JCAH sets standards tor surgery in nonhospital setting

Jean Carroll, PhD

To keep pace with the ever changing health care delivery system, the Joint Commission on Accreditation of Hospitals (JCAH) continually re- vises its standards. These are used as a yardstick for facilities that wish to attain a level of care set by a pro- fessional and nationally recognized group.

In the early 1970s new types of fa- cilities providing surgical services and postoperative management on an outpatient basis necessitated new JCAH standards. Ambulatory sur- gery was being done in hospitals, neighborhood health centers (some hospital affiliated and some not) and freestanding centers. While neigh- borhood health centers and free- standing centers share similarities, they differ in the way they are gov- erned. The neighborhood health cen-

Jean Carroll, PhD, i s program director of research and standards for the Joint Commission on Ac- creditation of Hospitals. She holds a PhD degree in social psychology from the University of Chi- cago.

ter has a governing body or advisory council that includes members of the neighborhood it serves. The free- standing center does not necessarily include neighborhood representatives on its governing body. In fact, it may be organized on a proprietary basis. While there are about 400 neighbor- hood health centers in the US, rela- tively few offer surgical services. There are about 200 nonhospital cen- ters for ambulatory health care. Some are operational, others are nearing completion, and still others are in the planning stage. This esti- mate is based on requests to the JCAH for standards from architects and firms engaged in planning non- hospital centers.

Outpatient surgery and day sur- gery programs in hospitals are reg- ulated by the JCAH Accreditation Manual for Hospitals. Standards for surgery in neighborhood health cen- ters, whether or not hospital affili- ated, and in freestanding centers for ambulatory health care, were adopted

AORN Journal, March 1974, Vol 19, No 3 649

by the JCAH in 1973. The mechan- ism for implementation of these standards is being studied by the JCAH board of 20 commissioners which includes representatives from the American College of Surgeons, the American College of Physicians, the American Hospital Association and the American Medical Associa- tion.

This article presents a review of the standards for surgical services in nonhospital and freestanding facil- ities. JCAH is planning to publish the complete manual, Standards for Neighborhood Health Centers and Nonhospital Centers for Ambulatory Health Care, this spring.

Contcnt. Emphasized is the need for effective organization to attain the center’s objectives as well as to ensure continuity of patient service. Qualifications of personnel and su- pervisory relationships are outlined, but no attempt is made to specify re- quired numbers of personnel or to establish desirable staffing ratios. The medical record is recognized for its value in facilitating continuity of care, review and evaluation of pa- tient care, and in the study of the utilization of resources and services. Hence, the need for completeness and accuracy in keeping medical records is emphasized.

The standards provide that, where outpatient surgery is performed, nursing services in operating rooms, postoperative recovery rooms and other patient observation areas must be under the full-time supervision of registered nurses. Only a qualified anesthetist shall administer anes- thetics other than local infiltration anesthetics. This person must have the competence to induce anesthesia,

maintain anesthesia at required levels, manage untoward reactions and provide professional observation and resuscitative care for patients during the postanesthesia recovery period.

Nursing service personnel, techni- cal personnel and assistants must be trained in the operation of x-ray, monitoring and other diagnostic, re- suscitative and therapeutic proced- ures.

Written procedures must be devel- oped covering at least the following areas: types of surgery and elective operative procedures that may be performed in the center; types of anesthesia that may be used; pre- operative evaluation (must meet the same standards that apply to in- patient surgery in accredited hos- pitals); the obtaining of a valid operative permit; and written pre- operative instructions to patients. The center’s procedures must provide that a physician discuss the planned operation and anesthetic with the patient, including reference to po- tential risk. Every gross specimen and microscopic section must be examined and evaluated by a pathol- ogist.

Any patient who has received anesthesia must be examined by a physician before discharge. Written instructions concerning follow-up care must be given to the patient, and all patients must be advised as to whom they should contact for help in the event of postoperative compli- cations.

Physical setting. Properly equipped and manned operating rooms and re- covery rooms must be provided. A clinical laboratory and a suitably

650 AORN Journal, March 1974, Vol 19, No 3

equipped radiology area must be pro- vided and control measures to deal with the hazards of infection, elec- trical or mechanical failure, fire and explosion must be in effect. Facilities must be provided to sterilize equip- ment and supplies necessary to main- tain sterile technique. The center must have equipment and instrumen- tation for anesthesia, cardiopul- monary resuscitation and other physiologic support. The OR suite must be located so it does not connect wit,h a corridor used as a thorough- fare. The standards also include pro- visions for electrical circuitry, air handling systems, suction, availabil- ity of oxygen and epidemiological precautions.

Protection of quality of care. The medical staff must strive to create and maintain an optimal level of pro- fessional performance through the appointment procedure, delineation of privileges and continuing review and evaluation of patient care. This is not limited to services directly pro- vided by the physician. The per- formance of physicians, dentists, nurses and other health care person- nel providing patient care must be studied in a program of analysis, re- view and evaluation of the clinical practice which exists in the center. The results of patient care evalua- tion studies should be used in planning the continuing education programs of the medical staff. 0

Guidelines for ORT refresher course

The Association of Operating Room Nurses, Inc 10170 E Mississippi Ave Denver, Colo 80231

Please send us the following:

___- Copies of Guidelines for ORJ Refresher Course

___ @ $1.25 each for AORN members

@ $2.50 for non-AORN members

Cash or check must be received before your order can be filled. Allow three weeks for delivery.

Please type or print clearly:

Name

Street

City __ State Zip

AORN Journal, March 1974, Vol 19, N o 3 651