A Description of Variables Relevant to Nursing Care in Ambulatory Surgery Centers
There is little descriptive information regarding health services research variables in ambulatory surgical centers (ASCs). This study’s purpose was to describe working conditions, licensed nursing personnel functions, and the nature and characteristics of state and institutional regulation in ASCs. A literature review was performed to determine the level of ASC regulatory oversight in each state based on mandates for state licensure, CMS certification, and third-party accreditation. Ten states with equal numbers of least-regulated states (ID, WI, IA, VE, and PA) and most-regulated states (CT, NY, DE, VA, and NV) were identified. A survey was mailed to ASC administrators in these states based on the Centers for Medicare and Medicaid Services (CMS) online ASC database (n= 714; response rate= 20.7%, total respondents= 144). Not all ASCs employed all provider types and labor quantity and number of patients assigned per shift were related to service type and volume. Flexible employment status, number of patients assigned per shift, scheduling process, provider duties, and assignment of nursing care showed statistically significant differences by service type. Anesthesia model, the individuals responsible for performing preoperative patient assessment and discharge, CRNA employment status, and CRNA remuneration methods varied. Several of these variations may be related to service type and procedural volume. Compliance with quality policies and participation in accreditation and licensure activities did not vary by state regulatory category. There were also no significant differences reported for hours of work, staffing variables, and patient concurrence based on regulatory status. These results suggest that future research in the ASC setting must adopt a greater focus on service types and procedures and should consider adjustment for case volume or case severity. This research contributes to the current knowledge of ASCs by describing variables relevant to this setting. The results of this study function to inform future workforce and outcomes research in ASCs.