Preventing Errors In The Outpatient Setting: A Tale of Three States

Elizabeth M. Lapetina and Elizabeth M. Armstrong

Disclosures

Health Affairs. 2002;21(4) 

In This Article

Setting Standards for Facilities

Standards for outpatient surgery facilities vary widely based on the specific practice specialty's requirements and the standards required by the particular accrediting organization. Three major bodies now issue accreditation of office-based practices: the Joint Commission on Accreditation of Healthcare Organizations ( JCAHO), the Accreditation Association for Ambulatory Health Care (AAAHC), and the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Twenty states, including New York and Florida, require the accreditation of ambulatory surgical facilities by one of these three agencies.[19] Only California, Connecticut, Florida, Pennsylania, and Rhode Island require that office-based surgical practices receive accreditation from one of these organizations.[20] The New Jersey Board of Medicine regulates outpatient settings with the same standards that are used to regulate hospitals. Some health plans have encouraged outpatient facilities to seek accreditation by reimbursing only those procedures performed in accredited facilities.[21] However, facilities in many areas are not required to seek any accreditation.

Each of the accrediting organizations has developed its own niche, and each has a specific set of requirements that must be met based on the level of anesthesia involved in the procedure. There are general d visions into classes, with each higher-level class encompassing progressively more advanced procedures. Their differing requirements and procedures have added to the confusion over proper accreditation and standards for office-based surgical procedures.

The AAAASF is predominantly an office-practice accrediting organization that mainly accredits plastic surgery facilities.[22] Any facility accredited by the organization must be owned or operated by American Board of Medical Specialties surgeons, who have been board-certified in the procedures they will perform. For all specialties, the physician must have hospital privileges, including transfer privileges, at a nearby facility. The accreditation program addresses the facility layout; patient and personnel records; quality assessment and quality improvement plans; and operating room personnel, equipment, operations, management, and sanitation. Once the inspection is complete, the AAAASF's Operations Committee and board of d rectors issue accreditation, provisional accreditation, or denial of accreditation. This process operates on a three-year cycle. In the intervening years facility d rectors are required to complete a self-evaluation. Failure to do so voids the accreditation.[23]

The AAAHC accreditation process is similar to that of the AAAASF. Following an initial self-assessment by the facility seeking accreditation, practicing professionals conduct an on-site survey of the facility. The AAAHC issues six-month, one-year, and three-year accreditation, depending on the facility's ability to meet all clinical and administrative aspects of ambulatory health care standards. Accredited facilities are required to meet standards in the following core areas: rights of patients, governance, administration, quality of care and quality improvement, clinical records, and facilities and environment.[24]

The JCAHO accredits the widest range of health care facilities, including office-based practices, ambulatory care facilities, and hospitals. Professional surveyors, who have completed JCAHO training programs, tour the organization's facilities, examine all patient care areas, interview staff members and patients, review documents and selected patient records, and, at the conclusion of the survey, issue a preliminary report and accreditation decision to the facility. In conducting its examination, the JCAHO looks at the facility's safety, security, treatment of hazardous wastes and materials, emergency preparedness, patient safety, equipment condition, and utility systems.[25] The JCAHO's accreditation process provides the most exposure of the facility to surveyors and also more flexibility in issuing accreditation. However, the JCAHO is relatively new to the field of accrediting office-based practice facilities. Although separate statistics are not available for office-based procedures, the JCAHO accredits more than 1,100 ambulatory surgery settings. In 2000, 358 facilities underwent a triennial survey. None was denied accreditation; 74 percent received Accreditation with Requirements for Improvement.[26]

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