048-5 Wyo. Code R. §§ 5-7 - Admissions
(a) All persons admitted to the ambulatory
surgical center shall be under the direct care of a member of the provider
staff. The provider staff shall ensure the continuity of care for each patient
including pre-operative, intra-operative, and post-operative care. Each patient
shall be provided prior to admission all necessary instruction and education
for pre and post-surgical care.
(b)
Restrictions: Surgical care shall be limited to the following:
(i) Those that do not exceed twenty-three
(23) hours of combined operating and recovery and/or convalescent time;
and
(ii) Those that do not
generally result in extensive blood loss, require major or prolonged invasion
of body cavities, directly involving major blood vessels, or constitute an
emergency or life threatening procedure.
(c) Identification:
(i) Each patient admitted to the center shall
have a visible means of identification placed and maintained on his/her person
until discharge.
(ii) In cases of
off-site, pre-planned transfer, such means of identification shall be
maintained throughout the period of transfer and until such time as the patient
becomes a patient in another licensed health care facility.
(d) Admission Requirements:
(i) All such admissions shall be in
accordance with appropriate written policies and procedures which reflect the
admission requirements established in this section, recommended by the provider
staff and adopted by the Governing Body, specific to the ambulatory surgical
center operations, that include at least the following:
(A) The patient must be in good health or
have mild systemic disease which is under good control and does not require
special management. Patient status shall be documented by the admitting
physician.
(B) The patient or a
responsible person acting on behalf of the patient must be able to strictly
follow instructions related to the ingestion of fluids or solids within the
specified time frame prior to the surgery.
(C) If the patient is to receive sedation or
anesthetic which will result in impaired mental status following surgery, the
patient must be accompanied upon discharge by a responsible adult.
(D) Patients who may require post-operative
ventilation following surgery, either because of the procedure to be performed
or because of a pre-existing condition, shall not be admitted for
surgery.
(E) Surgery which requires
the presence of special equipment, personnel, and/or facilities due to the risk
of the operation involved shall not be performed in the center unless such
equipment, personnel, and/or facilities are available in the ambulatory
surgical center.
(F) When overnight
care is provided, appropriate services shall be rendered within the defined
capabilities of the organization. If overnight care is to be provided by the
ambulatory surgical center, notice of such shall be provided to the Office of
Health Quality.
(G) The Governing
Body of the ambulatory surgical center shall have an organization wide policy
on the use of smoking materials in the facility which shall be posted and
disclosed to the patient upon admission.
(e) Off-Site Pre-Planned Transfers:
(i) Off-site pre-planned transfer of patients
shall be limited to only those licensed health care facilities, that are
physically located off-site or off-campus, when it is known in advance that
further post-surgical patient care will be needed.
(A) Off-site pre-planned transfers do not
include discharges to the patient's place of residence where further care will
be provided by home health or home care providers.
(ii) Ambulatory surgical centers providing
off-site pre-planned transfer service options shall adhere to the following
requirements:
(A) Disclosure. Ambulatory
surgical centers offering surgical services which include an off-site
pre-planned transfer to another licensed health care facility following
post-operative recovery shall disclose in written form to the patient all the
details of the transfer prior to admission to the ambulatory surgical center.
Disclosure includes but is not limited to the cost of the transfer, whether or
not such costs shall be covered by insurance or other third party payer, and
the details of the actual transfer, including but not limited to the mode of
transport. Disclosure shall be made prior to the time for admission to the
ambulatory surgical center. The patient shall acknowledge such disclosure in
writing, and the date thereof. Such disclosures on ambulatory surgical center
policies regarding off-site pre-planned transfers shall be in addition to the
requirements for informed consent.
(B) Off-site pre-planned transfers shall be
made only to other licensed health care facilities that can provide the level
of care necessary to meet the needs of the patient. The ambulatory surgical
center shall have a written agreement with any and each licensed health care
facility that admits patients for post-surgical care from an ambulatory
surgical center. The ambulatory surgical center shall provide written discharge
instructions, including patient progress information to the receiving health
care facility.
(I) An ambulatory surgical
center shall allow pre-planned transfers only with the written authorization of
the attending operating surgeon or physician. The attending operating surgeon
or physician shall approve such transfer if there are assurances that the
continuity of care for the patient shall be maintained and contact with the
patient's attending physician is continuous.
(C) All pre-planned transfers shall be by
ambulance. The ambulatory surgical center shall have a written agreement with
the provider(s) of ambulance services. Such transfer agreements shall include
the provision for an appropriate level of care commensurate with the needs of a
post-surgical recovering patient. If necessary, as determined by the attending
or operating physician, licensed provider staff from the ambulatory surgical
center shall accompany the patient on the ambulance to provide continuity of
care that meets the post-operative needs of the patient.
(D) Ambulatory surgical centers engaging in
pre-planned transfers shall provide space at the entrance to the building to
facilitate patient transfers. The ambulatory surgical center shall provide
close-in parking that shall be accessible at all times and shall not be
obstructed by other parked vehicles or architectural barriers. The space
provided shall include adequate height clearance for ambulances.
(E) Ambulatory surgical centers located above
the ground level of the building that admits patients for which a pre-planned
transfer is anticipated shall have at least one elevator available for the
transport of such patients. The elevator shall be large enough to accommodate
an ambulance cot in a horizontal position and a minimum of two
attendants.
(f) On-Site Pre-Planned Transfers:
(i) On-site pre-planned transfers of patients
are also authorized where it is known in advance that further post-surgical
care will be needed. Such transfers are limited to:
(A) Other licensed health care facilities
located on-site or on-campus and are physically connected to the ambulatory
surgical center.
(B) Ambulatory
surgical centers that provide extended recovery care services within the
physical confines of the centers.
(ii) Extended Recovery Care Services:
(A) Extended recovery care services provided
by an ambulatory surgical center shall not exceed twenty-three (23) hours
combined operating and recovery and/or convalescent time.
(B) Extended recovery care services shall not
be provided to more than four patients anywhere in the ambulatory surgical
center, between the hours of 10:00 p.m. and 6:00 a.m.
(C) Extended recovery care area and equipment
shall include as a minimum:
(I) Direct visual
observation of all patients;
(II)
Medicine administration;
(III)
Medical charting;
(IV)
Toileting;
(V) Hand
washing;
(VI) Oxygen;
(VII) Emergency call system;
(VIII) Storage space for supplies and
equipment; and
(IX) Bed space.
There must be at least 3'0" on each side or between recovery care area beds and
space at the foot of each bed for work and/or circulation.
(D) A minimum of two health care workers, one
of which shall be a registered nurse with Advanced Cardiac Life Support (ACLS)
certification, shall be on duty when patients are in the extended recovery care
unit.
(E) Extended recovery care
services shall have policies and procedures that describe the nature and extent
of the extended recovery services provided, which are consistent with
ambulatory surgery and anesthesia services.
(F) Extended recovery care services shall be
integrated with other departments and services of the facility.
(G) In addition to the items required in a
patient's medical record, the physician shall document the following:
(I) The reason(s) or need for a patient's
admission to the extended recovery care unit, and
(II) Dietary orders to meet the nutritional
needs of the patient.
(H) The facility shall obtain a Food Service
Establishment Permit, if required by the county health department.
(I) Inspection reports by the county health
department shall be maintained at the facility for review by the Office of
Health Quality.
(II) All personnel
who prepare or serve food shall observe personal hygiene and sanitation
practices which protect food from contamination.
(g) Emergency Services:
(i) Ambulatory surgical centers shall have
policies and procedures which provide for adequate care of the center's
patients in the event of an emergency.
(ii) There shall be a policy and procedure
for obtaining ambulance services to a hospital including the notification of
the next of kin or responsible party.
(iii) There shall be a written transfer
agreement with a hospital or all physicians performing surgery in the
ambulatory surgical center shall have admitting privileges at the
hospital.
(iv) Emergency equipment
and supplies shall be available on the premises.
(v) An ambulatory surgical center
transferring a patient to a hospital on an emergency basis, shall submit to the
receiving hospital at the time of transfer a copy of all medical records
related to the patient's condition, including observations of the patient's
signs and symptoms, preliminary diagnosis, treatment provided, results of any
tests, and a copy of the informed written consent.
Notes
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No prior version found.