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ADMISSION CRITERIA

1. To ensure adequate preparation for a patient's admission to the Surgery Center, the surgery should be scheduled a minimum of three (3) days in advance if possible. The posting phone number is 304-781-0676.
2. If block time is not scheduled (patient's name and the operation to be performed on the scheduling book) within 3 working days or 72 hours prior to the surgery date, the block time will be issued on a "first come, first serve" basis.
3. The first case posted at a given time on your block schedule day will be your starting time for that day. For example, if you request a 10:00 a.m. starting time for the first case, the room will be open for utilization by any other physician from 7:30 a.m. to 10:00 a.m. This will be on a first come, first serve basis. Only the 7:30 a.m. case is assured of starting on time.
4. The first surgeries scheduled for the day will begin at 7:30 a.m. The last cases will be scheduled in an attempt to have all patients discharged by 5:00 p.m. The following are examples of surgery cut off posting times:

   Full Nose Reconstruction/Sinusotomies	1:30 p.m.
   Breast Augmentation/Mammoplasty	1:00 p.m.
   Septoplasty	2:00 p.m.
   Laparoscopy	2:00 p.m.
   Hernia	2:00 p.m.
   Tonsillectomy and/or Adenoidectomy	2:00 p.m.
   Breast Biopsy, D&C, Myringotomies	2:30 p.m.
   Cataract Extraction	3:00 p.m.
   PU with Biopsy, Cystoscopy	3:00 p.m.

5. All surgeons must have pre-approved privileges to do any procedure.
6. All patients are to be classified according to their physical status as recommended by the American Society of Anesthesiology. Listed below are the physical status classifications:

   Class I:	A healthy patient. Example: Inguinal hernia in an otherwise healthy patient.
   Class II:	A patient with mild systemic disease. Example: chronic bronchitis, moderate obesity, diet-controlled diabetes mellitus, old myocardial infarction, mild hypertension.
   Class III:	A patient with severe systemic disease that is not incapacitating (controlled). Example: coronary artery disease with angina, insulin-dependent diabetes mellitus, morbid obesity, moderate to severe pulmonary insufficiency.

   Patients who are classified as I, II, or III are candidates for outpatient surgery. A patient that is a Class IV would be done at the discretion of the anesthesiologist. A patient posted as a straight local or local with sedation and an anesthesiologist is not on duty at the Center, the attending surgeon must be available until the patient is discharged. (If the case is posted as a local the surgeon must classify the patient.) In the best interests of the patient, those having an ASA IV classification should not have surgery at this facility.
7. Anesthesia related cases are to be cleared by the anesthesiologist before going to the O.R. or having a retrobulbar block. Patients with questionable pre-operative history obtained on the pre-op call will be reviewed by the anesthesiologist and additional pre-operative testing or other recommendations will be made at this time.
   • MEDICATIONS: All patients scheduled for surgery at CHSC no matter what type of anesthesia, (General, MAC or local) need to be instructed to take the following medications on the morning of surgery with a small sip of water: Blood pressure medications (unless it is as diuretic), cardiac medications, seizure medications, breathing medications (including inhalers and breathing treatments) and any other medications that is crucial to their well being. THE PATIENT SHOULD NOT TAKE ANY ORAL DIABETES MEDICATIONS OR INSULIN ON THE MORNING OF SURGERY.
     If there are any questions concerning a patient's medication please contact the CHSC and talk to a Pre/Post Op nurse.
   • FEVER/FLU: Any patient scheduled for General anesthesia that has had a fever along with a cold or flu symptoms or any respiratory symptoms should not be scheduled for surgery unless it has been 2 weeks since the symptoms have subsided. Any patient scheduled for MAC/Local anesthesia that has had a fever along with a cold or flu symptoms or any respiratory symptoms should not be scheduled for surgery unless it has been 3 days since the symptoms have subsided. (Fever will be a temperature of 100 degrees F and above.) Patients who have an acute URI (Upper Respiratory Infection) with a temperature or who have had an unexplained fever within 2 weeks of the scheduled surgery should reschedule their surgery until they are free of these symptoms. (Chronic rhino rhea will be accepted.)
8. General and MAC requirements:
   • EKG - An EKG is required on anyone with a previous abnormal EKG, arrhythmia, MI, hypertension or Congestive heart failure. The EKG will be accepted within 6 months of the date of surgery. Patients having had an EKG performed within 6 months of the date of surgery, that indicated a change in his or her cardiac status within that period of time, will be required to have the EKG repeated and a note from his or her physician clearing the patient for surgery. (Send the actual EKG tracing to the surgery center for the Anesthesiologist to review not just the written interpretation.)
   • Electrolytes - Patients with congestive heart failure or renal insufficiency and those taking diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) digoxin, or other medications that increase the likelihood or risks of an abnormal concentration. Required to have an electrolyte panel done within 14 days of the planned day of surgery.
   • CXR - A CXR (chest x-ray) Patients with higher than average likelihood of abnormal findings that might affect perioperative management, including patients with known cardiac or pulmonary disease and those with a history of physical examination findings of cardiopulmonary disease. The CXR is accepted within six months of the date of surgery, unless new symptoms have developed since that x-ray. Patients having had a CXR performed within six months of the date of surgery, that indicates a change in his/her pulmonary status within that period of time, will be required to have the CXR repeated and a note from his or her physician clearing the patient for surgery. (Patients with a history of asthma do not require a mandatory CXR - see asthma policy below.)
   • Potassium level - Patients that are taking potassium depleting medications will be required to have a serum potassium done within 14 days of the planned day of surgery as long as the level is within the acceptable range. Acceptable ranges are 3.2-5.2 for general cases and 3.0-5.2 for MAC cases.
   • Pregnancy Testing - Serum Pregnancy testing is required on all female patients from the onset of menses to the age of 50 years unless they have had a tubal ligation or hysterectomy. This testing must have been done within 7 days of the day of surgery.
   • A full term healthy baby under three (3) months of age or a premature baby under the age of one year are not candidates for outpatient surgery.
9. Asthma Policy:
   The following types of asthmatics are to be screened by the anesthesiologist and determination of suitability for scheduling will be determined on an individual basis:
   • Any asthmatic who has been treated in a hospital emergency room within the last two weeks.
   • Any asthmatic who has received oral or intravenous steroids to treat bronchospasm within the last 2 months. (Prednisone, Decadron, Dexamethasone, or similar drug). This does not include the use of a steroid puff inhaler.
   • Any asthmatic who has had an episode of wheezing or shortness breath within the last 2 weeks will be cleared by the anesthesiologist.
   • Mandatory CXR is not required for asthma patients.
10. Local anesthesia requirements: Those cases posted local are required to follow the same requirements as if they were MAC or General. Any local case with a questionable history or physical assessment should be evaluated by the anesthesiologist and recommendations be made to the surgeon.
    The anesthesiologist may cancel any case that he feels is inappropriate for outpatient surgery.
11. Cases scheduled for local anesthesia will have an IV started to assure quick access of medication in the event of a complication during the procedure/surgery. These cases will also have monitoring of EKG, BP and oxygen saturation.
12. All patient's must have a completed History and Physical (H&P) on the chart prior to the patient having a procedure/surgery done at the Cabell Huntington Surgery Center. This is to be completed by the surgeon or the surgeon may choose to send the patient out to their primary care physician for this. The H&P must have been done within 30 days of the day of surgery. (If the H&P is older than 30 days old it cannot be updated. A new one must be completed.) If the surgeon did not complete the H&P then he/she must sign and date that they have reviewed the H&P.
    Patients who have an acute URI (Upper Respiratory Infection) with a temperature or who have had an unexplained fever within 2 weeks of the scheduled surgery should reschedule their surgery until they are free of these symptoms. (Chronic rhino rhea will be accepted.)
13. Patients known to have Malignant Hyperthermia or a family history of such are not candidates for surgery.
14. The protocol for "Latex Allergy Management" will be implemented for any patient with a known Latex Allergy or states they are "Latex Allergic".
15. Guidelines for obese patients:
    Patients who weigh greater that 350 pounds will not be a candidate for surgery at the Cabell Huntington Surgery Center.
16. If any patient scheduled for surgery at the Cabell Huntington Surgery Center is on any type of diet pills whether prescription or over the counter they must be off of these medications for 2 weeks prior to their day of surgery.
17. N.P.O. Requirements:
    All patients receiving General, MAC or local with sedation are to adhere to the following requirements:
    • Do not eat within 8 hours of scheduled surgery.
    • Do not drink within 4 hours of scheduled surgery. (This should be only clear liquids.)
    • Pediatric patients may have clear liquids 2 hours pre-op. Clear liquids will be defined as water, apple juice or sprite. (No milk, formula or orange juice).
18. All patients must arrange to be accompanied and transported by a responsible person if anesthesia or sedation is administered. It is recommended that the patients not be left alone for 24 hours following surgery.
19. All children under the age of 18 must be accompanied by a parent or legal guardian or designated adult. If a guardian accompanies the child, legal documentation of their guardianship must be brought to the center and a copy placed on the chart.
20. Patients should be instructed to report to the surgery center for admission no less than one hour prior to the intended procedure. For local cases, one half hour prior to the procedure is an acceptable arrival time.
21. The patient should be given a copy of the Surgery Center patient information at the doctor's office.
22. Consent forms must be dated within 60 days of surgery.
23. Anesthesia cannot be administered until the attending surgeon is in the building.
24. It is beneficial for patients to come to the surgery center prior to their scheduled surgery date to pre register. Patients who do not pre register will receive a phone call from the business office about insurance and pre-registration. A nurse will attempt to call the patient at least three days prior to the day of surgery to obtain a medical history.
25. The patient's ability to meet discharge criteria will be documented on the chart. In instances where a patient cannot meet criteria for discharge, or any time there is an adverse change in the patient's post operative condition, the surgeon will be notified. The decision to transfer a patient to a hospital will ultimately rest with the anesthesiologist and/or surgeon.
26. The surgeon performing the procedure or surgery will sign an order for discharge for each patient with a Recovery Room Score equal to or greater than 7. All patients's receiving General or MAC anesthesia will be discharged from the surgery center by the anesthesiologist. Local cases will be discharged by order of the surgeon.
27. The anesthesiologist must assess add on cases, emergency add on cases or trauma cases for appropriateness for the surgery at the center. It is not recommended that emergency or trauma cases be performed at the surgery center.
28. Infection or Complication:
    If an incident regarding infection or complication should occur following a patient discharge, notify the PI Coordinator as soon as possible. Surgeons are sent a monthly printout of the patients that they performed surgery on each month. Please document any complications, infections, hospitalizations, etc. on these forms and mail them back promptly so that the information can be processed.
29. The anesthesiologist has the authority to waive any of the items 1-29 as deemed necessary.