SDS Accreditation Update: Anesthesia monitoring requirements clarified

Immediately available’ differs between programs

Requirements for credentialing and privileging, responsibility for patient care, anesthesia monitoring, and availability to resuscitate have undergone major changes in the Wilmette, IL-based Accreditation Association for Ambulatory Health Care’s standards for 2003.

The committee members charged with reviewing and revising these standards spent considerable discussion on anesthesia-related issues, says Francis P. DiPlacido, DMD, a Fort Myers, FL, oral and maxillofacial surgeon and chairman of the AAAHC’s Standards and Survey Procedures Committee.

"We decided that it was impossible to come up with a one-size-fits-all standard that defined the term immediately available’ when talking about a person being available to provide resuscitative measures," says DiPlacido.

The standards define immediately available as being ready to apply resuscitative measures in a timely manner, he says. "We decided not to apply a specific timeframe as the definition of immediately available because that would place unrealistic and unnecessary limitations on some organizations," he adds.

Because the ability to meet this standard will differ from facility to facility, surveyors will have to use their own judgment, DiPlacido points out.

"Not only will surveyors evaluate the physical facility, but they also will evaluate the level of skill and training of personnel other than the anesthesiologist or surgeon," he says.

For example, immediately available in a same-day surgery program that is part of, or attached to, a hospital might mean the physician or dentist is somewhere within the hospital, he says. For freestanding facilities, the surveyor will have to evaluate the training of the staff, level of anesthesia typically used, and equipment available in the recovery area to determine if the dentist, surgeon, or anesthesiologist can leave the facility and still be immediately available, he adds.

"The bottom line is patient safety," DiPlacido says. "The best way to evaluate your policy is to ask yourself if you would want one of your own family members in your facility with its current definition of immediately available."

Another addition to the standards clarifies that the organization is responsible for the patient as long as the patient is in the facility, DiPlacido says. This responsibility includes even the waiting room if the patient has been discharged from recovery and is waiting for a ride home, he adds.

Although AAAHC standards have always addressed privileging and credentialing, the new standards have been amplified and enhanced, says DiPlacido. "We want to make sure that organizations understand that credentialing and privileging are two separate processes that require ongoing evaluation and review. Just because a physician or dentist’s credentials have been verified, a same-day surgery program should not grant blanket privileges," he states.

"Each physician should be granted privileges for specific procedures based upon the procedures for which he or she is trained and qualified," he explains. The practice of allowing a physician to perform all procedures without verifying the training or skill for each is unacceptable, he adds. When verifying a physician or dentist’s educational and training, the organization must rely upon primary sources for verification, DiPlacido says. Primary sources include the schools, training programs, or colleges at which the applicant was trained, he says. The new standards manual includes a list of primary sources acceptable for verification of training, education, board certification, and licensure, he adds.

The new standards are well defined without placing an unreasonable burden on the accredited organization, DiPlacido points out.

"We recognize that each organization is different, and we developed standards that allow for those differences without jeopardizing patient safety, which is our main concern," he says.

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For information, contact: AAAHC, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. Telephone: (847) 853-6060. Fax: (847) 853-9028. Web: www.aaahc.org/accreditation/standards.shtml.