Patient Selection, CME Rules Reduce Risk in
Office-based Surgery

Patients appreciate the convenience and cost savings of having a surgical procedure performed at their doctor's office, and the demand for office-based procedures is growing. With careful patient selection and adherence to rules set forth by the Illinois Department of Professional Regulation, physicians can address patient safety and quality concerns, and thereby reduce risk of liability.

Recommendations for selecting patients for office-based surgery include:

• Perform physical examination and thorough history on each patient.
• Conduct pre-operative testing, in consultation with a specialist, if there are concerns about the patient's physical condition.
• Consider only lower-risk patients (Class I or Class II, as defined by the American Society of Anesthesiologists) as candidates for in-office procedures.
• Evaluate use of anesthesia before surgery, if it is to be used during the procedure.

Anesthesia Requirements

Physicians who perform in-office anesthesia, or those who collaborate with a CRNA to provide in-office anesthesia, must have clinical privileges to administer anesthesia in a hospital or licensed ambulatory surgical treatment center. Alternatively, physicians may complete the following continuing medical education (CME) credits in each three-year licensure cycle, based on the level of sedation administered:

• Conscious sedation (moderate sedation) only: minimum eight hours of CME in delivery of anesthesia, including the administration of conscious sedation within each three-year license renewal period.
• Deep sedation, regional anesthesia and/or general anesthesia: 34 hours CME in anesthesia within each three-year license renewal period.

Additionally, physicians (including anesthesiologists) and CRNAs providing anesthesia services in the office setting must be certified in advanced cardiac life support (ACLS) during each licensure cycle. The current licensure cycle ends July 31, 2005.

For more information on risk reduction measures for office-based surgery, call the ISMIE Risk Management division, (800) 782-4767, ext. 1627.