Working Group on Defining High-Risk Medical Procedures/Practices Performed in Ambulatory Setting
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Working Group on Defining High-Risk Medical Procedures/Practices Performed in Ambulatory Setting Consultation on the Draft Recommendations. Secretariat, Working Group on Defining High-Risk Medical Procedures/Practices Performed in Ambulatory Setting 5 December 2013. Background.

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Working Group on Defining High-Risk Medical Procedures/Practices Performed in Ambulatory SettingConsultation on the Draft Recommendations

Secretariat,

Working Group on Defining High-Risk Medical Procedures/Practices Performed in Ambulatory Setting

5 December 2013


Background
Background Procedures/Practices Performed in Ambulatory Setting

  • The Working Group is one of the working groups set up under the Steering Committee on Review of Regulation of Private Healthcare Facilities

Steering Committee on Review of the Regulation of Private Healthcare Facilities

Working Group on Differentiation between Medical Procedures and Beauty Services

Working Group on Regulation of Premises processing Health Products for Advanced Therapies

Working Group on Defining High-Risk Medical Procedures Performed at Ambulatory Setting

Working Group on Regulation of Private Hospitals


Composition of the working group
Composition of the Working Group Procedures/Practices Performed in Ambulatory Setting

  • Chairman: Professor Raymond Liang

  • Members:

    • Steering Committee members – representatives from MCHK, HKMA, HKDA, FHB, HA, DH and other professional bodies

    • Co-opted members – representatives from HKAM and Colleges, Federation of Medical Societies, patient group


Objectives of the working group
Objectives of the Working Group Procedures/Practices Performed in Ambulatory Setting

  • To define the range of high-risk procedures/practices that should be performed in regulated ambulatory facilities only

  • To recommend appropriate regulatory approaches to the Steering Committee


Work approach
Work Approach Procedures/Practices Performed in Ambulatory Setting

  • Review of overseas regulatory framework and local situation

  • Set up Expert Groups

    • Surgical procedures

    • Endoscopic procedures

    • Dental and maxillofacial procedures

    • Chemotherapy, diagnostic/interventional radiological procedures

    • Haemodialysis, peritoneal dialysis, cardiac catheterisation, lithotripsy


Current regulatory framework
Current Regulatory Framework Procedures/Practices Performed in Ambulatory Setting


Recommendations
Recommendations Procedures/Practices Performed in Ambulatory Setting

  • Scope of high-risk procedures

  • Regulatory approach for ambulatory facilities where high-risk procedures are performed

  • Regulatory standard for such facilities


Scope of high risk procedures
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting

  • Three principle factors of classifying high-risk procedures -

    • Risk of procedure

    • Risk of anaesthesia involved

    • Patient’s condition

  • “High-risk” can be defined by ANY of the three factors


Scope of high risk procedures1
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting

Highest risk

Procedures to be performed in hospital-setting only

Procedures to be performed in regulated facilities only

  • High-risk vs Non-high-risk

  • Risk of anaesthesia

  • Risk of procedure

  • Patient’s condition

Procedures may be performed in any facilities

Lowest risk


Scope of high risk procedures2
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures3
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures4
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures5
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures6
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures7
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures8
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures9
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures10
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures11
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures12
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures13
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures14
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures15
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


Scope of high risk procedures16
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting


High risk procedures at ambulatory setting
High-Risk Procedures at Procedures/Practices Performed in Ambulatory SettingAmbulatory Setting

  • High-risk procedures could be performed at regulated ambulatory facilities only if:

    • the patient is discharged on the same calendar day of admission; AND

    • the expected total duration of the procedure and the recovery does not exceed 12 hours; AND

    • the patient is classified not higher than Class 3-unstable based on ASA Physical Status classification system


Scope of high risk procedures17
Scope of High-Risk Procedures Procedures/Practices Performed in Ambulatory Setting

Highest risk

Hospital vs Ambulatory

Operation + recovery not more than 12 hours

Same day discharge

Patient’s condition classified not higher than ASA physical status class 3-unstable

Procedures to be performed in hospital-setting only

Procedures to be performed in regulated facilities only

  • High-risk vs Non-high-risk

  • Risk of anaesthesia

  • Risk of procedure

  • Patient’s condition

Procedures may be performed in any facilities

Lowest risk


Hospital only high risk procedures
Hospital-Only Procedures/Practices Performed in Ambulatory Setting High-Risk Procedures

  • Chemotherapy that is not administered by parenteral or oral route; (e.g. intrathecal, intravesical)

  • Radiological-guided core biopsy of deep-seated organ

  • Cardiac catheterisation

  • Continuous venous-venous haemofiltration

  • Organ transplant [except corneal transplant] and complicated transplant procedures

    • Some members proposed to include bronchoscopy


Regulatory approach
Regulatory Approach Procedures/Practices Performed in Ambulatory Setting

  • Ambulatory facilities for high-risk procedures:

    • Statutory registration in the long run

    • Administrative listing as interim measure

  • Administrative listing also proposed for facilities for peritoneal dialysis and endoscopic procedures outside the scope of high-risk procedures


Regulatory standards
Regulatory Standards Procedures/Practices Performed in Ambulatory Setting


Regulatory standards1
Regulatory Standards Procedures/Practices Performed in Ambulatory Setting

  • The regulatory standards in general should not be more stringent than those for private hospitals

  • HKAM to be invited to set and update the procedure-specific regulatory standards


Way forward
Way Forward Procedures/Practices Performed in Ambulatory Setting

  • The Working Group will present its final recommendations to the Steering Committee in Q1 2014

  • Other preparatory works

    • Survey to estimate the number and type of facilities under the proposed scope of high-risk procedure

    • Public consultation on legislative proposal


Advice sought
Advice Sought Procedures/Practices Performed in Ambulatory Setting

  • HKAM and member Colleges to advise on the draft recommendations

  • HKAM to set up mechanisms to -

    • maintain and update the list of high-risk procedures

    • set procedure-specific regulatory standards

      and advise the regulatory authority accordingly


- End - Procedures/Practices Performed in Ambulatory Setting


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