(512) 944-8388
info@diversehc.com

Facility Classification (Quad A)

When preparing/renewing your application to Quad A, it’s important you choose the correct facility classification. It is not intuitive, so we’ve provided a cheat sheet below. In its essence:

-Class C allows your facility the most latitude, allowing licensed anesthesia providers todeliver general anesthesia using inhaled gases with a secured airway placement. If your operating rooms (or procedure rooms) have anesthesia machines, gases, and the vaporizer, but you mostly perform total IV anesthesia (TIVA) with an LMA or ETT, this is still the correct type.The classification is about the scope of anesthesia services and the depth of anesthesia that can be provided.

-Class C-M allows for the administration of propofol by an anesthesia provider along with spinal and epidural anesthesia, but restricts the use of a secured airway except in airway emergencies. Think, deep sedation, but not general anesthesia. It is common to see this type of facility type in office-based surgery setting providing plastic surgery and in office-based procedural settings providing endoscopy.

-Class B does not allow for the administration of propofol but does allow monitored anesthesia care or nurse-administered moderate sedation (when the surgeon/proceduralist has had training in moderate sedation).

-Class A is rarely used, mostly in a practice where the accreditation is used for marketing purposes. This may only be used in an office-based setting where the surgeon/proceduralist is performing a small procedure and is not administering any form of sedation. There is a small exception allowing the physician to administer one dose of opioid/analgesic pre-operatively. However, if the patient is prescribed a benzodiazepine to take ahead of time (or to bring and take at the center) as is often seen, the facility is performing surgery on a sedated patient and discovery of this upon chart review may put the facility at risk of a deficiency because of incorrect classification.

This classification system allows Quad A to ensure the appropriate emergency equipment, monitoring requirements, and staffing guidelines are embedded into the safety standards and that they are specific to the type of anesthesia services provided to your patient population.

Lastly, should your scope of anesthesia services change in between your triennial surveys, it’s important to notify Quad A so that your classification can be updated. An increase in the type of anesthesia services offered will trigger a focused re-survey, but a decrease should not.

Please reach out to us at (512) 944-8388 should you have any questions about your facility’s classification type.

Procedures may be performed under:

Class

A

Class

B

Class

C-M

Class

C

Local Anesthesia, may be administered by any of the following: Surgeon/proceduralist,
Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA) under
physician supervision if required by state/local law, Anesthesia assistant as
certified by the National Commission for the Certification of
Anesthesiologist Assistants (NCCAA) under direct supervision of an
anesthesiologist, or a Registered Nurse under the supervision of a qualified
physician.

X

X

X

X

Topical Anesthesia, may be administered by any of the following: Surgeon/proceduralist,
Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA) under
physician supervision if required by state/local law, Anesthesia assistant as
certified by the National Commission for the Certification of
Anesthesiologist Assistants (NCCAA) under direct supervision of an anesthesiologist,
or a Registered Nurse under the supervision of a qualified physician.

X

X

X

X

A Single Dose of the same post-operative
analgesic prescribed to the patient may be administered to that patient
pre-operatively. Any additional doses or agents
is considered sedation and should be conducted under Class B, C-M, or C
standards.

X

 

 

 

Parenteral Sedation, may be administered by any of the following: Anesthesiologist,
Certified Registered Nurse Anesthetist (CRNA) under physician supervision if
required by state/local law, Anesthesia assistant as certified by the
National Commission for the Certification of Anesthesiologist Assistants
(NCCAA) under direct supervision of an anesthesiologist, or a Registered
Nurse under the supervision of a qualified physician.

 

X

X

X

Field and Peripheral Nerve Blocks, may be administered by any of the following:
Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA) under
physician supervision if required by state/local law, Anesthesia assistant as
certified by the National Commission for the Certification of
Anesthesiologist Assistants (NCCAA) under direct supervision of an
anesthesiologist, or a Registered Nurse under the supervision of a qualified
physician.

 

X

X

X

Dissociative Drugs (excluding Propofol) may be administered by any of the following:
Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA) under
physician supervision if required by state/local law, Anesthesia assistant as
certified by the National Commission for the Certification of Anesthesiologist
Assistants (NCCAA) under direct supervision of an anesthesiologist, or a
Registered Nurse under the supervision of a qualified physician IF ALLOWED BY
THE STATE BOARD OF NURSING.

 

X

X

X

Nitrous Oxide,
may be administered by any of the following: Anesthesiologist, Certified
Registered Nurse Anesthetist (CRNA) under physician supervision if required
by state/local law, Anesthesia assistant as certified by the National
Commission for the Certification of Anesthesiologist Assistants (NCCAA) under
direct supervision of an anesthesiologist, or a Registered Nurse under the
supervision of a qualified physician.

 

X

X

X

Propofol, may be administered by any of the
following: Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA)
under physician supervision if required by state/local law, Anesthesia
assistant as certified by the National Commission for the Certification of
Anesthesiologist Assistants (NCCAA) under direct supervision of an
anesthesiologist.

 

 

X

X

Epidural Anesthesia, may be administered by any of the following:
Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA) under
physician supervision if required by state/local law, Anesthesia assistant as
certified by the National Commission for the Certification of Anesthesiologist
Assistants (NCCAA) under direct supervision of an anesthesiologist.

 

 

X

X

Spinal Anesthesia, may be administered by any of the following:
Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA) under
physician supervision if required by state/local law, Anesthesia assistant as
certified by the National Commission for the Certification of
Anesthesiologist Assistants (NCCAA) under direct supervision of an
anesthesiologist.

 

 

X

X

General Anesthesia (with or without endotracheal intubation or
laryngeal mask airway anesthesia), which may be administered by any of the
following: Anesthesiologist, Certified Registered Nurse Anesthetist (CRNA)
under physician supervision if required by state/local law, Anesthesia
assistant as certified by the National Commission for the Certification of
Anesthesiologist Assistants (NCCAA) under direct supervision of an
anesthesiologist.

 

 

 

X