Frequently Asked Questions
Safe and Effective Analgesia and Administration for Osteopathic Physicians in office-based settings
Why was the rule put into effect?
In 2007 the Legislature passed ESHB 1414 requiring facilities that use general anesthesia to be licensed by the Department of Health. The legislation authorized the Board of Osteopathic Medicine and Surgery to create rules governing office-based surgery using less than general anesthesia. The rule establishes enforceable standards for physicians who perform office-based surgery to reduce the risk of substandard care, inappropriate administration of anesthesia, infections, and other serious complications. The rules that are currently in effect are WAC 246-853-650
http://apps.leg.wa.gov/WAC/default.aspx?cite=246-853-650.
What caused the legislation?
Over the past 25 years, advances in anesthesia and medical technology have made surgery outside of hospitals the preferred option for many patients. Currently, outpatient surgeries account for an estimated 70% of all surgeries performed in the United States. Of all outpatient operations, an estimated 20% are performed in physicians’ offices. Patients may find that having surgery performed in the physician’s office is more convenient and less expensive than having surgery in a hospital or ambulatory surgical facility. As a result, a significant volume of surgery is being transferred from large, regulated surgical centers to unregulated, small offices. Due to that, the department established office-based surgery rules to ensure physicians performing office-based surgery are meeting certain standards and keeping patients safe.
How long does a physician have to become accredited or certified with either the Joint Commission, Accreditation Association for Ambulatory Health Care, the American Association for Accreditation of Ambulatory Surgery Facilities, the Centers for Medicare and Medicaid Services, Planned Parenthood or the National Abortion Federation?
The physician must receive accreditation within 365 calendar days from the effective date of this rule. Because the rule took effect on January 17, 2011, a facility must be accredited by January 17, 2012.
Who sets accreditation standards for appropriate equipment to ensure patient safety?
A physician who performs a procedure under this rule must ensure he or she performs it in a facility that is appropriately equipped and maintained to ensure patient safety through accreditation or certification and in good standing from one of the following:
- The Joint Commission
- The Accreditation Association for Ambulatory Health Care
- The American Association for Accreditation of Ambulatory Surgery Facilities
- The Centers for Medicare and Medicaid Services
- Planned Parenthood Federation of America or the National Abortion Federation, for facilities limited to office-based surgery for abortion or abortion-related services.
Are there exemptions to this rule?
Yes. Attached are links to the rules which outline the exemptions for the osteopathic physician.
http://apps.leg.wa.gov/WAC/default.aspx?cite=246-853-650
Can the physician who performs the surgery also administer the intravenous sedation?
No. The physician performing the surgical procedure must not administer the intravenous sedation, or monitor the patient. Also, the licensed health care practitioner designated by the physician to administer intravenous medications and monitor the patient who is under moderate sedation, may assist the operating physician with minor, interruptible tasks of short duration once the patient's level of sedation and vital signs have been stabilized, provided that they maintain adequate monitoring of the patient's condition. The licensed health care practitioner who administers intravenous medications and monitors a patient under deep sedation or analgesia must not perform or assist in the surgical procedure.
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