Patient selection is a crucial component of ensuring procedures performed in an OHP are safe. The appropriateness of performing a procedure in the OHP setting depends on ensuring that the proposed procedure can be performed safely for that particular patient and their particular circumstances.

Standards

1. Physicians must use their professional judgement to determine whether a procedure can be provided to a particular patient safely and effectively in an OHP, on a case by case basis.
2. Physicians must only perform a procedure on a patient where they are satisfied that the procedure can be safely and effectively performed in the OHP, and it is in the patient’s best interest to do so, taking into account:
   1. the patient’s existing health status (e.g., any co-morbidities, frailty, stability of any existing conditions), their specific health-care needs and the specific circumstances;
   2. the potential complications that could arise from that specific procedure, including potential complications in surgical management if more than one procedure is to be performed at a time;
   3. anesthetic or sedation factors that may place the patient at a higher risk;
   4. the resources that may be required to perform a procedure on that particular patient;
   5. the duration of the procedure and the potential for a prolonged recovery period; and
   6. the location of the OHP and its proximity to emergency services or hospitals¹, should complications arise from the procedure.
3. Where a prospective patient would be required to undergo general or regional anesthesia or sedation, the physician administering the anesthesia or sedation must assign an ASA classification² for that prospective patient.
   1. Physicians must only perform Level 2 or 3 procedures on patients classified as ASA III if:
      1. the comorbid condition is unlikely to add significant risk to the anesthetic, sedation or procedure; and
      2. the comorbid condition could not reasonably be expected to be adversely affected by the anesthetic, sedation, or procedure;
   2. The physician administering the anesthesia or sedation and the physician performing the procedure³ must, where possible, discuss all potential ASA III cases well in advance of the scheduled procedure where more than mild sedation will be administered, with regard to the:
      3. appropriateness of OHP setting for the safe performance of the procedure (including the factors listed in Provision 2 above),
      4. pre-procedure assessment and care required, and
      5. intra-procedure and post-procedure requirements.

Endnotes

^1. The Adverse Events Standard requires OHPs to have an established protocol to facilitate the urgent transfer of patients to the hospital for the management of an urgent adverse patient event.

^2. For more information on ASA classifications see the Advice to the Profession document.

^3. In a situation where the same physician is administering the anesthesia or sedation and performing the procedure (e.g., for surgical abortion), the physician will need to consider all ASA III cases in advance, including the considerations in provision 3.b., and consult with a colleague where appropriate.