Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-10 - OFFICE-BASED SURGERY › Section 540-X-10-.01 - Preamble

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Office-based
			 surgery is surgery 1 performed outside a hospital or outpatient facility
			 licensed by the Alabama Department of Public Health. It is the position of the
			 Alabama Board of Medical Examiners that the physician is responsible for
			 providing a safe environment for office-based surgery. Surgical procedures in
			 medicine have changed over the generations from procedures performed at home or
			 at the surgeon's office to the hospital and, now, often back to outpatient
			 locations. However, the premise for the surgery remains unchanged: that it be
			 performed in the best interest of the patient and under the best circumstances
			 possible for the management of disease and the well-being of the patient.
			 Surgery that is performed in a physician's office at this time varies from a
			 simple incision and drainage with topical anesthesia to semi-complex procedures
			 under general anesthesia. It is imperative that the surgeon evaluate the
			 patient, advise and assist the patient with a decision about the procedure and
			 the location for its performance and, to the best of the surgeon's ability,
			 assure that the quality of care be equal in any facility that the surgeon
			 advises. If the physician performs surgery in the physician's office, it is
			 expected that the physician will require office standards similar to those at
			 other sites where the physician performs such procedures. It is also expected
			 that any physician who performs a surgical procedure is knowledgeable about
			 sterile technique, the need for pathological evaluation of certain surgical
			 specimens, about any drug that the physician administers or orders
			 administered, and about potential untoward reactions and complications and
			 their treatment. Recognizing that there have been serious adverse events in
			 office surgical settings, both in Alabama and in other states, the Board of
			 Medical Examiners, in conjunction with an
ad hoc
committee
			 representing various medical and surgical specialties, has developed guidelines
			 for physicians who perform surgery in their offices. These guidelines are
			 intended to remind the physician of the minimal suggested necessities for
			 various levels of surgery in the office setting. The physician must decide on a
			 case-by-case basis the location and level of service that is best for the
			 physician's particular patient and procedure; this decision must always be made
			 with the patient's best interest in mind.
(2) The Alabama Board of Medical Examiners
			 recommends the following general guidelines for office-based
			 surgery/procedures:
(a) Training: A procedure,
			 whether done in an office, outpatient surgical facility or hospital, should be
			 performed by physicians operating within their area of professional training.
			 Appropriate training and continuing medical education should be documented and
			 that documentation readily available to patients and the Alabama Board of
			 Medical Examiners. Physicians who perform office-based procedures must have
			 plans for managing emergency complications.
(b) Patient Selection: Patients must be
			 individually evaluated for each procedure to determine if the office is an
			 appropriate setting for the anesthesia required and for the surgical procedure
			 to be performed.
(c) Patient
			 Evaluation: Patients undergoing office-based surgery must have an appropriately
			 documented history and physical examination as well as other indicated
			 consultations and studies.
(d)
			 Anesthesia: When deep sedation, major regional anesthesia or general anesthesia
			 is provided in the office setting, it must be administered by a qualified
			 person(s)2 other than the person performing the procedure. Anesthesia personnel
			 should be familiar with variations in technique based on the specifics of the
			 patient and the procedure, particularly patients requiring large volumes of
			 fluids and/or requiring airway management. Patients must be properly monitored
			 before, during and after the procedure. Anesthesia personnel should be
			 currently trained in ACLS.
(e)
			 Office Setting: The office should be set up with patient safety as a primary
			 consideration. Safety issues should include, but not be limited to,
			 accessibility, sterilization and cleaning routines, storage of materials and
			 supplies, supply inventory, emergency equipment, and infection
			 control.
(f) Emergency Planning:
			 Planning should include, but not be limited to, emergency medicines, emergency
			 equipment, and transfer protocols 3. Practitioners should be trained and
			 capable of recognizing and managing complications related to anesthesia that
			 he/she administers and the procedures that he/she performs.
(g) Follow-up Care: As with any surgical
			 treatment or procedure, follow-up care by the responsible surgeon is a
			 requirement. Arrangements shall be made for follow-up care and for treatment of
			 complications outside normal business hours. The patient, or a responsible
			 adult, should be aware of these arrangements and of any medications prescribed
			 after the procedure.
(h) Quality
			 Improvement: Continuous quality improvement should be a goal.
(i) Facility accreditation is encouraged for
			 those settings where deep sedation/analgesia (level 4) and general anesthesia
			 (level 5) are provided.