(a) All persons admitted to the ambulatory surgical center shall be under the direct care of a member of the provider staff. The provider staff shall ensure the continuity of care for each patient including pre-operative, intra-operative, and post-operative care. Each patient shall be provided prior to admission all necessary instruction and education for pre and post-surgical care.
(b) Restrictions: Surgical care shall be limited to the following: - (i) Those that do not exceed twenty-three (23) hours of combined operating and recovery and/or convalescent time; and
- (ii) Those that do not generally result in extensive blood loss, require major or prolonged invasion of body cavities, directly involving major blood vessels, or constitute an emergency or life threatening procedure.
(c) Identification: - (i) Each patient admitted to the center shall have a visible means of identification placed and maintained on his/her person until discharge.
- (ii) 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 in another licensed health care facility.
(d) Admission Requirements: - (i) All such admissions shall be in accordance with appropriate written policies and procedures which reflect the admission requirements established in this section, recommended by the provider staff and adopted by the Governing Body, specific to the ambulatory surgical center operations, that include at least the following:
- (A) The patient must be in good health or have mild systemic disease which is under good control and does not require special management. Patient status shall be documented by the admitting physician.
- (B) The patient or a responsible person acting on behalf of the patient must be able to strictly follow instructions related to the 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.
- (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 ambulatory surgical center.
- (F) When overnight care is provided, appropriate services shall be rendered within the defined capabilities of the organization. If overnight care is to be provided by the ambulatory surgical center, notice of such shall be provided to the Office of Health Quality.
- (G) The Governing Body of the ambulatory surgical center shall have an organization wide policy on the use of smoking materials in the facility which shall be posted and disclosed to the patient upon admission.
(e) Off-Site Pre-Planned Transfers: - (i) Off-site pre-planned transfer of patients shall be limited to only those licensed health care facilities, that are physically located off-site or off-campus, when it is known in advance that further post-surgical patient care will be needed.
- (A) Off-site pre-planned 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.
- (ii) Ambulatory surgical centers providing off-site pre-planned transfer service options shall adhere to the following requirements:
- (A) Disclosure. Ambulatory surgical centers offering surgical services which include an off-site pre-planned transfer to another licensed health care facility following post-operative recovery shall disclose in written form to the patient all the details of the transfer prior to admission to the ambulatory surgical center. 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 prior to the time for admission to the ambulatory surgical center. The patient shall acknowledge such disclosure in writing, and the date thereof. Such disclosures on ambulatory surgical 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 health care facilities that can provide the level of care necessary to meet the needs of the patient. The ambulatory surgical center shall have a written agreement with any and each licensed health care facility that admits patients for post-surgical care from an ambulatory surgical center. The ambulatory surgical center shall provide written discharge instructions, including patient progress information to the receiving health care facility.
- (I) An ambulatory surgical center shall allow pre-planned transfers only with the written authorization of the attending operating surgeon or physician. The attending operating surgeon or physician shall approve such 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 ambulance. The ambulatory surgical 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 provider staff from the ambulatory surgical center shall accompany the patient on the ambulance to provide continuity of care that meets the post-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 patient transfers. The ambulatory surgical center shall provide close-in parking that shall be accessible at all times and shall not be obstructed by other parked vehicles or architectural barriers. The space provided shall include adequate height clearance for ambulances.
- (E) Ambulatory surgical centers located above the ground level of the building that admits patients for which a pre-planned transfer is anticipated shall have at least one elevator available for the transport of such patients. The elevator shall be large enough to accommodate an ambulance cot in a horizontal position and a minimum of two attendants.
(f) On-Site Pre-Planned Transfers: - (i) On-site pre-planned transfers of patients are also authorized where it is known in advance that further post-surgical care will be needed. Such transfers are limited to:
- (A) Other licensed health care facilities located on-site or on-campus and are physically connected to the ambulatory surgical center.
- (B) Ambulatory surgical centers that provide extended recovery care services within the physical confines of the centers.
- (ii) Extended Recovery Care Services:
- (A) Extended recovery care services provided by an ambulatory surgical center shall not exceed twenty-three (23) hours combined operating and recovery and/or convalescent time.
- (B) Extended recovery care services shall not be provided to more than four patients anywhere in the ambulatory surgical center, between the hours of 10:00 p.m. and 6:00 a.m.
- (C) Extended recovery care area and equipment shall include as a minimum:
- (I) Direct visual observation of all patients;
- (II) Medicine administration;
- (VII) Emergency call system;
- (VIII) Storage space for supplies and equipment; and
- (IX) Bed space. There must be at least 3'0" on each side or between recovery care area beds and space at the foot of each bed for work and/or circulation.
- (D) A minimum of two health care workers, one of which shall be a registered nurse with Advanced Cardiac Life Support (ACLS) certification, shall be on duty when patients are in the extended recovery care unit.
- (E) Extended recovery care services shall have policies and procedures that describe the nature and extent of the extended recovery services provided, which are consistent with ambulatory surgery and anesthesia services.
- (F) Extended recovery care services shall be integrated with other departments and services of the facility.
- (G) In addition to the items required in a patient's medical record, the physician shall document the following:
- (I) The reason(s) or need for a patient's admission to the extended recovery care unit, and
- (II) Dietary orders to meet the nutritional needs of the patient.
- (H) The facility shall obtain a Food Service Establishment Permit, if required by the county health department.
- (I) Inspection reports by the county health department shall be maintained at the facility for review by the Office of Health Quality.
- (II) All personnel who prepare or serve food shall observe personal hygiene and sanitation practices which protect food from contamination.
(g) Emergency Services: - (i) Ambulatory surgical centers shall have policies and procedures which provide for adequate care of the center's patients in the event of an emergency.
- (ii) There shall be a policy and procedure for obtaining ambulance services to a hospital including the notification of the next of kin or responsible party.
- (iii) There shall be a written transfer agreement with a hospital or all physicians performing surgery in the ambulatory surgical center shall have admitting privileges at the hospital.
- (iv) Emergency equipment and supplies shall be available on the premises.
- (v) An ambulatory surgical center transferring a patient to a hospital on an emergency basis, shall submit to the receiving hospital at the time of transfer a copy of all medical records related to the patient's condition, including observations of the patient's signs and symptoms, preliminary diagnosis, treatment provided, results of any tests, and a copy of the informed written consent.