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AMBULATORY ANESTHESIA

Development of an Appropriate List of Surgical Procedures of a Specified Maximum Anesthetic Complexity to Be Performed at a New Ambulatory Surgery Facility

Franklin Dexter, MD, PhD^*, Alex Macario, MD, MBA, Donald H. Penning, MS, MD, and Patricia Chung, MHA

*Division of Management Consulting and Department of Anesthesia, University of Iowa, Iowa City; Department of Anesthesia, Stanford University, Stanford, California; Department of Anesthesia, Sunnybrook and Women’s Health Sciences Centre; Department of Anaesthesiology, University of Toronto, Ontario, Canada; and Decision Support, Hospital Administration, Sunnybrook and Women’s Health Sciences Centre, Toronto, Ontario, Canada

Address correspondence and reprint requests to Franklin Dexter, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242. Address e-mail to Franklin-Dexter{at}UIowa.edu

A common but difficult task for a hospital when it decides to open a freestanding ambulatory surgery facility is how to decide which surgical procedures should be done at the new facility. This is necessary in order to determine how many operating rooms to plan for the new facility and which ancillary services are needed on-site. In this case study, we describe a novel methodology that we used to develop a comprehensive list of procedures to be done at a new ambulatory facility. The level of anesthetic complexity of a procedure was defined by its number of ASA Relative Value Guide basic units. Broad categories of procedures (e.g., eye surgery) were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. We identified 22 categories that are of a type that every procedure in the category has no more than seven basic units. In addition, by analyzing all procedures that the hospital being studied actually performed on an ambulatory basis, we identified six other categories of procedures that were of a type that all procedures eligible for surgery at the new facility had seven or fewer basic units.

IMPLICATIONS: We describe a novel method to develop a comprehensive list of procedures that have a prespecified maximum level of anesthetic complexity to be performed at a new ambulatory surgery facility.

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