Center of Excellence in Orthopedic Surgery
The Center of Excellence in Orthopedic Surgery (COEOS) program is focused on improving the safety and quality of orthopedic surgical care worldwide, lowering the costs associated with successful treatment and the recognition of surgeons and facilities performing orthopedic surgery procedures.
Data from COEOS participants will be used to determine which treatment works best for which patient under what circumstances. This information enables clinicians, patients, payors and policymakers to make informed decisions that improve healthcare at the individual level and for the patient population as a whole. The COEOS program helps position surgeons at the forefront of care and demonstrate the improved outcomes and cost savings that result from a quality initiative.
The COEOS designation requirements were developed to address the present and future needs of patients and providers, and they are coupled with an objective evaluation process that enables a thorough review of each candidate.
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1: Institutional Commitment to Excellence
The applicant facility demonstrates a commitment to excellence in orthopedic surgery from the highest levels of its medical staff and administration.
This commitment includes having specialty-specific credentialing and privileging guidelines in orthopedic surgery.
2: Surgical Experience
The applicant facility performs at least 150 orthopedic surgery procedures annually.
Each applicant surgeon has served as the primary surgeon for at least 125 orthopedic surgery procedures in their lifetime, and performs at least 100 procedures annually.
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 or residency 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 Orthopedic Surgery (COEOS) 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 Orthopedic Surgery (COEOS) surgeon.
- Be primarily responsible for coordinating the multidisciplinary services and systems for orthopedic surgery.
- Participate in multidisciplinary team meetings.
Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to orthopedic surgery 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 orthopedic surgery patients and their potential complications.
- During surgery and until discharge from the post-anesthesia care unit (PACU):
- Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all orthopedic surgery 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):
- 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:
- General surgeon
- Physician with critical care credentials to manage complications, specifically a critical care physician/intensivist, hospitalist, cardiologist or pulmonologist
- Vascular surgeon
- The facility is also able to identify the following consultative staff:
- Infectious disease specialist
- Occupational Therapy
- Pain Management
- Physical Therapy or Physiatrist
- Wound care specialist
5: Equipment and Instruments
The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for orthopedic surgery patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.
If the facility does not have an emergency department or intensive care unit, it must have equipment, such as ventilators and hemodynamic monitoring equipment, necessary to resuscitate and stabilize critically ill patients until they can be transferred to another facility.
6: Surgeon Dedication and Qualified Call Coverage
Each applicant surgeon spends a significant portion of their efforts in the field of orthopedic surgery and has active, full privileges in orthopedic surgery at the applicant facility.
Each applicant surgeon is board-certified or an active candidate for board certification in orthopedic surgery by the highest certifying authority available.
Each applicant surgeon must complete at least 12 hours of continuing medical education (CME) focused on orthopedic surgery 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 orthopedic surgeons to have qualified call coverage, and each applicant surgeon certifies that each covering surgeon is capable of identifying and treating orthopedic surgery complications. Each covering surgeon is board-certified or an active candidate for board certification in orthopedic surgery 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 orthopedic surgery procedures. The following pathways are required:
- Anesthesia, including monitoring and airway management
- Perioperative care, including monitoring, pain management and airway management
- Deep vein thrombosis (DVT) prevention and management
- Instructions for identification, evaluation and management of early warning signs of complications.
- Preoperative patient preparation, evaluation, patient education, consent and plan of action for discharge that includes follow-up and any necessary patient education
- Enhanced recovery including physical therapy and/or rehabilitation
- Pain management
- Site identification and tourniquet protocol
- Wound care management
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 orthopedic surgery patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings, and ongoing orthopedic surgery program compliance.
The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of orthopedic surgery and the appropriate management of the orthopedic surgery 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 orthopedic surgery 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 orthopedic surgery 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.
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 your 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.
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.