SDS Accreditation Update

AAAHC standards clarify medical and physical discharge

Medical discharge requires physicians’ presence, then they can leave

Physicians must be present or immediately available until patients are medically discharged, but they don’t need to be present until the patient leaves the same-day surgery program area, according to revised standards approved by the Wilmette, IL-based Accreditation Association for Ambulatory Health Care (AAAHC) for 2004. The standards become effective upon publication late this month.

While the 2003 standards made it clear same-day surgery programs are responsible for patients until they physically have left the facility, the 2004 revisions further clarify the responsibility, says Beverly K. Philip, MD, director of the Day Surgery Unit for Brigham and Women’s Hospital in Boston and chair of AAAHC Standards and Survey Procedures Committee. "The difference between the 2003 and the 2004 standards is that the physician does not have to be present or immediately available once the patient is medically discharged," she explains.

To address the same-day surgery program’s responsibility after medical discharge, Standard T-I states that personnel who are qualified in advanced resuscitative techniques such as advanced cardiac life support, or pediatric advanced life support, must be present or immediately available until the patient has physically left the facility, Philip states.

Another revision passed by the AAAHC board is a requirement that same-day surgery programs that serve pediatric patients develop and maintain a policy defining the care of pediatric patients with reference to specific components of perioperative care, Philip says. "This revision emphasizes our recognition that pediatric patients do require specialized care," she explains.

While AAAHC always has required accredited organizations to use the National Practitioner Data Bank for original credentialing, organizations now must use the service for reappointments in addition to verification of current licensure, Philip adds. "This step ensures that the organization has the most current, up-to-date information because things in the physician’s profile may have changed since the original credentialing," she says. (For information about the National Practitioner Data Bank, go to

Another important enhancement to the standards is the inclusion of related services in standards that typically have applied only to surgical facilities, Philip explains. "These standards now apply to any organization that performs invasive procedures such as pain management, endoscopy, cardiac catheterization, lithotripsy, and in vitro fertilization in addition to surgery." The reason for the change is patient safety, she says. "Although these are not necessarily surgical procedures, they are procedures that are done inside the body and carry some of the same risks that surgical procedures carry. For that reason, we want to ensure all AAAHC-accredited organizations meet the highest patient safety standards," Phillips says.


The 2004 edition of the AAAHC Accreditation Handbook for Ambulatory Care will be available soon. The cost is $120 and includes shipping costs. To order, contact:

Accreditation Association for Ambulatory Health Care, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. Phone: (847) 853-6060. Fax: (847) 853-9028. Web:

The 2004 Comprehensive Accreditation Manual for Ambulatory Care provides a detailed description of all standards and requirements for accreditation in a three-ring binder and costs $240. The softcover 2004 Standards for Ambulatory Care is a reference guide and costs $95. Other manuals include the Accreditation Manual for Office-Based Surgery Practices ($95) and The 2004 Comprehensive Accreditation Manual for Hospitals ($350). A separate standards manual for hospitals is available for $110. Costs include shipping. Any organization that submits an application for survey receives a complimentary copy of the accreditation manual, and currently accreditation organizations receive complimentary updates of the manuals. Contact:

Joint Commission on the Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (877) 223-6866 or (630) 792-5800. To order on-line, go to, choose "publications" at top of home page, then choose "manuals" on left navigation bar.