Current through Register Vol. 47, No. 5, March 10, 2024
9.1
All persons admitted to the ambulatory surgical center shall be under the
direct care of a member of the medical staff. The medical staff shall ensure
the continuity of care for each patient including pre-operative,
intra-operative, and post-operative care. All necessary instruction and
education shall be provided to each patient prior to admission (for
pre-surgical care) and discharge (for post-surgical care).
9.2 Restrictions:
(A) Surgical procedures shall be limited to
the following:
(1) Those in which the expected
combined operating and recovery time does not exceed 24 hours from the time of
admission; and
(2) Those that do
not generally result in extensive blood loss; require major or prolonged
invasion of body cavities; directly involve major blood vessels or constitute
an emergency or life-threatening procedure.
(B) There shall be no pre-planned, off-site
transfers to a higher level of care and no transfers shall occur solely for the
convenience of the ambulatory surgical center or its staff.
9.3 Identification: Each patient
admitted to the center shall have a visible means of identification placed and
maintained on his/her person until discharge. In cases of off-site pre-planned
transfer such means of identification shall be maintained throughout the period
of transfer and until such time as the patient becomes a patient of another
licensed facility.
9.4 Admission
Requirements: All admissions shall be in accordance with appropriate written
policies and procedures which reflect the admission requirements established in
this section, recommended by the medical staff and adopted by the governing
body, specific to the ambulatory surgical center operations, that includes at
least the following:
(A) The physicians
performing the procedure shall document in writing that the patient is in good
health or that any pre-existing health conditions are adequately controlled,
require no special management and are such that performance of the procedure in
a center, rather than an inpatient hospital setting, does not pose an increased
risk to the patient.
(B) The
patient or a responsible person acting on behalf of the patient must be able to
strictly follow instructions related to ingestion of fluids or solids within
the specified time frame prior to the surgery.
(C) If the patient is to receive sedation or
anesthetic which will result in impaired mental status following surgery, the
patient must be accompanied upon discharge by a responsible adult, unless
exempted in writing by the attending physician.
(D) Patients who may require post-operative
ventilation following surgery, either because of the procedure to be performed
or because of a pre-existing condition, shall not be admitted for
surgery.
(E) Surgery which requires
the presence of special equipment, personnel, and/or facilities due to the risk
of the operation involved shall not be performed in the center unless such
equipment, personnel, and/or facilities are available in the center.
(F) When overnight care is provided,
appropriate services shall be rendered within the defined capabilities of the
organization.
9.5
Discharge: Patients shall be in a stable condition which will not endanger
their continued well-being or shall be transferred to a licensed hospital,
convalescent center or other treatment facility. There shall be written
procedures and assigned responsibilities for implementing such procedures,
including provisions for transportation. The center shall provide verbal and
written patient instructions regarding post-operative or post-procedure care,
physician follow-up, and physician contact information.
9.6 Off-Site Pre-Planned Transfers: Off-site
pre-planned transfers of patients include those transfers of patients to other
licensed health facilities, which are physically located off-site or
off-campus, where it is known in advance that further post-surgical patient
care will be needed. Off-site preplanned transfers do not include discharges to
the patient's place of residence where further care will be provided by home
health or home care providers. Ambulatory surgical centers providing off-site
pre-planned transfer service options shall adhere to the following
requirements:
(A) Disclosure: Facilities
offering surgical services which include an off-site pre-planned transfer to
another licensed facility following post-operative recovery shall disclose in
written form to the patient all the details of the transfer prior to admission
to the facility. Disclosure includes, but is not limited to, the cost of the
transfer, whether or not such costs shall be covered by insurance or other
third party payer, and the details of the actual transfer, including, but not
limited to, the mode of transport. Disclosure shall be made to the patient
prior to the time for admission to the facility. The patient shall acknowledge
such disclosure in writing, and the date thereof. Such disclosures on center
policies regarding off-site pre-planned transfers shall be in addition to the
requirements for informed consent.
(B) Off-site pre-planned transfers shall be
made only to other licensed facilities that can provide the level of care
necessary to meet the needs of the patient. The center shall have a written
agreement with any and each licensed facility that admits patients for
post-surgical care from a center. The center shall provide written discharge
instructions, including patient progress information, to the receiving
facility.
(1) An ambulatory surgical center
shall allow preplanned transfers only with the written consent of the patient
and the written authorization of the attending or operating surgeon or
physician. The attending or operating surgeon or physician shall approve such a
transfer if there are assurances that the continuity of care for the patient
shall be maintained and contact with the patient's attending physician is
continuous.
(C) All
pre-planned transfers shall be by licensed ambulance. The center shall have a
written agreement with the provider(s) of ambulance services. Such transfer
agreements shall include the provision for an appropriate level of care
commensurate with the needs of a post-surgical recovering patient. If
necessary, as determined by the attending or operating physician, licensed
medical staff from the ambulatory surgical center shall accompany the patient
on the ambulance to provide continuity of care and a level of care that meets
the peri-operative needs of the patient.
(D) Ambulatory surgical centers engaging in
pre-planned transfers shall provide space at the entrance to the building to
facilitate transfer. The center shall provide close-in parking that shall be
accessible at all times and shall not be obstructed by other parked vehicles or
any other architectural barriers. The space provided for ambulance access shall
also contain adequate height clearance to accommodate a type I or a type III
ambulance.
9.7 On-Site
Pre-Planned Transfers: On-site pre-planned transfers of patients are also
authorized where it is known in advance that further post-surgical patient care
will be desired or needed. Such transfers are limited to those transfers of
patients to convalescent centers licensed in accordance with section 25 or
other licensed health facilities, located on-site or on campus and are
physically connected to the ambulatory surgical center.
(A) The provisions of paragraph 9.6(A) and
(B) shall apply to on-site pre-planned transfers. The provisions of paragraph
9.6(C) and (D) shall not apply to on-site pre-planned transfers.
