OMB control number

Ambulatory Surgery Center Survey on Patient Safety Culture Database

OMB 0935-0242 · HHS/AHRQ.

OMB 0935-0242

Background on the Ambulatory Surgery Center Survey on Patient Safety Culture (ASC SOPS): The survey is designed to enable ASCs to assess provider and staff perspectives about patient safety issues, medical error, and error reporting. The survey includes 27 items that measure 8 composites of patient safety culture. In addition to the composite items, the survey includes one item measuring how often ASCs document near-misses; one item asking whether the respondent is in the room during surgeries, procedures, or treatments; and three items about communication before and after surgeries, procedures, or treatments. The survey also includes an overall rating item on patient safety, two items about respondent characteristics, and a section for open-ended comments. AHRQ made the survey publicly available along with a Survey User’s Guide and other toolkit materials in May 2015 on the AHRQ website. The AHRQ ASC SOPS Database consists of data from the AHRQ ASC Survey on Patient Safety Culture. Ambulatory surgery centers in the U.S. can voluntarily submit data from the survey to AHRQ, through its contractor, Westat. The ASC SOPS Database (OMB NO. 0935-0242; Approved September 10, 2018) was developed by AHRQ in 2019 in response to requests from ASCs interested in tracking their own survey results. Organizations submitting data receive a feedback report, as well as a report of the aggregated, de-identified findings of the other ASCs submitting data. These reports are used to assist ASC staff in their efforts to improve patient safety culture in their organizations. Rationale for the information collection. The ASC SOPS and the ASC SOPS Database support AHRQ’s goals of promoting improvements in the quality and safety of health care in ASCs. The survey, toolkit materials, and database results are all made publicly available on AHRQ’s website. Technical assistance is provided by AHRQ through its contractor at no charge to ASCs, to facilitate the use of these materials for ASC patient safety and quality improvement. This database will: 1. Present results from ASCs that voluntarily submit their data; 2. Provide data to ASCs to facilitate internal assessment and learning in the patient safety improvement process; and 3. Provide supplemental information to help ASCs identify their strengths and areas with potential for improvement in patient safety culture.

The latest form for Ambulatory Surgery Center Survey on Patient Safety Culture Database expires 2028-04-30 and is listed under ICR 202410-0935-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form Form 4 SOPS ASC Survey Data Files SubmissionForm and Instruction
Form Form 4 Attachment D - Data Files SubmissionForm and Instruction
Form Form 2 ASC Site InformationForm and Instruction
Form Form 2 Attachment C - ASC Site Information FormForm and Instruction
Form Form 3 Data Use AgreementForm and Instruction
Form Form 3 Attachment B - Data Use AgreementForm and Instruction
Form Form 1 Attachment A - ASC Eligibility and Registration Form (document unavailable)Form and Instruction
Form Form 1 Attachment A - ASC Eligibility and Registration FormForm and Instruction
Supporting Statement Part B -- ASC SOPS_Renewal 3-5-25.docx (document unavailable)Supporting Statement B
OMB Passback_Jan 17 25_Supporting Statement Part A -- ASC SOPS_Extension 0935-0242_CLEAN.docxSupporting Statement A
Supporting Statement Part A -- ASC SOPS_Extension 0935-0242 10.2.24.docxSupporting Statement A
Attachment G - Example Screenshots of SOPS ASC Data Submission Website.docxSupplementary Document
Attachment G - Example Screenshots of SOPS ASC Data Submission Website.docx Supplementary Document
Attachment F - SOPS Technical Expert Panel (TEP) List.docxSupplementary Document
Attachment F - SOPS Technical Expert Panel (TEP) List.docx Supplementary Document
Attachment E - Survey Data File Specifications.docxSupplementary Document
Attachment E - Survey Data File Specifications.docx Supplementary Document
Attachment D - Data Files Submission Form and Instruction
Attachment D - Data Files Submission Form and Instruction
Attachment C - ASC Site Information Form Form and Instruction
Attachment C - ASC Site Information Form Form and Instruction
Attachment B - Data Use Agreement Form and Instruction
Attachment B - Data Use Agreement Form and Instruction
Attachment A - ASC Eligibility and Registration Form Form and Instruction
Attachment A - ASC Eligibility and Registration Form Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202410-0935-003 Extension without change of a currently approved collection 2024-10-17
202109-0935-001 Extension without change of a currently approved collection 2021-09-08 Approved without change
201807-0935-001 New collection (Request for a new OMB Control Number) 2018-07-09 Approved without change

OMB Details

Attachment A - ASC Eligibility and Registration Form

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form Form 1Attachment A - ASC Eligibility and Registration FormFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.