Patient safety is reliant on clear communication and shared decision-making between the surgeon and anesthesia professional. This communication is the intent behind QUAD A Standard 8-B-24, a requirement that often sparks questions amongst our facilities. The standard ensures that the surgeon/proceduralist and the licensed or qualified anesthesia professional are truly aligned on the appropriateness of procedures performed at the facility. This agreement is further based on the patient’s medical status, age, physiological suitability, provider qualifications, and available facility resources.
More than a formality, this concurrence is designed to ensure that everyone is on the same page regarding the anesthesia plan, ensuring it aligns with the procedure and the patient's specific needs. While these vital verbal conversations usually occur, it’s not enough for a verbal agreement; it must also be demonstrated through action. For instance, during a procedure, if a surgical team does not know how to use a particular instrument without the IFUs, they may cause harm to the patient or staff. Even simple mistakes can have serious consequences. By keeping the manufacturers' instructions, healthcare facilities make it less likely that such issues will occur.
The surveyor will look for some form of documentation to confirm that this conversation took place. There are several locations in the clinical record where this concurrence can be appropriately documented. A great way to achieve compliance with this requirement is to simply add a check box to your facility’s time-out section of the operative record. By bringing everyone into the discussion during the time-out, the team not only strengthens communication but also safeguards against misunderstandings or undue pressures, especially if complications arise. This collaborative approach also serves as a final check, confirming that the correct patient, procedure, and all necessary equipment and medications are ready before the procedure begins.
If the facility chooses to use a checkbox as its documentation, a definition of the time-out and covered components must be defined and outlined in the facility’s time-out policy. Including a checkbox and having a formal discussion that the anesthesia provider and the surgeon/proceduralist concurred on the appropriateness of the procedure/surgery indicates compliance with the standard. Another way for facilities to achieve compliance is to include the statement in their clinical record documentation (i.e., pre-operative assessment notes, H&P).
This vital step provides the OR team with a final check that everything is in place and ready to proceed. An additional point of clarification, when a registered nurse provides sedation under the direction/supervision of the surgeon, 8-B-24 is not applicable as there is no anesthesia professional involved. is that when a registered nurse provides sedation under the direction/supervision of the surgeon, 8-B-24 is not applicable, as no anesthesia professional is involved. We hope this helps facilitate and maintain compliance with this standard.
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.