Current through Register Vol. 46, No. 39, September 25, 2024
Outpatient services, including ambulatory care services
and extension clinics, shall be provided in a manner which safely and
effectively meets the needs of the patients.
(a)
General requirements.
As a minimum when provided, outpatient services shall
comply with the rules and regulations set forth in this Part as well as the
outpatient care provisions of Part 751, sections 752.1 and
753.1 and Parts 756, 757 and 758
of Subchapter C of this Title.
(1) The
provision of this section shall apply to hospital-sponsored ambulatory
services, including part-time and off-site clinics, which accept primary
responsibility for health supervision and medical care of patients.
(2) The hospital shall ensure that all care
provided by its ambulatory services is in accordance with prevailing standards
of professional practice.
(3) The
hospital shall conduct periodic reviews of the care rendered by its ambulatory
services as part of its overall quality assurance program.
(b) The hospital shall assign a physician to
be responsible for the professional services of the outpatient department.
Either this physician or an administrator qualified by training and experience
shall be responsible for administration of the outpatient services.
(c)
Patient care.
The hospital shall effectively meet outpatient patient
care needs by:
(1) the provision of
patient care in a continuous manner by the same health care practitioner,
whenever possible;
(2) the
appropriate referral to other health care facilities or health care
practitioners for services not available;
(3) the identification, assessment, reporting
and referral of cases of suspected child abuse or neglect as required by
section 405.9(d) of this
Part;
(4) compliance with the
domestic violence provisions of section
405.9(e) of this
Part;
(5) identification,
assessment, and referral of individuals with documented substance use disorders
or who appear to have or be at risk for substance use disorders, as that term
is defined in section
1.03 of the
Mental Hygiene Law, as described in section
405.9(f) of this
Part;
(6) compliance with the human
trafficking provisions pertaining to the identification, assessment, and
appropriate treatment or referral of individuals who are suspected to be human
trafficking victims, as described in section
405.9(g) of this
Part; and
(7) the development of a
written plan of treatment. When treatment is provided it is revised, as
necessary, in consultation with other health care professionals.
(d)
Hospital-based
ambulatory surgery service.
In a hospital maintaining an on-site hospital-based
ambulatory surgery service, the following requirements supplement existing
applicable requirements of sections
405.12 (Surgical services) and
405.13 (Anesthesia services) of this Part. Hospital-based ambulatory
surgery services shall mean a service organized to provide surgical
procedures which shall be performed for reasons of safety in an operating room
on anesthetized patients requiring a stay of less than 24 hours' duration.
These procedures do not include outpatient surgical procedures which can be
performed safely in a private physician's office or in an outpatient treatment
room.
(1) The hospital-based
ambulatory surgery service shall be directed by a physician found qualified by
the governing body to perform such duties.
(2) The governing body and the medical staff
shall develop, maintain and periodically review a list of surgical procedures
which may be performed in the service. The medical staff shall assure that
procedures performed in the service conform with generally accepted standards
of professional practice, in accordance with the competencies of the medical
and professional staff who have privileges in the hospital-based ambulatory
surgery service, and are appropriate in the facilities and consistent with the
equipment necessary to meet the needs of all patients. The medical staff shall,
based upon its review of individual medical staff qualifications, recommend to
the governing body specific surgical procedures which each practitioner is
qualified to perform in the hospital-based ambulatory surgery
service.
(3) Hospital-based
ambulatory surgery services may be located at the same site as the hospital
(on-site) or apart from the hospital (off-site), pursuant to section
709.5 of this Title.
(i) Recovery rooms adequate for the needs of
hospital-based ambulatory surgery patients, conveniently located to the
operating room, shall be provided.
(ii) Waiting rooms adequate for the needs of
patients and responsible persons accompanying patients shall be
provided.
(4) Prior to
surgery, each patient shall have a timely history and physical examination,
appropriate to the patient's physical condition and the surgical procedure to
be performed, which shall be recorded in the patient medical record.
(5) Each postsurgery patient shall be
observed for postoperative complications for an adequate time period as
determined by the attending practitioner and the anesthesiologist. The service
shall have written policies for hospital admission of patients whose
postoperative status prevents discharge or necessitates inpatient admission to
a hospital capable of providing the appropriate level of care.
(6) Detailed verbal instructions
understandable to the patient, or the patient's parent, legal guardian, or
health care agent, confirmed by written instructions, and approved by the
medical staff of the hospital-based ambulatory surgery service shall be
provided to each patient, or the patient's parent, legal guardian, or health
care agent, at discharge, to include at least the following:
(i) information about complications that may
arise;
(ii) telephone number(s) to
be used by the patient should complications or questions arise;
(iii) directions for medications prescribed,
if any;
(iv) date, time and
location of follow-up visit or return visit; and
(v) designated place to go for treatment in
the event of an emergency.
(7) The hospital-based ambulatory surgery
service staff shall develop written policies, approved by the medical staff,
for documentation of the patient's postoperative course of treatment. The
policies must be reviewed and adopted by the governing body of the hospital
prior to implementation. The policies must provide a mechanism to assure that
complications of surgery or anesthesia, which occur before and after discharge,
are identified and documented in the patient's medical record.
(8) The hospital-based ambulatory surgery
service shall have an organized system of quality assurance approved by the
medical staff and the governing body which undertakes investigations into
operative results of surgical procedures performed on the service and maintains
statistics on operative failures and complications.
(9) Notwithstanding anything herein to the
contrary, an off-site hospital-based ambulatory surgery service shall be
operated in accordance with the provisions of Part 755 of this Title.
