Benchmarking Form

Please respond with monthly totals of your Quarterly Benchmarking data.

1st Quarter includes: Jan, Feb, Mar – due Apr 15th
2nd Quarter includes: Apr, May, Jun – due July 15th
3rd Quarter includes: Jul, Aug, Sep – due Oct 15th
4th Quarter includes: Oct, Nov, Dec – due Jan 15th

Data submitted after the deadline will not be included as part of the alliance data.

Please enter the passcode to access the form:*

If you do not have an access code, please contact support at 770-325-0140, for assistance.** Please note: passcode is case-sensitive **

Enter the name of your facility*

This will be the name used on the quarterly report

Enter your email address*

We will send the quarterly report to you at this address

Please choose the month this benchmarking data covers*

If entering for the entire quarter at once, there is an option to indicate that here

1. Total number of cancellations on the day of surgery:

2. Percentage of counter payments collected on the day of surgery:

please provide your answer in decimal form (ex: 25%=0.25 and 100%=1.00)

3. Cases started on time in minutes (cut time minus scheduled start time, totaled, then divide by total number of cases for average result):

please provide your answer in minutes

4. Turnover time (next cut time minus out of room time (prior) sum, divide total number of cases):

please provide your answer in minutes

5. Antibiotic prophylaxis given within 1 hour prior to cut time – include all cases where antibiotics are ordered. (Subtract antibiotic start time from cut time, and provide percentage within 60 minutes):

please provide your answer in decimal form (ex: 25%=0.25 and 100%=1.00)

6. DVT protocol compliance (percentage of compliance with initiation of DVT prophylaxis when indicated):

please provide your answer in decimal form (ex: 25%=0.25 and 100%=1.00)

7. Normothermia: Percentage of general and regional surgical cases that were longer than 60 minutes, with temperature above 96.8 (temp must have been taken within 15 minutes of arrival to PACU):

please provide your answer in decimal form (ex: 25%=0.25 and 100%=1.00)

8. Total number of hospitalizations within 72 hours of surgery:

do not include direct admits or transfers

9. Total number of hospital direct admits or transfers:

10. Total number of patient falls:

11. Total number of medication errors:

12. Total number of patients burned during procedure:

13. Total number of patients who received a procedure on any of the following: Wrong Site; Wrong Side; Wrong Patient; Wrong Procedure; Wrong Implant

14. Hand Hygiene Compliance (compliance % based on observed opportunities):

please provide your answer in decimal form (ex: 25%=0.25 and 100%=1.00)

15.Infection rate as a % of total cases:

please provide your answer in decimal form (ex: 25%=0.25 and 100%=1.00)

16. Percent of patients reached post operatively:

please provide your answer in decimal form (ex: 25%=0.25 and 100%=1.00)

17. Ophthalmic Only: Number of unplanned vitrectomy surgeries:

Benchmarking Form

Benchmarking Data Entry Form