AHRQ Safety Program for Improving Surgical Care and Recovery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5 Attachment J – Data collection instrument: Site Visit Assessment	Form and Instruction	New	Available
Form 3 Readiness and Implementation assessment	Form and Instruction	New	Available
Form 2 Attachment D – Patient Experience Survey_Data collection instrument	Form and Instruction	New	Available
Form 1 Attachment B – Safety culture survey_Data collection instrument	Form and Instruction	New	Available
Part B Surgical Care Supporting Statement Part B 20170720.doc	Supporting Statement B	Uploaded 2017-07-28	Repair queued
Part A Surgical Care Supporting Statement Part A 20170720.doc	Supporting Statement A	Uploaded 2017-07-28	Available
Attachment K_Program list of experts_20170727.docx	Supplementary Document	Uploaded 2017-07-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
227747	Attachment J – Data collection instrument: Site Visit Assessment	Form and Instruction	New
227746	Readiness and Implementation assessment	Form and Instruction	New
227745	Attachment D – Patient Experience Survey_Data collection instrument	Form and Instruction	New
227743	Attachment B – Safety culture survey_Data collection instrument	Form and Instruction	New

ICR Details

OMB Control No: 0935-0239	ICR Reference No: 201707-0935-004
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: AHRQ Safety Program for Improving Surgical Care and Recovery
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2017
	Date Received in OIRA: 08/01/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved
Responses	14,560	0	0
Time Burden (Hours)	4,706	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a quality improvement project that aims to provide technical assistance to hospitals to help them implement evidence-based practices to improve outcomes and prevent complications among patients who undergo surgery. Enhanced recovery pathways are a constellation of preoperative, intraoperative, and postoperative practices that decrease complications and accelerate recovery. A number of studies and meta-analyses have demonstrated successful results. In order to facilitate broader adoption of these evidence-based practices among U.S. hospitals, this AHRQ project will adapt the Comprehensive Unit-based Safety Program (CUSP), which has been demonstrated to be an effective approach to reducing other patient harms, to enhanced recovery of surgical patients. The approach uses a combination of clinical and cultural (i.e., technical and adaptive) intervention components. The adaptive elements include promoting leadership and frontline staff engagement, close teamwork among surgeons, anesthesia providers, and nurses, as well as enhancing patient communication and engagement. Interested hospitals will voluntarily participate. This project has the following goals: • Improve outcomes of surgical patients by disseminating and supporting implementation of evidence-based enhanced recovery practices within the CUSP framework • Develop a bundle of technical and adaptive interventions and associated tools and educational materials to support implementation • Provide technical assistance and training to hospitals for implementing enhanced recovery practices • Assess the adoption and evaluate the effectiveness of the intervention among the participating hospitals

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 22830	05/18/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 35208	07/28/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Readiness and Implementation assessment	3, 4	Readiness assessment ,   Implementation assessment
Attachment B – Safety culture survey_Data collection instrument	1	Attachment B – Safety culture survey_Data collection instrument
Attachment J – Data collection instrument: Site Visit Assessment	5	Site visits
Attachment D – Patient Experience Survey_Data collection instrument	2	Patient experience survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	14,560	0	0	14,560	0	0
Annual Time Burden (Hours)	4,706	0	0	4,706	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new Information Collection Request.

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Annual Cost to Federal Government: $310,697

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/01/2017

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