Outpatient Facility Considerations
The number of elective surgical procedures performed at freestanding diagnostic and ambulatory surgical centers (ASCs) is increasing dramatically. As anesthesia professionals, CRNAs consider multiple factors, from facility type and resources to patient comorbidities, in order develop a safe anesthetic plan specifically tailored to the unique needs of each patient. This webpage provides patient safety considerations for anesthesia services provided in outpatient facilities, including ASCs and office-based anesthesia settings (OBSs).
Outpatient facilities may be regulated at the local, state, and federal level. They may also be accredited by an accreditation program. Please comply with applicable regulatory and accreditation requirements.
Ambulatory Surgery Centers
- ASCs are regulated at the local, state and federal levels. Visit the Code of Federal Regulations to view the current CMS ASC Regulations.
Office-Based Anesthesia Settings
- Some states regulate OBSs. Visit the Office Anesthesia Practice Map to see which states have laws and/or regulations governing office practice.
- Visit AANA resources:
- Position Statement Office Based Anesthesia
- Assessment Checklist Minimum Elements for Providing Anesthesia Services in the Office Based Practice Setting.
ASCs and OBSs
Considerations / Questions to Ask Your Facility
All personnel should be trained for emergency procedures. Under Centers for Medicare & Medicaid Services (CMS) Conditions for Coverage, Medicare-certified ASCs must have two annual emergency preparedness tests. To learn more, visit the Ambulatory Surgery Center Association's Emergency Preparedness page. Drills should involve all staff and focus on specific individual roles.Examples of Emergency Equipment
- Basic airway equipment (adult and pediatric)
- Nasal and oral airway
- Face mask (appropriate for patient)
- Laryngoscopes, endotracheal tubes (adult and pediatric)
- Ambu bag or other positive pressure ventilation device
- Difficult airway equipment (laryngeal mask airway, light wand, cricothyrotomy kit)
- Supplemental O2
- Emergency drugs
- Compression board
- Suction equipment (suction catheter, Yankaur type)
- Drugs and equipment to treat MH on site
- Back-up power
Equipment must be maintained, labeled, and inspected regularly according to manufacturer’s requirements. Standard 6 of the Standards for Nurse Anesthesia Practice states that CRNAs must “adhere to manufacturer’s operating instructions and other safety precautions to complete a daily anesthesia equipment check” and “verify function of anesthesia equipment prior to each anesthetic.” Equipment should be available that can accommodate the needs of obese patients. The capacity limit is site-specific.
The AANA offers the Anesthesia Equipment and Supplies Checklist, which can be printed and kept in a log book.
- Patient's physical status (e.g., diagnoses, severity of the disease state)
- Degree of stability of that physical status
- Patient's psychological status
- Patient's support system at home
- Intensity and duration of post-procedure monitoring
- Risk of developing a deep vein thrombosis (DVT) and pulmonary embolism (PE) and the ability to provide thromboembolic prophylaxis
Note: The Practice Committee and AANA Professional Practice Division are working on clinical patient selection considerations.
- Documenting Anesthesia Care (2016)
- Login to view AANA Member Business Resources to view templates, tools, and checklists in a customizable (Word) format. Specific examples include Anesthesia Records (short and complex) and Pre-anesthesia Evaluations.
Policies and Procedures
- Preoperative lab requirements
- Transfer to higher level of care
- Infection prevention and control (see the guidelines at Infection Prevention and Control Guidelines for Anesthesia Care, 2015 and Infection Prevention and Control Resources)
- Discharge criteria, including case cancellations (see Postanesthesia Care, 2019 and Discharge After Sedation or Anesthesia on the Day of the Procedure, 2018)
- Malignant Hyperthermia protocols (see Malignant Hyperthermia Crisis Preparedness and Treatment, 2018 and Malignant Hyperthermia Crisis Policy Template, 2017 (login required))
- Latex allergy protocols (see Latex Allergy Management, 2018)
- Reporting adverse reactions (see Adverse Medical Events/Critical Incidents for coping strategies)
- Sharps safety
- The Occupational Safety and Health Administration (OSHA)’s Bloodborne Pathogens Standard (BBP) requires employers to provide information and training to workers. Visit the OSHA website to learn more.
- Emergency Policies, e.g.,
- Chemical spill
- Building evacuation
- Bomb threat
- Active shooter incidents (see AANA NewsBulletin Wellness Milestone Workplace Shootings: CRNAs Surviving as the First and Second Victim, Sept. 2019)
See the Practice Management resource, Anesthesia Staffing Considerations Checklist (login required).
Questions to ask the facility:
- Does the facility liability insurance cover office/outpatient anesthesia? (see AANA Insurance)
- Does the surgeon have liability insurance which covers the procedures performed in the setting, including the anesthesia/sedation?
- Does the surgeon have an unrestricted license to practice in the state of the practice setting?
- Does the facility/surgeon have a Drug Enforcement Agency (DEA) number?
- Does the surgeon have admitting privileges at a local appropriate hospital? If not, does the facility have documented procedures for transfer of patient for emergency conditions beyond the capabilities of the facility?
Regulation and Accreditation of Surgical Facility
- Facilities may be required to be licensed and/or accredited in accordance with state laws and regulations. In addition, facilities may voluntarily choose to be accredited by one of the accreditation programs (e.g. The Joint Commission, the Accreditation Association for Ambulatory Health Care (AAAHC), the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), or the Healthcare Facilities Accreditation Program (HFAP)).
- Facilities and CRNAs should review federal, state, and local laws and regulations and accreditation requirements that apply to the facility.
- Is the facility licensed? By whom?
- Is the facility accredited? By whom? What is the accreditation program?
- For more information, visit Facility Accreditation