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 to develop a safe anesthetic plan specifically tailored to the unique needs of each patient. This webpage provides patient safety considerations for anesthesia services 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.

Facility Types

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

ASCs and OBSs

For specific state law requirements, please contact the State Government Affairs division at 847-655-1130 or sga@aana.com.

Considerations / Questions to Ask Your Facility

Emergency Preparedness

All personnel should be trained for emergency procedures. Under Centers for Medicare & Medicaid Services (CMS) Conditions for Coverage, Medicare-certified ASCs must have one annual emergency preparedness test. To learn more, visit CMS's Omnibus Burden Reduction Final Rule and the Ambulatory Surgery Center Association's Emergency Preparedness page. Drills should involve all staff and focus on specific individual roles.

Equipment Requirements

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.

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)
  • Defibrillator
  • Supplemental O2
  • Emergency drugs
  • Compression board
  • Suction equipment (suction catheter, Yankaur type)
  • Drugs and equipment to treat MH on site
  • Back-up power

Patient Selection

Outpatient facilities should develop policies based on their population needs and procedures to be performed. Anesthesia professionals evaluate each patient based on the policy and clinical judgment to optimize patient safety. The following criteria should be evaluated:
  1. Patient's physical status (e.g., diagnoses, severity of the disease state)
  2. Degree of stability of that physical status
  3. Patient's psychological status
  4. Patient's support system at home
  5. Intensity and duration of post-procedure monitoring
  6. 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.

Additional Resources

Policies and Procedures

The following policies, procedures, and protocols are examples of what should be in place:
See Employment Resources for additional information on OSHA, HIPAA, and NIOSH resources.

Staffing Considerations

Staffing should reflect the patient's acuity, the type and expected duration of the procedure, any environmental factors, and the setting in which the procedure will be performed.

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.
Questions to ask the facility:
  • Is the facility licensed? By whom?
  • Is the facility accredited? By whom? What is the accreditation program?