Groundbreaking work to build a benchmarking database of ambulatory nursing outcomes is beginning to benefit ASCs across the United States.

To date, most available national metrics are reflective of physician participation. Now, people are beginning to understand that it’s important for every member of the team to contribute to overall outcomes and reflect their contribution in outcomes data.

Inpatient organizations have been encouraged for years to collect outcomes data that reflects nursing and other healthcare contributions. Such data can present a better picture about how important each healthcare professional is to patient care. But the same has not been true of ambulatory sites until recently, says Rachel Start, MSN, RN, NE-BC, director, ambulatory nursing and nursing practice, Rush Oak Park Hospital in Oak Park, IL.

“One key way to support nurses’ role and to help them evolve is to provide them with data that allows them to look at where they need to improve,” Start says.

There have been inpatient nursing indicators for 15 to 20 years, says Ann Marie Matlock, DNP, RN, NE-BC, service chief for medical surgical specialties and captain, United States Public Health Service, National Institutes of Health (NIH) Clinical Center in Bethesda, MD, noting that data indicators in the ambulatory surgery arena are new. “Until we collect data, we are unable to make that value argument that we need to compare both what staffing levels look like, as well as indicators to say whether or not there are benefits when you have X number of RNs or certified staff.”

Matlock, Start, and data management professionals from the Collaborative Alliance for Nursing Outcomes (CALNOC) of San Ramon, CA, have completed pilot testing of nursing indicators for ASC settings. Any ASC can participate in the nonprofit CALNOC for a fee, says Harriet Udin Aronow, PhD, director of data management services for CALNOC.

“We started a couple of years ago doing pilot testing for ASCs because they’re the closest cousins to inpatient,” Aronow says. “We started with a set of measures that include measures developed by ASC quality collaboration, such as burns, patient falls, injuries, wrong site side for implant, and unplanned hospital admissions.”

In all, about 300 facilities — both inpatient and ambulatory — participate in the CALNOC database, she adds.

“The development of an ambulatory service line is novel and groundbreaking. It’s an opportunity for surgery centers to be on the vanguard,” says Lynn M. Soban, PhD, MPH, RN, associate director of data management services, CALNOC.

A few ASCs participated in the pilot study. Its goal was to ascertain feasibility of the outcomes measures, the process, and structure, including the mix of RNs, LPNs, and unlicensed personnel. Participating ASCs also collected data on cancellations and no-shows, Aronow says.

“We still have 10 to 12 facilities reporting ambulatory surgery center data,” Aronow adds. “But collection of ambulatory center data has exploded since we expanded our work to include primary care and specialty clinics.”

Meanwhile, the pilot testing for ASCs is complete, and benchmarking data are readily available for surgery centers, Start says.

“We can distinguish between hospital-based and freestanding surgery centers, as well,” Aronow notes.

Here are some measures that were used in the pilot program and/or are available now for ASCs and hospital outpatient surgery centers: pain assessment and follow-up; falls risk screening; BMI; hypertension; depression screening; patient burns; staffing, skill mix, patient care hours; surgery adverse outcomes of care: wrong site, wrong side, wrong patient, wrong procedure, wrong implant; and surgery hospital transfer/admission.

“If any ASCs are participating in quality improvement and need to justify their staffing matrix in that realm, they can take heart knowing there is a national benchmark for ambulatory surgery centers,” she says. “Data pertinent to the surgery setting are ready and up and running.”

For information about ASC data collection and benchmarking, ASCs can contact, to request a link to upload information, or they can visit the website:

“It’s really important to us, especially with ambulatory nursing, that we have partners in this work that value the expertise of nurses in this setting,” Start says. “Data collection and benchmarking give us the ability to say to our patients and our board and many entities, ‘This is how we performed; this is what we’re good at, and this is how we serve you.’”

Access to benchmarking adds value that cannot be found solely with internal databases, she adds.

“We have to benchmark to make valid arguments about what we’re doing and how we exceed and improve,” Start adds. “The way our teams are using this data is to see how they benchmark against other similar facilities.”

One of the metrics that draws the most discussion and interest is the unplanned transfer to the hospital, Start says. “We see an opportunity with nursing and the team to see what we can do to improve on unplanned transfers so our outcomes are what patients anticipated.”