Application of Facility Class Standards vs. Anesthesia Monitoring

Regulatory Guidance on Anesthesia Classification & Patient Monitoring Requirements: 

QUAD A Standard 1-A-1 requires that the facility practices strictly within the Anesthesia Class for which it is accredited, and in accordance with facility policies and procedures, industry standards, regulations, and laws governing the facility. Facilities should reference the QUAD A Anesthesia Class Definitions & Requirements located here:

View the QUAD A - Anesthesia Class Requirements to verify that they are practicing within the Anesthesia Class they are accredited for. 

Facility Class vs. Anesthesia Type: 

Facilities are surveyed according to the Facility Class under which they are accredited, not the type of anesthesia or sedation used in a specific patient case.  

For example: 

• Class C Facility: A facility performing liposuction under local anesthesia may remove greater than 500 mL of aspirate (up to the 5,000 mL limit per Standard 1-C-5). This is permitted because Class C facility accreditation standards mandate rigorous monitoring, staffing, and equipment; therefore, the facility is more equipped for handling the increased physiological risk associated with removing >500 mL. 
• Class A Facility: A facility may remove no more than 500 mL of aspirate during liposuction performed under local anesthesia. This limit exists because the patient-monitoring accreditation standard requirements, staffing, and equipment standards for Class A accreditation are not designed to support the level of assessment and monitoring needed when more than 500 mL of aspirate is removed. Compliance with these requirements aligns with the facility’s ability to perform procedures with the resources appropriate for patient safety. 

Documentation & Monitoring Requirements: 

Facility Class determines what procedures you can perform. 
Anesthesia Type determines how you must monitor the patient. 

A higher-class facility performing a procedure under local (Class A) anesthesia must follow the monitoring standards for that anesthesia type. 

The table below summarizes monitoring expectations by anesthesia classification:

The "Class" in the table headers (A, B, C-M, and C) refers to the clinical classification of the anesthesia type administered, as defined by accreditation and clinical standards. This is separate from Facility Accreditation Class (e.g., Class A, B, C-M, or C). The C-M class is a specific QUAD A facility type for international facilities only.

Conclusion

As office-based and ambulatory surgical practices continue to expand, it is essential that clinical and operational decisions remain aligned with QUAD A standards, accreditation requirements, and country or state-specific regulations.  

Facilities must: 

• Operate within the scope of their approved anesthesia class , including any applicable country or state anesthesia-specific rules or regulations 

• Apply monitoring and documentation requirements appropriate to the anesthesia administered 

• Ensure policies, equipment, and personnel remain aligned with regulatory expectations, professional scope-of-practice, and patient safety standards 

A consistent application of these requirements supports regulatory compliance and promotes safe, high-quality patient care across all accredited settings.  

Thank you for your continued dedication to safety and excellence. 

Please email any questions to standards@quada.org.  

Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.