Center of Excellence in Specialized Anesthesia - Orthopedic Surgery

In partnership with key opinion leaders and industry professionals, SRC developed the Center of Excellence in Specialized Anesthesia – Orthopedics (COESA-OS) program.  The COESA-OS program identifies anesthesiologists who provide excellent care and are dedicated to continuously improving healthcare quality and patient safety.

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



Program Requirements

1. Institutional Commitment to Excellence

The applicant demonstrates a commitment to excellence at the highest levels of its medical staff and administration in the delivery of anesthesia and related care to orthopedic surgical patients. This commitment includes providing ongoing, regularly scheduled in-service education in the unique needs of orthopedic surgical patients.

The applicant facility must have credentialing and privileging guidelines for anesthesiologists.

Requirement 1 Notes:

In-service education programs must ensure that all staff providing perioperative care to orthopedic surgical patients have a basic understanding of the unique needs and the appropriate management of the orthopedic patient population.

All members of the anesthesia department, including physicians and ancillary staff, must be trained on the specific needs of the orthopedic surgical patient through regular educational programs; including, but not limited to, safe patient transfers and positioning, monitoring, medication dosing and the proper use of appropriate equipment.

The applicant must have a letter of recommendation from the Chief of Orthopedic Surgery, the Chief of Anesthesia or facility equivalent.

2. Surgical Volume and Outcomes

The applicant facility must have significant, ongoing experience delivering safe anesthesia services to orthopedic surgical patients.  The applicant facility must have provided anesthesia care for at least 250 orthopedic surgical patients in the preceding 12 months.

The applicant anesthesiologist must have significant, ongoing experience delivering safe anesthesia services to orthopedic surgical patients.  The applicant must have been the primary anesthesia physician for at least 100 orthopedic surgical patients in the preceding 12 months.

The applicant physician must have provided primary anesthesia care for at least 150 orthopedic surgical patients in his or her lifetime.

Requirement 2 Notes:

For facilities and anesthesiologists, all perioperative anesthesia-related patient care, anesthesia-related complications and mortalities must be thoroughly documented to enable a medical chart review. This would include multidisciplinary mortality and morbidity audit and review with minutes available for review during inspection.

3. Designated Program Director

The applicant maintains a designated Program Director for anesthesia services who participates in the relevant decision-making administrative meetings of the facility and ensures that the unique needs of the orthopedic surgical patient are met.                                                      

Requirement 3 Notes:

The Physician Program Director must participate in interdisciplinary team meetings to ensure that key decisions related to anesthesia care for the orthopedic surgical patients are addressed in a comprehensive manner.

Two anesthesiologists may share the position as co-program directors.

Meetings will be held at least every six months within the anesthesia department to evaluate the management and outcomes of orthopedic surgical patients.

4. Consultative Services

The applicant facility maintains a full complement of consultative services required for the routine and intensive care of orthopedic surgical patients.

  • Documentation that an anesthesiologist supervises anesthesia delivery on all orthopedic surgical patients; is physically present until the patient is discharged from the Post-Anesthesia Discharge Unit (PACU); and, following PACU discharge, is available onsite within 30 minutes if needed.
  • Onsite at all times when patients are present – A physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS certified, available onsite at all times when patients are present, with an established protocol to follow in the event of a sudden respiratory or cardiac event
  • Onsite 24/7 (or within 30 minutes of request) – a 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:

  • Intensivist
  • Cardiologist
  • Radiologist
  • Pulmonologist
  • Endocrinologist
  • Infectious disease specialist

If the facility does not have an emergency department or intensive care unit, a written transfer protocol that details the transfer plan of surgery patients to other emergency or critical care facilities must be in place.

The applicant facility has trained personnel, services and equipment to support the immediate care of the unstable patient until a safe transfer is completed.

5. Equipment and Instruments

The applicant has a full line of equipment and instruments appropriate for the safe anesthesia care of orthopedic surgical patients.  Personnel are trained in the safe operation of this equipment.

All anesthesia equipment is properly checked before each surgical procedure, and the results are documented in the patient’s record.

Requirement 5 Notes:

This requirement applies all areas where orthopedic surgical patients receive anesthesia-related care.

If the facility does not have an emergency department or intensive care unit, it must have a clear pathway and agreement of escalation to provide the required levels of care. Suitable equipment, including ventilators and hemodynamic monitoring equipment, must be available onsite to stabilize and resuscitate critically ill patients until transfer to that facility can occur.

6. Anesthesia Dedication and Qualified Coverage

The applicant must have completed an approved anesthesia residency and be board certified or an active candidate for certification by the highest certifying authority of his or her country.

Every three years, the applicant must have completed at least 24 hours of Category 1 continuing medical education or have attended at least three nationally or internationally recognized anesthesia meetings focused on the unique needs of the orthopedic surgical patient.

The applicant has privileges as an anesthesiologist at the co-applicant facility.

7. Clinical Pathways

The applicant formally adopts and implements clinical pathways that facilitate the standardization of perioperative anesthesia care for the orthopedic surgical patient:

  • Preoperative evaluation:
    • Cardio pulmonary system evaluation
    • Preoperative medical management
    • Evaluation of airway and/or obstructive sleep apnea using suitable screening tools, sleep tests and/or use of pressure assisted devices
    • American Society of Anesthesiologists risk classification
    • Preoperative deep vein thrombosis and antibiotic protocols
  • Intraoperative:
    • World Health Organization timeout or equivalent
    • Patient transfer and positioning
    • Difficult airway protocol and equipment
    • Standardized anesthesia protocols for methods, agents and monitoring
    • Drug dosing algorithms including calculation of ideal and lean body weights
    • Tourniquet protocol
  • Postoperative:
    • Postoperative multi modal pain management
    • Assignment to appropriate level of care (critical care, ward or discharge)
    • Nausea prevention and management
    • Regional anesthesia fall prevention protocol

Requirement 7 Notes:

Facilities and surgeons must formally adopt and utilize clinical pathways/protocols that facilitate the standardization of perioperative anesthesia care for the orthopedic surgical patient.

Clinical pathways can be documented in a variety of formats, including tables, algorithms/process maps and paragraph form. Pathways must be part of the patient record or available in each patient care area for reference. Nurses, physician assistants, residents and other applicable staff must be knowledgeable of the pathways and implementing them.

8. Anesthesia Team and Support Staff

The applicant facility has ancillary anesthesia staff including one or more classifications of specially trained personnel including Certified Registered Nurse Anesthetists (CRNAs), Anesthesia Assistants (AAs), physician extenders, nurses and/or operating department technicians to assist the anesthesiologist in delivering excellent anesthesia care to the orthopedic surgical patient in the appropriate setting.

Requirement 8 Notes:

A physician extender is defined as any healthcare provider who assists an anesthesiologist.

Current certification and hospital privileges must be documented for all CRNA’s and AA’s providing anesthesia services within the applicant facility.

9. Patient Education and Informed Consent

The applicant provides all orthopedic surgical patients with comprehensive preoperative patient education that includes anesthesia options and individualized discussion of possible risks.

The applicant has a process for obtaining informed anesthesia consent and selecting the type of anesthesia that is most appropriate for the patient.

Requirement 9 Notes:

Preoperative education and informed anesthesia consent must be provided and documented for every orthopedic surgical patient.

10. Continuous Quality Assessment

Facilities and surgeons must have an outcomes data tracking process in place. This data will be provided to evaluate the effectiveness, efficiency and safety of anesthesia for the orthopedic surgical patient.

Applicant must collect prospective outcomes data on all patients who undergo a qualifying surgical procedure 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 site 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.