Center of Excellence in Neurosurgery

The Center of Excellence in Neurosurgery (COENS) program recognizes neurosurgery centers and surgeons around the world who provide exceptional neurosurgical care and are dedicated to continuously improving healthcare quality and patient safety.

The goal of the COENS program is to improve patient safety and satisfaction, increase access to neurosurgical procedures and provide data-driven results through the COENS Outcomes Database available to all COENS surgeons. The COENS program serves the present and future needs of patients and providers by addressing the issues facing the specialty, including:

  • Difficulty in identifying excellence for patients and providers
  • The need to control care provider costs and outcomes (including reimbursement and malpractice rates)
  • Use of outdated procedures
  • The need to establish universal standards to measure program performance
  • Lack of a central outcomes database

COENS accreditation is available to neurosurgery centers and surgeons around the world that provide neurosurgical care on an outpatient basis.

If you’re interested in accreditation, please complete the Accreditation Program Information Form or contact


Program Requirements

 1: Institutional Commitment to Excellence

The applicant facility demonstrates a commitment to excellence in neurosurgery from the highest levels of its medical staff and administration.

This commitment includes having credentialing and privileging guidelines for neurosurgery.

2: Surgical Experience

The applicant facility performs at least 200 neurosurgical procedures annually.

Each applicant surgeon performs at least 100 procedures annually and has served as the primary surgeon for at least 150 neurosurgical procedures in their lifetime.

For surgeons, procedures performed at any facility may be used toward volume. Surgeons must have served as the primary surgeon for a procedure to qualify. If the surgeon’s role as primary surgeon has been properly documented, procedures performed during fellowship may qualify. Cases in which the surgeon served as co-surgeon or assisting surgeon do not qualify.

Each procedure used for volume must be thoroughly documented to enable a medical chart review.

Volume waivers may be approved in some circumstances.

3: Physician Program Director

The applicant facility must appoint a Physician Program Director (or Co-Directors) for the Center of Excellence in Neurosurgery (COENS) program. The Physician Program Director(s) must:
– Participate in the relevant decision-making administrative meetings of the facility.
– Be accredited, or in the process of becoming accredited as a Center of Excellence in Neurosurgery (COENS) surgeon.
– Be primarily responsible for coordinating the multidisciplinary services and systems for neurosurgery.
– Participate in multidisciplinary team meetings.

Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to neurosurgery are addressed in a comprehensive manner.

4: Consultative Services

The applicant facility must have a full complement of consultative services required for the routine and intensive care of neurosurgical patients and their potential complications.
– During surgery and until discharge from the post-anesthesia care unit (PACU):
o Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all neurosurgical patients and is physically present until the patient is discharged from the PACU. Following PACU discharge, the anesthesiologist or CRNA must be available onsite within 30 minutes if needed.
– Available on site 24/7 (or at all times when patients are present):
o Physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS-certified, trained with an established protocol to follow in the event of a sudden respiratory or cardiac event.
– Available on site within 30 minutes:
o Interventional radiologist or other physician capable of performing inferior vena cava filter placement and percutaneous drainage of intra-abdominal abscess
o Physician with critical care credentials to manage complications, specifically a critical care physician/intensivist, hospitalist, cardiologist or pulmonologist
– The facility is also able to identify the following consultative staff:
o Cardiologist
o Endocrinologist
o Infectious disease specialist
o Nursing program manager
o Pulmonologist

5: Equipment and Instruments

The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for neurosurgery patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.

6: Surgeon Dedication and Qualified Coverage

Each applicant surgeon spends a significant portion of their efforts in the field of neurosurgery and has active, full privileges in neurosurgery at the applicant facility.

Each applicant surgeon is board-certified or an active candidate for board certification in their surgical specialty by the highest certifying authority available.

Each applicant surgeon must complete at least 12 hours of continuing medical education (CME) focused on neurosurgery every three years. Only American Medical Association Physician’s Recognition Award Category 1 Credits or similar credits from a CME accrediting body outside the United States or three national or international meetings qualify.

The applicant facility has policies in place that require all neurosurgeons to have qualified call coverage, and each applicant surgeon certifies that each covering surgeon is capable of identifying and treating neurosurgical complications. Each covering surgeon is board-certified or an active candidate for board certification in their surgical specialty by the highest certifying authority available and has admitting privileges at the co-applicant facility.

7: Clinical Pathways and Standardized Operating Procedures

The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative care for neurosurgical procedures. The following pathways are required:

  1. Anesthesia, including monitoring and airway management
  2. Perioperative care, including monitoring, pain management and airway management
  3. Deep vein thrombosis (DVT) prevention and management
  4. Instructions for identification, evaluation and management of early warning signs of complications.
  5. Preoperative patient preparation, evaluation, patient education, consent and plan of action for discharge that includes follow-up and any necessary patient education
  6. Enhanced recovery including physical therapy, occupational therapy and/or rehabilitation.

 The first three pathways will be deemed satisfied if the facility has accreditation from The Joint Commission (formerly known as JCAHO), DNV-GL or an equivalent healthcare organization approved by SRC.

Each applicant surgeon performs each surgical procedure in a standardized manner as allowed by variations in operative circumstances.

Each applicant surgeon uses a template for operative note dictation that ensures proper collection of data for surgical procedures.

8: Surgical Team and Support Staff

The applicant facility employs nurses and/or physician extenders who provide education and care to patients as well as an operative team trained to care for neurosurgical patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings, and ongoing neurosurgery program compliance.

The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of neurosurgery and the appropriate management of the neurosurgical patient. In-service topics must include:

  • Signs and symptoms of common postoperative complications
  • Equipment and surgical instruments
  • Clinical pathways

9: Patient Education

The facility and each applicant surgeon must provide all neurosurgical patients with comprehensive preoperative patient education.

The facility and each applicant surgeon must also have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for each patient’s condition.

10: Continuous Quality Assessment

Each applicant surgeon must collect prospective outcomes data on all patients who undergo neurosurgical procedures in SRC’s Outcomes Database (or a similar qualifying database) in a manner consistent with applicable patient privacy and confidentiality regulations. This de-identified data must be available to SRC for initial and renewal inspections or upon request.

Program Fees

Initial Fees

Facility Application Fee: $3,975 USD
Surgeon Application Fee: $650 USD

  • Discounts may be available for surgeons that participate in multiple accreditation programs. Contact SRC for details.
  • Upon payment of application fees, applicants achieve Provisional Status and gain access to SRC’s Outcomes Database at no additional charge.

Site Inspection Fees

Domestic Site Inspection Fee (US, Canada, Mexico): $1,850 USD
International Site Inspection Fee: $5,450 USD

  • The site inspection fee covers a one-day inspection with one site inspector and includes one COE program with up to four co-applicant surgeons. A day will be added to the site inspection for every four additional co-applicant surgeons or each additional COE program. Each additional day is $925.
  • Applicant facilities are responsible for arranging and paying for the site inspector’s hotel, ground transportation and, if needed, an interpreter/translator. These items are not included in the standard site inspection fee.
  • Renewal inspections are required every three years to ensure ongoing program compliance.

Annual Fees

Facility Annual Fee: $3,975 USD
Surgeon Annual Fee: $650 USD

  • Annual participation fees will be billed one year after applicants achieve Provisional Status and each year thereafter.

Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.