With the improvement in technology and advances in anesthesia and pain control, many less invasive surgical procedures are now being performed in outpatient ambulatory settings. However, not all patients are appropriate to have these procedures in these types of settings.
QUAD A does not dictate the American Society of Anesthesiologists (ASA) Physical Status Classification that patients must meet for their procedure to be performed in an outpatient ambulatory setting. While the ASA addresses ASA Physical Status Classifications and industry standards regarding patient appropriateness for outpatient surgical procedures, the classification system alone does not predict the perioperative risks for a specific patient; however, when used with other patient factors (e.g., type of surgery, frailty, level of deconditioning, comorbidities, etc.), it can be helpful in predicting perioperative risks.
The facility must make the determination that the patient is appropriate to have the procedure performed in their facility. This determination must be based on several other factors, including, but not limited to, patient age; type of surgical procedure and anesthesia planned; likely need for blood products; expected length of stay in the post-anesthesia care unit; necessary medications and equipment; experience, ability, and skill of the surgical, anesthesia, preoperative and postoperative teams; and the facility’s equipment, personnel, and resources.
How the facility determines if a patient is appropriate for the procedure at their facility must be outlined in the facility’s policy. The facility’s policy must also address the types of patients that are inappropriate for procedures in the facility (i.e., ASA classification of three (3) or higher).
QUAD A standards that address patient selection and appropriateness for the facility are listed below.
Standard 1-C-1 - A patient who, by reason of pre-existing or other medical conditions, is at significant risk for outpatient surgery in this facility should be referred to alternative facilities.
Standard 8-B-24 - The surgeon/proceduralist and the licensed or qualified anesthesia provider concur on the appropriateness of the procedures performed at the facility based on the medical status of the patient, age and physiological appropriateness of the patient, and qualifications of the providers and the facility resources.
You may want to check your state law to verify if there are regulations that prohibit any ASA classification from being performed in an outpatient surgery center.
Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.