The appropriate guidelines and policies governing sedation at the hospital or ambulatory surgical facility where it is performed should be maintained at all times.  The American Society of Anesthesiologists Guidelines for Ambulatory Anesthesia and Surgery specifies that at minimum: 

• A licensed physician should be in attendance in the facility at all times during patient treatment, recovery, and discharge.
• The facility must be established, equipped, constructed, and operated in accordance with applicable federal, state, and local laws.
• Staff in attendance should be adequate to meet patient and facility needs and must consist of:
  • Professional staff including physicians, nurses, and other practitioners who are duly licensed and qualified
  • Administration staff
  • Housekeeping and maintenance staff

The physicians who provide medical care in the facility should be organized into a medical staff.  This group will assume responsibility for credential review, delineation of privileges and responsibilities, quality assurance, and peer review. There must be adequate personnel and equipment available to manage emergencies.  The facility must have established policies and procedures to handle unanticipated patient transfer to an acute care hospital.

According to the American Society of Anesthesiologists Guidelines for Ambulatory Anesthesia and Surgery, patient care shall include:

• Preoperative instructions and patient preparation.
• An appropriate history and physical exam by a physician prior to sedation.
• Preprocedure studies as outlined in the American Society for Gastrointestinal Endoscopy Position Statement on Laboratory Testing Before Ambulatory Elective Endoscopic Procedures.
• Procedural sedation shall be administered by or under the direction of a qualified physician.
• General anesthesia shall be administered by the appropriate anesthesiology personnel.
• The physician is responsible for directing discharge criteria.
• Patients must be provided with written postoperative and follow-up instructions.
• Medical records must be accurate, confidential and current.

Sources

American Society of Anesthesiologists. Guidelines for ambulatory anesthesia and surgery (Approved by ASA House of Delegates on October 11, 1973; last affirmed on October 15, 2003) http://www.asahq.org/publicationsAndServices/standards/04.pdf  Accessed April 17, 2008.

American Society for Gastrointestinal Endoscopy. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointestinal Endoscopy. 2003;58(3):317-322.
http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/2003_sedation.pdf Accessed August 24, 2009.

Last Updated September 29, 2008