6 Colo. Code Regs. § 1011-1-20-9
Current through Register Vol. 47, No. 22, November 25, 2024
Section 6 CCR 1011-1-20-9 - ADMISSIONS AND DISCHARGE9.1 All persons admitted to the ambulatory surgical center shall be under the direct care of a member of the medical staff. The medical staff shall ensure the continuity of care for each patient including pre-operative, intra-operative, and post-operative care. All necessary instruction and education shall be provided to each patient prior to admission (for pre-surgical care) and discharge (for post-surgical care).9.2 Restrictions: (A) Surgical procedures shall be limited to the following:(1) Those in which the expected combined operating and recovery time does not exceed 24 hours from the time of admission; and(2) Those that do not generally result in extensive blood loss; require major or prolonged invasion of body cavities; directly involve major blood vessels or constitute an emergency or life-threatening procedure.(B) There shall be no pre-planned, off-site transfers to a higher level of care and no transfers shall occur solely for the convenience of the ambulatory surgical center or its staff.9.3 Identification: Each patient admitted to the center shall have a visible means of identification placed and maintained on his/her person until discharge. In cases of off-site pre-planned transfer such means of identification shall be maintained throughout the period of transfer and until such time as the patient becomes a patient of another licensed facility.9.4 Admission Requirements: All admissions shall be in accordance with appropriate written policies and procedures which reflect the admission requirements established in this section, recommended by the medical staff and adopted by the governing body, specific to the ambulatory surgical center operations, that includes at least the following:(A) The physicians performing the procedure shall document in writing that the patient is in good health or that any pre-existing health conditions are adequately controlled, require no special management and are such that performance of the procedure in a center, rather than an inpatient hospital setting, does not pose an increased risk to the patient.(B) The patient or a responsible person acting on behalf of the patient must be able to strictly follow instructions related to ingestion of fluids or solids within the specified time frame prior to the surgery.(C) If the patient is to receive sedation or anesthetic which will result in impaired mental status following surgery, the patient must be accompanied upon discharge by a responsible adult, unless exempted in writing by the attending physician.(D) Patients who may require post-operative ventilation following surgery, either because of the procedure to be performed or because of a pre-existing condition, shall not be admitted for surgery.(E) Surgery which requires the presence of special equipment, personnel, and/or facilities due to the risk of the operation involved shall not be performed in the center unless such equipment, personnel, and/or facilities are available in the center.(F) When overnight care is provided, appropriate services shall be rendered within the defined capabilities of the organization.9.5 Discharge: Patients shall be in a stable condition which will not endanger their continued well-being or shall be transferred to a licensed hospital, convalescent center or other treatment facility. There shall be written procedures and assigned responsibilities for implementing such procedures, including provisions for transportation. The center shall provide verbal and written patient instructions regarding post-operative or post-procedure care, physician follow-up, and physician contact information.9.6 Off-Site Pre-Planned Transfers: Off-site pre-planned transfers of patients include those transfers of patients to other licensed health facilities, which are physically located off-site or off-campus, where it is known in advance that further post-surgical patient care will be needed. Off-site preplanned transfers do not include discharges to the patient's place of residence where further care will be provided by home health or home care providers. Ambulatory surgical centers providing off-site pre-planned transfer service options shall adhere to the following requirements:(A) Disclosure: Facilities offering surgical services which include an off-site pre-planned transfer to another licensed facility following post-operative recovery shall disclose in written form to the patient all the details of the transfer prior to admission to the facility. Disclosure includes, but is not limited to, the cost of the transfer, whether or not such costs shall be covered by insurance or other third party payer, and the details of the actual transfer, including, but not limited to, the mode of transport. Disclosure shall be made to the patient prior to the time for admission to the facility. The patient shall acknowledge such disclosure in writing, and the date thereof. Such disclosures on center policies regarding off-site pre-planned transfers shall be in addition to the requirements for informed consent.(B) Off-site pre-planned transfers shall be made only to other licensed facilities that can provide the level of care necessary to meet the needs of the patient. The center shall have a written agreement with any and each licensed facility that admits patients for post-surgical care from a center. The center shall provide written discharge instructions, including patient progress information, to the receiving facility.(1) An ambulatory surgical center shall allow preplanned transfers only with the written consent of the patient and the written authorization of the attending or operating surgeon or physician. The attending or operating surgeon or physician shall approve such a transfer if there are assurances that the continuity of care for the patient shall be maintained and contact with the patient's attending physician is continuous.(C) All pre-planned transfers shall be by licensed ambulance. The center shall have a written agreement with the provider(s) of ambulance services. Such transfer agreements shall include the provision for an appropriate level of care commensurate with the needs of a post-surgical recovering patient. If necessary, as determined by the attending or operating physician, licensed medical staff from the ambulatory surgical center shall accompany the patient on the ambulance to provide continuity of care and a level of care that meets the peri-operative needs of the patient.(D) Ambulatory surgical centers engaging in pre-planned transfers shall provide space at the entrance to the building to facilitate transfer. The center shall provide close-in parking that shall be accessible at all times and shall not be obstructed by other parked vehicles or any other architectural barriers. The space provided for ambulance access shall also contain adequate height clearance to accommodate a type I or a type III ambulance.9.7 On-Site Pre-Planned Transfers: On-site pre-planned transfers of patients are also authorized where it is known in advance that further post-surgical patient care will be desired or needed. Such transfers are limited to those transfers of patients to convalescent centers licensed in accordance with section 25 or other licensed health facilities, located on-site or on campus and are physically connected to the ambulatory surgical center. (A) The provisions of paragraph 9.6(A) and (B) shall apply to on-site pre-planned transfers. The provisions of paragraph 9.6(C) and (D) shall not apply to on-site pre-planned transfers.