Ambulatory Surgery Center of Excellence in Vascular & Endovascular Surgery
The Ambulatory Surgery Center of Excellence in Vascular & Endovascular Surgery (ASCOEVES) program recognizes ambulatory surgery centers and surgeons around the world who provide exceptional vascular and endovascular surgical care and are dedicated to continuously improving healthcare quality and patient safety.
The goal of the ASCOEVES program is to improve patient safety and satisfaction, increase access to vascular and endovascular procedures and provide data-driven results through the ASCOEVES Outcomes Database available to all ASCOEVES surgeons. The ASCOEVES 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- Use of outdated procedures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
ASCOEVES designation is available to ambulatory surgery centers and surgeons around the world that provide vascular and endovascular surgical care on an and outpatient basis.
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1: Institutional Commitment to Excellence
The applicant facility demonstrates a commitment to excellence in endovascular surgery from the highest levels of its medical staff and administration.
This commitment includes having specialty-specific credentialing and privileging guidelines in vascular surgery and interventional radiology.
2: Surgical Experience
The applicant facility performs at least 1,000 vascular and endovascular surgery procedures annually.
Each applicant interventional radiologist or vascular surgeon has served as the primary provider for at least 800 vascular surgery procedures in their lifetime, and performs at least 400 procedures annually.
For radiologists and surgeons, procedures performed at any facility may be used toward volume. Radiologist and surgeons must have served as the primary provider for a procedure to qualify. If the applicant’s role as the primary provider has been properly documented, procedures performed during fellowship or residency may qualify. Cases in which the applicant served as co-surgeon or assisting radiologist/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: Program Director
The applicant facility must appoint a Program Director (or Co-Directors) for the Ambulatory Surgery Center of Excellence in Vascular & Endovascular Surgery (ASCOEVES) program. The Physician Program Director(s) must:
- Participate in the relevant decision-making administrative meetings of the facility.
- Be a vascular surgeon who is accredited, or in the process of becoming accredited as an ASCOEVES provider.
- Be primarily responsible for coordinating the multidisciplinary services and systems for endovascular surgery.
- Participate in multidisciplinary team meetings.
Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to endovascular 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 endovascular surgery patients and their potential complications.
- During surgery and until discharge from the post-anesthesia care unit (PACU):
- Board-certified anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all endovascular 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:
- Critical care specialist (if a critical care specialist is not available, a written transfer protocol that details the transfer plan of «Surgical_Specialty» patients to other emergency or critical care facilities can be provided)
- Interventional radiologist or other physician capable of performing inferior vena cava filter placement and percutaneous drainage of intra-abdominal abscess
- Vascular surgeon
- The facility is also able to identify the following consultative staff:
- Nephrologist (only if performing dialysis)
- Nursing program manager
5: Equipment and Instruments
The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for endovascular 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 spends a significant portion of their efforts in the field of endovascular surgery and has active, full privileges in vascular surgery or interventional radiology 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 must complete at least 12 hours of continuing medical education (CME) focused on vascular surgery or radiology 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 endovascular surgery surgeons and radiologists to have qualified call coverage, and each applicant certifies that each covering provider is capable of identifying and treating endovascular surgery complications. Each covering provider is board-certified or an active candidate for board certification in vascular surgery or radiology 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 endovascular 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
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.
- 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
- Individualized follow up protocols per procedures performed
Each applicant performs each surgical procedure in a standardized manner as allowed by variations in operative circumstances.
Each applicant 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 endovascular surgery patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings, and ongoing program compliance.
The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of endovascular surgery and the appropriate management of the endovascular surgery patient. In-service topics must include:
- Signs and symptoms of common postoperative complications
- Equipment and surgical instruments
- Clinical pathways
Requirement 9: Patient Education
The facility and each applicant must provide all vascular and endovascular surgery patients with comprehensive preoperative patient education.
The facility and each applicant 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 must collect prospective outcomes data on all patients who undergo endovascular 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.
Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.