Office Based Surgery Facility

What is office based surgery?

Years ago, all surgery was performed in hospitals, usually with at least an overnight stay. Subsequently, the concept of ambulatory surgery developed. Initially hospitals had created facilities where surgery was performed on ambulatory basis where the patients would arrive at the facility on the day of surgery, and then be discharged home after recovering from anesthesia. Next, free-standing ambulatory surgery facilities opened where surgery could be performed by surgeons of a number of specialties, all on an outpatient basis. Most recently, in the past twenty years or so, office based surgery became a reality. In this setting, a portion of the surgeon’s office is constructed to contain a preoperative area, operating room, recovery room and instrument processing and storage areas.

What is accreditation?

Accreditation is a process of assessing and certifying a facility, be it a hospital, ambulatory surgery center or office based surgical facility of meeting certain minimum standards as required by that certifying organization. It is a means for the consumer of knowing that appropriate quality assurance, infection control processes and procedures, safety and competency standards are being met by the facility. In New York State, accreditation was not required of office based surgery facilities until July, 2009.

Who performs accreditation of a facility?

Accreditation can be performed by the American Association for Accreditation of Ambulatory Surgery (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission (JC). The latter organization is responsible for the accreditation of hospitals while to former two are responsible for the accreditation of ambulatory and office based surgical facilities. In 2003, Joint Commission offered accreditation of office based surgery programs. The Joint Commission standards are the most detailed and stringent of all three for office based surgery facilities. A Joint Commission inspection includes but is not limited to: assessment of competency of all staff, infection control, quality assurance, environment of care, national patient safety goals, chart review, safety, medication management, governance, equipment management, staff education, clinical performance, benchmarking and policy and procedure, just to name some of the areas of concentration.

What type of accreditation does Dr. Epstein’s office based surgery facility have?

When Dr. Epstein opened his office based surgical facility in 1999, he obtained accreditation from the AAAASF as the only available accrediting organizations for office based surgery were the AAAASF and the AAAHC. In 2003, when Joint Commission offered accreditation for office based surgery programs, Dr. Epstein’s facility became the first office based plastic surgical facility on Long Island to be accredited by the Joint Commission.

When is surgery not performed in Dr. Epstein’s office?

If there are underlying medical issues such as diabetes, uncontrolled high blood pressure or other medical problems, Dr. Epstein may escalate the surgery to an ambulatory surgery facility or even a hospital, particularly if an overnight stay in the hospital is required.

Who provides anesthesia services in Dr. Epstein’s facility?

Dr. Epstein prefers to have anesthesiologists (physicians who practice anesthesia) as opposed to a nurse anesthetist who must work under the supervision of a physician. Dr. Epstein works with two anesthesiologists, Adrienne Levy, M.D. and Brian Slepian, M.D. Dr. Epstein has worked with both of these fine physicians since 1994 when they were all on the full time staff at University Medical Center at Stony Brook. Currently, Drs. Levy and Slepian are on staff at the North Shore SurgiCenter, a local ambulatory surgery facility, located in Smithtown, N.Y. Both of these anesthesiologists are extremely skilled and caring, and play an integral role in the enhanced recoveries that Dr. Epstein offers, including the One Day Recovery method of breast augmentation.

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