a 24-day period within a single academic institution.10 This single finding leaves further room for interpretation and predictions of how the impact of telehealth has been pertinent to the success of other medical facilities during the pandemic and how it will continue.

Taking into consideration telehealth and telemedicine services in both inpatient and outpatient settings, providers may expect to see an increase in not only delivery of patient care, but quality of care as well. The advancement in telehealth technology and services has introduced more accurate and effective patient monitoring, capturing continuous data over time—which can provide a more thorough understanding of disease trends and allow providers to grow with the patient and disease.

The demand of disease-focused specificity in many ASFs may allow these facilities to set the platform as innovators in areas of telemedicine, considering telemedicine is also seen as an outpatient care source. This idea can be further understood as moving beyond telemedicine to provide acute care, but incorporating chronic care cases as well, increasing the access and exposure in provider areas of expertise to varying healthcare organizations and domains.

However, we still face disparities among populations and demographics of patients who have limited access to technological advances and or have limited medical and technological literacy.11 In order to tackle this impediment, it is imperative that medical facilities and surrounding associated healthcare systems are equipped with the accommodations and understanding to cater patients’ needs in order to uphold the highest standard of continued patient satisfaction.

Patient engagement and outcomes

As the very first regulations and shutdowns were implemented across the country, one freestanding vascular ASF continued to try and find ways to navigate the unknown, which included the implementation of a patient satisfaction survey to gain a more thorough understanding of how patients were feeling. The execution of this patient engagement tool provided keen insight into the minds of the patients, openly and confidentially providing them with a voice and chance to be heard, while gauging how patients felt towards the pandemic and whether or not their feelings had a direct effect on their views and trust in returning to ASFs. All questions on the survey were pertinent to patient services and satisfaction.

Patients rated the comfort and cleanliness of one vascular ASF’s facilities with a 100% satisfaction with no standard deviation in ratings post-procedure, and 64% of patients stated they were not nervous about coming into the facility for their procedure. In addition to feeling comfortable and clean in the facility during a pandemic, 90% of patients who answered this question also stated that the medical staff and personnel were able to answer any concerns they may have had regarding the pandemic, providing further reassurance of their trust in that vascular center. This is important to note, considering 60% of patients stated they were fearful of returning to a hospital setting given these circumstances.

During a public health crisis like COVID-19, ASFs provide the ability to effectively complete procedures without requiring patients to stay overnight, allowing more patients and essential procedures to be scheduled in a timely fashion. The quicker access to procedural care that ASFs provide can be better understood by the 92% average patient satisfaction rating when they were asked to rate the quickness of care for their illness or injury.

Continued implementation of technological advancements and adaptations also yielded positive feedback from patients, showing that of those who participated in a telehealth session, 100% patient satisfaction was received. To further improve patient satisfaction in telemedicine, one outpatient vascular ASF partnered with Current Health technologies, an AI remote patient monitoring organization, to implement patient monitoring devices and platforms.12

Over a 3-year period using electronic health record (EHR) and the state Patient Safety Reporting System (PSRS) system, data was gathered for primary analysis of an adverse event (morbidity or mortality) within 72 hours post-procedure. The procedural related outcomes presented outstanding with a 99% success rate overall with a vascular system and an average of a 99% patient engagement and satisfaction rating of overall experience for a survey processed in 2017. The survey processed in 2017 included a 98% average rating of pain management post-procedure and a 99% average rating of ease of appointment. The characteristics and outcomes of the survey processed in 2017 similarly correlate to responses seen in the 2020 survey processed during the COVID-19 pandemic exemplifying the success of ASFs during pre- and current pandemic times.

Conclusion

Freestanding, outpatient vascular centers are an important part of the care continuum. In the pandemic recovery period, with patients still reluctant to seek medically necessary care, ASFs can provide an appealing, safe alternative to larger medical facilities, and play a role in the future of education and patient engagement.

References

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