Rules for Office-Based Surgery - North Carolina
NORTH CAROLINA OFFICE-BASED SURGERY GUIDELINES Office-based surgery is surgery* performed outside a hospital or an outpatient facility accredited by the North Carolina Division of Facility Services. Although surgery is not a perfect science in any setting, office-based surgery is generally safe, effective, and efficient, provided proper measures are taken in the process. It is the position of the North Carolina Medical Board that the physician is responsible for providing a safe environment for office-based surgery.
The following general guidelines are recommended for office-based surgery.
- Training: Any procedures, whether done in an office or a hospital, should be performed by physicians operating within their area of professional training. Appropriate training and continuing medical education should be documented and that documentation should be readily available to patients and the North Carolina Medical Board. Those who perform office-based surgery must have plans, such as prearranged hospital admission protocols, for managing emergency complications.
- Patient Selection: Patients must be evaluated per procedure to determine if the office is an appropriate setting for the surgery.
- Patient Evaluation: Patients undergoing office surgery must have an appropriately documented history and physical examination, and any other studies or consultations indicated.
- Anesthesia: When general anesthesia or sedation is provided in the office setting, it must be administered by those qualified to do so. Anesthesia personnel should be familiar with variations in technique based on the specifics of the patient and the procedure, particularly those requiring large volumes of fluids or airway management. Patients must be properly monitored before, during, and after the procedure. Physicians are referred to the protocols of the American Society of Anesthesiologists** for guidance. ACLS certification of anesthesia personnel is an important consideration.
- Office Setting: The office should be set up with patient safety as a primary consideration. Safety issues should include, but not be limited to, accessibility, sterilization and cleaning routines, storage of materials and supplies, supply inventory, and emergency equipment.
- Emergency Planning: Planning should include, but not be limited to, emergency medicines, emergency equipment, and transfer protocols. Practitioners should be trained and capable of managing complications related to the procedures they perform.
- Follow-Up Care: As with any surgical treatment or procedure, follow-up care by the responsible surgeon is requisite. Arrangements should be made for follow-up care and for treatment of problems or complications outside normal office hours.
- Quality Improvement: Continuous quality improvement should be a goal.
*Definition of surgery as adopted by the NCMB, November 1998: "Surgery, which involves the revision, destruction, incision, or structural alteration of human tissue performed using a variety of methods and instruments, is a discipline that includes the operative and non-operative care of individuals in need of such intervention, and demands pre-operative assessment, judgment, technical skills, post-operative management, and follow up."
**"Guidelines for Office-Based Anesthesia," "Guidelines for Ambulatory Anesthesia and Surgery," "Basic Standards for Preanesthesia Care," "Standards in Basic Anesthetic Monitoring," "Standards for Postanesthesia Care," "Guidelines for Nonoperating Room Anesthetizing Locations." All available from the American Society of Anesthesiologists
(Adopted September 2000)