Here is a sample additions to approved procedures list policy, used for the clinical policies and procedures manual at Western Reserve Surgery Center in Kent, Ohio, you can adapt for use in your ASC.
To download a copy of this letter, click here (doc).
Additions to Approved Procedures List
SECTION: Risk Management
Procedure: [Name of Procedure]
POLICY: Approval of New Procedure
EFFECTIVE DATE:
REVISION DATE:
SIGNATURE: _____________________________________
The Approved Procedure List is reviewed and approved by the Governing Body of the facility on at least an annual basis. Decisions as to the addition or deletion of procedures to this list are based on criteria including but not limited to:
1. Medical history/physical condition of certain patient groups,
2. The standard of medical care in the individual community,
3. Consideration of the recovery period required for the procedure.
4. The necessary training and competency required to perform the procedure.
5. The necessary training and competency required by the facility staff to care for the patient post-operatively.
6. Procedures in which airway compromise is anticipated or expected.
7. Procedures where considerable blood loss is expected or anticipated.
Source: Laurie Simon, Western Reserve Surgery Center. Adapted and reprinted with permission.