Office Based Procedure LSA Document #07-842(F)
- AAAASF (QuadASF) – American Association for Accreditation of Ambulatory Surgery Facilities, Inc.
- AAAHC (TripleAHC) – Accreditation Association for Ambulatory Health Care, Inc.
- JC – Joint Commission
- HFAP – Health Facilities Accreditation Program
Frequently Asked Questions
What type of accreditation is needed to perform procedures that require anesthesia in an office-based setting?
After January 1, 2010, a physician may not perform or supervise a procedure that requires anesthesia in an office-based setting unless the office-based setting is accredited by an accreditation agency approved by the board.
What is the purpose of the accreditation?
- Because sedation is a continuum, it is not always possible to predict how a patient will respond. Physicians administering sedation must be able to rescue a patient whose level of sedation becomes deeper than initially intended. Physicians administering regional anesthesia, or supervising or direction the administration of regional anesthesia, must be knowledgeable about the risks and the interventions required correcting any adverse physiological consequences that may occur.
What accrediting bodies are approved by the Medical Licensing Board?
- The following have been approved by the Board to offer this accreditation:
- (QuadASF) – American Association for Accreditation of Ambulatory Surgery Facilities, Inc.
- (TripleAHC) – Accreditation Association for Ambulatory Health Care, Inc.
- Joint Commission
- (HFAP) Health Facilities Accreditation Program
How long is the application process and what are the costs associated with the accreditation?
- You need to contact the accrediting bodies. Their websites and contact information are available on the Board’s website at http://www.in.gov/pla/2879
What is considered an “Office-based Setting?”
- Office based setting means any facility, clinic, center, office or other setting where procedures are performed that require anesthesia, which includes the following types: moderate sedation/analgesia, deep sedation/analgesia, or regional anesthesia. This term does NOT include a hospital operated by the federal government or a setting licensed under IC 16-21-2 as a hospital, ambulatory surgical center, abortion clinic or birthing center.
How do I know if I need this accreditation?
- If your office based setting described above is administering moderate sedation/analgesia, deep sedation/analgesia, general anesthesia, or regional anesthesia, you will need to be accredited by January, 2010.
What is the definition of the above types of anesthesia or sedation?
- “moderate sedation/analgesia" (also sometimes called "conscious sedation") means a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.
The following are conditions that a patient under moderate sedation/analgesia may experience:
- No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.
- Cardiovascular function is usually maintained.
- “deep sedation/analgesia" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. For purposes of this rule, reflex withdrawal from a painful stimulus is not considered a purposeful response.
The following are conditions that a patient under deep sedation/analgesia may experience:
- The ability to independently maintain ventilatory function may be impaired.
- Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate.
- Cardiovascular function is usually maintained.
- "general anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by pain stimulation.
The following are conditions that a patient under general anesthesia may experience:
- The ability to independently maintain ventilatory function is often impaired.
- Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function.
- Cardiovascular function may be impaired.
- "regional anesthesia" means the administration of anesthetic agents to a patient to interrupt nerve impulses without the loss of consciousness and includes the following:
- Major conduction blocks, such as:
(B) spinal; and
- Peripheral nerve blocks, such as:
(B) lumbar plexus;
(C) peribulbar; and
- Intravenous regional anesthesia, such as Bier blocks.
Notwithstanding section 2 of this rule, a superficial nerve block or application of a local anesthetic agent in which the total dosage administered exceeds the recommended maximum dosage per body weight described in the manufacturer's package insert shall be considered regional anesthesia for purposes of this rule.
Do I need accreditation if I am administering local anesthesia, topical anesthesia, superficial nerve blocks or minimal sedation/anxiolysis?
- No, accreditation is not required. Those are defined as the following:
- "local anesthesia" means a transient and reversible loss of sensation in a circumscribed portion of the body produced by:
- a local anesthetic agent; or
- cooling a circumscribed area of the skin.
(The term includes subcutaneous infiltration of an agent.)
- “topical anesthesia" means a transient and reversible loss of sensation to a circumscribed area produced by an anesthetic agent applied directly or by spray to the skin or mucous membranes.
- "superficial nerve block" means an agent placed in the proximity of any nerve or group of nerves outside of the vertebral canal to produce a loss of sensation in an anatomic or circumscribed area. The term is limited to the following blocks:
- digit; and
- "minimal sedation/anxiolysis" means a drug-induced state during which a patient responds normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are usually not affected.
What else is required of a physician?
A physician who performs a procedure that requires anesthesia in an office-based setting, or who directs or supervises the administration of anesthesia in an office-based setting, must have:
- Admitting privileges at a nearby hospital;
- A transfer agreement with another practitioner who has admitting privileges at a nearby hospital;
- An emergency transfer agreement with a nearby hospital.
- Agreements with local emergency medical services (EMS) for the purposes of transfer of patients to the hospital in case of an emergency.