For questions regarding this survey, contact Elizabeth Cobb Please complete the survey by October 24, 2014.
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1 Kentucky Hospital Association, through our Certificate of Need Committee, is conducting a survey of hospital outpatient surgery and ambulatory surgery center (ASC) utlization and trends. This information will be used to support the development of comments and positions related to ASCs under the CON program. We are gathering data to help support our members' position regarding calculating need for new ASC services and how to most accurately estimate the need for these services given current health care practice. This work is being conducted to support KHA's position to assure access to quality health care services, preserve the CON program and prevent the proliferation of unnecessary health services. For questions regarding this survey, contact Elizabeth Cobb (ecobb@kyha.com). Please complete the survey by October 24, Please provide the following information about your hospital or ASC. If you will be responding for multiple facilities, please provide individual surveys for each of these facilities. Facilty Name: Respondent Name Address: City/Town: ZIP: County Respondent Address: Phone Number: 2. Please indicate if you are responding as an ASC or an acute care hospital Acute Hospital ASC Hospital Based ASC Free standing with Hospital Affiliation (e.g. Joint Venture) Free standing ASC not affiliated with a hospital by ownership or management 3. How many surgical suites are licensed for this location? Page 1
2 4. How many of these surgical suites are operational? Do not include procedure rooms. Built, equipped and in use Built and equipped but not in use CON approved, but not built Reserved for emergency procedures Operating for special types of service or procedure only (e.g. cardiac surgery and cysto). If you indicated you have surgical suites not in use, please indicate why: Patient Demand not sufficient Currently in implementation phase Physician availability. Do you regularly perform some surgical procedures in "procedure rooms" rather than licensed surgical suites (e.g. colonoscopy) Yes No 7. If yes, how many procedure rooms do you operate separate from licensed surgical suites? Page 2
3 8. Please provide information regarding surgical procedures performed in surgical suites during calendar year If you are responding for an ASC, indicate "0" for inpatient cases. Do not include information on cases performed in a procedure room. INPATIENT: Total Number of Cases INPATIENT: Total Surgical Hours (Including clean up time) INPATIENT: Average Cleanup Time Between Cases (indicate in minutes) OUTPATIENT: Total Number of Cases OUTPATIENT:Total Surgical Hours (Including clean up time) OUTPATIENT: Average Clean up Time Between Cases (indicate in minutes) 9. For this facility, how many surgical suites are routinely staffed and available for use (starting a case) during the days and times indicated below? Please answer for eachtime/day. If you do not provide the service during that time, indicate by selecting "0". Inpatient Only Outpatient Only Combination of IP and OP Procedures 7 Days a week/24 hours a day Monday Friday early a.m. until 4:00 p.m. Monday Friday 4:00 p.m. 7:00 p.m Monday Friday after 7:00 p.m. Saturday early a.m. until 4:00 p.m. Saturday 4:00 7:00 p.m Saturday after 7:00 p.m. Sunday early a.m. until 4:00 p.m. Sunday 4:00 7:00 p.m Sunday after 7:00 p.m. Share any comments about special circumstances Page 3
4 10. Do you have the capability to flex hours of operation based on demand to meet your outpatient surgery needs? Capability means physician and staff coverage. yes no If no, why? Page 4
5 11. How often do you have to flex hours of operation to meet surgical demand? Never One day a month Two to 3 days a month One day a week More than one day a week Seasonally (days, weeks or longer during certain certain times of year) Comments 12. For outpatient surgical procedures only, what is your typical lead time from scheduling to case? One week or less One week to two weeks Two weeks to one month More than one month 13. What is the primary driver of the length of time between scheduling and procedure? Availability of the surgeon Preference of the surgeon Availability of the surgical suite and staff Patient preference Page
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