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OMB Control No: 0935-0242	ICR Reference No: 202109-0935-001
Status: Historical Active	Previous ICR Reference No: 201807-0935-001
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Ambulatory Surgery Center Survey on Patient Safety Culture Database
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/07/2021
	Date Received in OIRA: 09/08/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2024	36 Months From Approved	10/31/2021
Responses	400	0	400
Time Burden (Hours)	121	0	121
Cost Burden (Dollars)	0	0	0

Abstract: 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. Rationale for information collection approval. The Agency for Healthcare Research and Quality (AHRQ) requests that the Office of Management and Budget (OMB) reapprove, under the Paperwork Reduction Act of 1995, AHRQ’s collection of information for the AHRQ ASC SOPS Database; OMB NO. 0935-0242; Approved September 10, 2018. 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.

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

Citations for New Statutory Requirements: None

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

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 28111	05/25/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 48703	08/31/2021
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
ASC Site Information Form	3
Data Files Submission	4
Data Use Agreement	2
Eligibility and Registration Form	1

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	400	400
Annual Time Burden (Hours)	121	121
Annual Cost Burden (Dollars)	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

Annual Cost to Federal Government: $200,000

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? No

Agency Contact: Erwin Brown 301 427-1652 erwin.brown@ahrq.hhs.gov

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