February, 2000

Information Bulletin 00-4
ASC-3

MN Rule 4675.0700 and 4675.0800, Subp. A

Recent initial licensure surveys of Freestanding Outpatient Surgical Centers have raised questions regarding the above referenced rules. This Information Bulletin provides the Department's understanding of those requirements.

MN. Rule 4675.0700, reads: "Treatment areas for patient preparation, surgery, and recovery shall be separate. Each area shall be equipped to accommodate its functional needs."

MN. Rule 4675.0800, reads: "The patient preparation area shall include the following elements:"

Subp. A reads: "An arrangement which permits patient access to the area for initial entry and final departure from the dressing area without passing through the postoperative recovery area; and provides gowned patients access to the surgical suite without entering the recovery area or a public space or corridor."

This rule was promulgated in the mid-1970s. At that time, the concept of stage 1 and stage 2 postoperative recovery was not as popular as it is today. In fact, this concept was not addressed in the rule. It was, and still is, the intent of the rule to provide access to the preoperative area without passing through what is now generally referred to as the stage 1 postoperative area.

This separation of the postoperative area is required in order to avoid having preoperative patients observing patients who just came out of surgery. In some cases, these postoperative patients are attempting to regain consciousness from general anesthesia. This situation can result in vocalization, vomiting, thrashing, and other disturbing behavior that can increase the anxiety level of the preoperative patient. This type of behavior is generally not evident in stage 2 recovery.

Therefore, a layout that requires a preoperative patient to pass by but not through a stage 2 postoperative recovery area is acceptable, provided the stage 2 recovery bed(s) or chair(s) are enclosed with privacy curtain(s). It is not acceptable to have preoperative patients pass through a stage 1 postoperative recovery area. In addition, it is not acceptable to have a preoperative patient pass by a stage 1 postoperative recovery area where the only separation between the route of travel and the bed/chair is a privacy curtain or screen. It is acceptable to have the route of travel pass by the entrance or opening leading to a stage 1 postoperative recovery area.