Healthcare Services (Ambulatory Surgical Centre Service) Regulations 2023

every personnel complies with the technical and clinical standards mentioned in paragraph (1);

there is active management and review of the quality of clinical services and patient safety in the provision of the ambulatory surgical centre service; and

the licensee’s clinical support personnel are provided with adequate training and subject to regular competency assessments to enable them to perform their work effectively, safely and in compliance with the applicable laws, guidelines, policies, processes, procedures and protocols.

the technical and clinical standards mentioned in paragraph (1);

every review conducted under paragraph (2)(b).

where the licensee only provides dental procedures — 3 dentists;

where the licensee does not provide dental procedures — 3 medical specialists; or

where the licensee provides both dental and non‑dental procedures — 3 dentists or medical specialists.

where the licensee only provides dental procedures —

a dentist who is registered under section 14C(1) of the Dental Registration Act 1999 as a specialist in a branch of dentistry within the licensee’s scope of practice and has surgical experience; and

a dentist —

who is not registered under section 14C(1) of the Dental Registration Act 1999 as a specialist;

who is registered under section 14C(1) of the Dental Registration Act 1999 as a specialist in a branch of dentistry within the licensee’s scope of practice but in a different branch of dentistry from the dentist mentioned in sub‑paragraph (i); or

who is not, for the period the dentist is a member of the committee, employed, engaged or accredited by the licensee;

where the licensee does not provide dental procedures —

a medical specialist who is registered under section 22 of the Medical Registration Act 1997 as a specialist in a branch of medicine within the licensee’s scope of practice; and

a medical specialist —

who is registered under section 22 of the Medical Registration Act 1997 as a specialist in a branch of medicine within the licensee’s scope of practice but in a different branch of medicine from the medical practitioner mentioned in sub‑paragraph (i); or

who is not, for the period the medical practitioner is a member of the committee, employed, engaged or accredited by the licensee;

where the licensee provides both dental and non‑dental procedures —

a dentist who is registered under section 14C(1) of the Dental Registration Act 1999 as a specialist in a branch of dentistry within the licensee’s scope of practice and has surgical experience;

a medical specialist who is registered under section 22 of the Medical Registration Act 1997 as a specialist in a branch of medicine within the licensee’s scope of practice; and

a dentist mentioned in sub‑paragraph (a)(ii)(A), (B) or (C) or a medical practitioner mentioned in sub‑paragraph (b)(ii)(A) or (B).

grant clinical privileges to a medical practitioner or dentist employed or engaged by the licensee in accordance with the framework mentioned in paragraph (1);

regularly review the clinical privileges granted to the medical practitioner or dentist to ensure that he or she continues to have the necessary professional qualifications, experience, competency and skills to be so granted those clinical privileges; and

ensure that the medical practitioner or dentist only provides care or treatment or performs procedures within the scope of the clinical privileges granted.

where the surgical procedure is a dental procedure — there is at least one registered nurse or dental surgery assistant with relevant operating theatre experience of not less than 6 months assisting the dentist in the surgical procedure; and

where the surgical procedure is not a dental procedure — there is at least one registered nurse with relevant operating theatre experience of not less than 6 months assisting the medical practitioner in the surgical procedure.

establish, implement and regularly review processes and standards for healthcare professionals and clinical support personnel undertaking any activity in the licensee’s provision of the ambulatory surgical centre service in the following areas:

preparation, dispensing and administration of medication;

collection, packing and labelling of specimens;

precautions to be taken to avoid contamination and degradation of specimens;

proper and safe use of medical and surgical equipment, instruments, appliances, materials and facilities;

prevention, management, control and containment of the spread of any infection at those approved permanent premises; and

ensure that each healthcare professional and clinical support personnel has demonstrated, and documented to have demonstrated, that he or she is able to implement the processes or standards relevant to the area of work undertaken by the healthcare professional or clinical support personnel.

there is a bed available for each patient who undergoes a relevant procedure, for the patient to rest and recover after the relevant procedure;

the premises include an area that is designated for the use of patients recovering after an operation;

there is adequate resuscitative equipment in the area mentioned in sub‑paragraph (b); and

there is adequate space for the movement of personnel for the monitoring of patients and treatment of complications.

either —

ensure that sufficient supplies of anaesthetic, anaesthetic delivery equipment and patient monitoring devices are kept and maintained at every approved permanent premises; or

establish, implement and regularly review processes to ensure that the licensee may obtain the supplies mentioned in sub‑paragraph (i) at any time;

before administering any type of anaesthetic to cause any anaesthesia in a patient, properly inform the patient of the risks and benefits of, and (if any) the alternatives to, the anaesthesia;

having satisfied the condition mentioned in sub‑paragraph (b) in respect of a patient, keep and maintain proper and accurate records of this fact;

where any anaesthetic is administered to a patient for the purpose of conducting a relevant procedure on the patient — ensure that the patient is regularly monitored throughout the procedure by the person who administered the anaesthetic, using the appropriate patient monitoring device; and

establish, implement and regularly review processes and procedures to ensure the continued monitoring and care of the patient mentioned in sub‑paragraph (d) after completion of the procedure mentioned in that sub‑paragraph.

a relevant procedure is not offered to or performed on any patient at any approved permanent premises unless the approved permanent premises has the appropriate equipment and facilities to ensure that the relevant procedure may be carried out safely and effectively;

a relevant procedure is not offered to or performed on any patient for whom that relevant procedure would be inappropriate; and

every medical practitioner or dentist who offers a relevant procedure to a patient documents the reasons for doing so and includes such documentation as part of the patient’s clinical management and care plan.

the medical practitioner or dentist (as the case may be) assesses that the patient is a suitable candidate for the relevant procedure; and

where a relevant procedure may only be performed on an individual who is under deep sedation, general anaesthesia or neuraxial anaesthesia, an anaesthesiologist assesses that the patient is a suitable candidate for the administration of anaesthetics that cause the deep sedation, general anaesthesia or neuraxial anaesthesia, as the case may be.

the taking of a comprehensive medical and surgical history of the patient;

physical examination of the patient; and

the conduct of relevant tests and investigations.

only an appropriate relevant procedure is performed on a patient, and the relevant procedure is performed in a proper, effective and safe manner;

the patient or the patient’s caregiver is informed of all relevant perioperative care instructions before the relevant procedure starts; and

appropriate post‑operative care instructions are given to the patient or the patient’s caregiver, including the patient’s care needs and the signs and symptoms of possible adverse reactions that the patient may experience after the relevant procedure.

in relation to surgical procedures — perioperative measures to minimise the risk of surgical site infections;

protocols and processes to ensure that the correct surgical procedure is performed on the correct patient at the correct surgical site and (where applicable) the correct implant, prosthesis or invasive device is inserted into the patient.

one or more of the licensee’s personnel observe and monitor the patient at intervals and for the length of time appropriate to the relevant procedure performed and the anaesthetics administered;

timely and appropriate post‑operative treatment is given to the patient where necessary;

one or more of the licensee’s personnel assists the patient with toileting needs where necessary; and

adequate nutrition and hydration are given to or available to the patient.

there is a protocol for the discharge of patients;

the attending medical practitioner or dentist (who is the licensee’s personnel) for a patient assesses whether the patient is fit for discharge;

where the attending medical practitioner or dentist for a patient is not available to assess whether the patient is fit for discharge, another medical practitioner or dentist (who is the licensee’s personnel) assesses the patient for this purpose instead;

a patient is not asked to leave the approved permanent premises before the patient is assessed to be fit for discharge;

a patient who is assessed to be fit for discharge leaves the premises within 6 hours after the time the patient is so assessed; and

a patient who is assessed to be fit for discharge but who has not left the premises continues to be monitored by the licensee’s personnel.

only as a service that is incidental to the provision of an ambulatory surgical centre service;

at the licensee’s approved permanent premises; and

by the licensee’s personnel who is —

a medical practitioner who is trained in the conduct of ultrasound imaging;

a dentist who is trained in the conduct of ultrasound imaging;

a radiographer who is a duly qualified allied health professional; or

a sonographer.

using testing material in respect of which —

the expiry date has not passed; and

the personnel who is administering the test does not suspect or have any reason to suspect that the testing material is no longer fit for use; and

in accordance with the instructions specified by the manufacturer of the testing material.

ensure that adequate and appropriate facilities, equipment and drugs for the provision of any essential life‑saving measure to a patient are readily available at every approved permanent premises; and

at all times, be capable of providing any essential life‑saving measures to any patient who is at risk of death.

there is a comprehensive and detailed response plan to resuscitate, treat and transfer unstable patients;

the licensee’s personnel promptly assesses a patient who shows any sign of being unwell at any time after a relevant procedure and delivers the necessary treatment to stabilise the patient;

any patient who remains unwell despite the delivery of treatment to stabilise the patient is transferred to the care of an acute hospital service licensee who is equipped to deliver the appropriate treatment to the patient;

all necessary arrangements with one or more acute hospital service licensees are in place to ensure a transfer mentioned in sub‑paragraph (c) takes place without delay at any time;

any patient who requires conveyance by an emergency ambulance is conveyed by an emergency ambulance operated by an emergency ambulance service licensee;

only resuscitation drugs that have not passed their expiry dates and are fit for use and resuscitation equipment that is fit for use are made available for use in the provision of any essential life‑saving measure; and

every personnel who provides any essential life‑saving measure to a patient is adequately trained —

to provide the essential life‑saving measure in a proper, effective and safe manner; and

in the use of the equipment that is needed to deliver the essential life‑saving measure.

the emergency water supply, power and lighting are sufficient to ensure that any relevant procedure that has commenced may be safely completed; and

where any life support equipment is used, the life support equipment is connected to an emergency power supply at all times during its use.

represent to any person or give any person the impression that the licensee is an approved institution; or

otherwise mislead any person as to whether the licensee is an approved institution.

an approved medical institution within the meaning of regulation 2(1) of the Central Provident Fund (Medisave Account Withdrawals) Regulations (Rg 17);

an approved medical institution approved by the Minister under the MediShield Life Scheme Act 2015;

an accredited clinic under the scheme established by the Government known as the Community Health Assist Scheme or any other similar public scheme providing financial assistance established by the Government.

the estimated range of the fees for the care, treatment or procedure;

the fee benchmark for the same or similar care, treatment or procedure that is published on the website of the Ministry of Health at https://www.moh.gov.sg (if available);

whether any part of the fees mentioned in sub‑paragraph (a) may be —

deducted from any medisave account;

reimbursed under the MediShield Life Scheme; or

reduced by any subsidy or grant under a public scheme; and

any other benefit that the MediShield Life Scheme provides to the patient in respect of the care, treatment or procedure, if any.

to a fine not exceeding $20,000 or to imprisonment for a term not exceeding 12 months or to both; and

in the case of a continuing offence, to a further fine not exceeding $1,000 for every day or part of a day during which the offence continues after conviction.