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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)
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