Statement on Ambulatory Anesthesia and Surgery

Developed By: Committee on Ambulatory Surgical Care
Last Amended: October 18, 2023 (original approval: October 15, 2003)

The American Society of Anesthesiologists (ASA) endorses and supports the concept of Ambulatory Anesthesia and Surgery. ASA encourages the anesthesiologist to maintain a leadership role as the perioperative physician in all hospitals, ambulatory surgical facilities, and office-based settings, and to participate in facility accreditation as a means for standardization and improving the quality of patient care.

This statement encompasses perioperative care of the ambulatory surgical patient in all ambulatory settings. The statement describes basic minimum expectations which may be exceeded based on the judgment of the involved anesthesiologist, together with the patient care team. These guidelines encourage high-quality patient care, but observing them cannot guarantee any specific patient outcome. This statement is subject to periodic revision, as warranted by the evolution of technology and practice.

1. ASA Standards, Guidelines, and Policies should be adhered to in all settings.
2. A licensed physician should be in attendance in the facility until the patient is discharged from anesthesia care.  Discharge of the patient from anesthesia care is the responsibility of the anesthesiologist or other qualified physician. A licensed anesthesiologist or other qualified physician should be in attendance in the facility until the patient is discharged from anesthesia-related medical care. For all other non-anesthesia medical related issues, a licensed physician should be in attendance in the facility or immediately available by telephone at all times during patient treatment and recovery and until the patients are medically discharged. If the patient's care needs exceed the facility's capabilities, the patient should be transferred to a more appropriate facility.  
3. The facility must be established, constructed, equipped and operated in accordance with applicable local, state and federal laws and regulations.  At a minimum, all settings should have a reliable source of oxygen, suction, resuscitation equipment and emergency drugs.  Specific reference is made to the ASA Statement on Nonoperating Room Anesthetizing Locations.
4. The facility must meet the required definitions and possess the appropriate national accreditation, state licensure and CMS deemed status as applicable.
5. The facility must have a governing body that assumes full legal responsibility for its operational policies. The governing body ensures that facility policies and programs are administered so as to provide quality health care in a safe environment.
6. The facility must ensure that contracted services are provided in a safe and effective manner.
7. Qualified personnel and equipment should be on hand to manage emergencies.  The facility must have well defined policies and procedures for the immediate transfer of patients requiring emergency medical care beyond its capabilities to a facility with the necessary resources. This hospital must be a local, Medicare-participating hospital or a local, nonparticipating hospital that meets the requirements for payment for emergency services.
8. The facility must maintain and annually review a disaster/emergency preparedness plan.
9. Staff should be adequate in number and qualifications to meet patient and facility needs for all procedures performed in the setting, and should consist of:
   1. Professional Staff
      1. Physicians and other practitioners who hold a valid license or certificate are duly qualified.
      2. Nurses who are duly licensed and qualified.
   2. Administrative Staff
   3. Housekeeping and Maintenance Staff
10. Professional staff should be credentialed and privileged upon initial hire and credentials verified at least every three years. 
11. Physicians providing medical care in the facility should assume responsibility for credentials review, delineation of privileges, quality assurance, and peer review.
12. Minimal patient care should include:
    1. Preoperative instructions and preparation.
    2. An appropriate pre-anesthesia evaluation and examination by an anesthesiologist, prior to anesthesia and surgery. In the event that nonphysician personnel are utilized in the process, the anesthesiologist must verify the information and repeat and record essential key elements of the evaluation.
    3. Preoperative studies and consultations as medically indicated.
    4. An anesthesia plan developed by an anesthesiologist, discussed with and accepted by the patient and documented.
    5. Administration of anesthesia by anesthesiologists, other qualified physicians or nonphysician anesthesia personnel medically directed or supervised by an anesthesiologist. Non-anesthesiologist physicians who are administering or supervising the administration of the continuum of anesthesia must be qualified by education, training, licensure, and appropriately credentialed by the facility.
    6. Discharge of the patient from anesthesia care is the responsibility of the anesthesiologist or other qualified physician. A licensed anesthesiologist or other qualified physician should be in attendance in the facility until the patient is discharged from anesthesia-related medical care. In the case of observation or overnight care, the admitting physician should be immediately available by telephone at all times during patient treatment and recovery and until the patient is medically discharged.
    7. Patients who receive other than unsupplemented local anesthesia must be discharged with a responsible adult.
    8. Written postoperative and follow-up care instructions.
    9. Accurate, confidential, and current medical records.