Out-of-Hospital Premises (OHP) clinics allow physicians to perform procedures outside of a hospital environment while maintaining strict patient safety and regulatory standards.

Across Ontario, more physicians are developing specialized procedural clinics for services such as interventional pain management, endoscopy, ophthalmology procedures, minor surgery, and diagnostic interventions. These facilities can improve patient access, reduce hospital wait times, and give physicians greater control over scheduling and patient care.

However, opening an Out-of-Hospital Premises clinic involves careful planning. Facilities must comply with standards established by the College of Physicians and Surgeons of Ontario (CPSO) and must successfully pass a formal inspection before they are permitted to operate.

This guide outlines the key steps involved in developing an OHP clinic in Ontario, including regulatory approval, facility design considerations, construction requirements, and the CPSO inspection process.

What Is an Out-of-Hospital Premises (OHP)?

An Out-of-Hospital Premises (OHP) is a healthcare facility where certain medical or surgical procedures are performed outside of a hospital setting.

These facilities are regulated by the College of Physicians and Surgeons of Ontario (CPSO) through the Out-of-Hospital Premises program. The program ensures that clinics performing procedural care meet strict standards for patient safety, infection control, and clinical quality.

OHP clinics are commonly used for procedures that require specialized equipment, imaging, sedation, or recovery monitoring but do not require a full hospital operating room.

Examples of procedures commonly performed in OHP clinics include:

• Interventional pain procedures

• Endoscopy procedures

• Cosmetic and plastic surgery

• Ophthalmologic surgery

• Dermatologic procedures

• Certain cardiology procedures

• Fertility procedures

• Minor surgical interventions requiring sedation

Because these procedures involve higher clinical risk than standard office-based services, facilities must meet detailed regulatory and infrastructure requirements before receiving approval.

Understanding OHP Levels (Level 1, Level 2, and Level 3)

Out-of-Hospital Premises are categorized based on the complexity of procedures performed and the level of anesthesia or sedation involved.

OHP Level 1:

Level 1 facilities typically perform minor procedures with minimal sedation. These procedures carry lower risk and generally require less complex infrastructure.

OHP Level 2:

Level 2 facilities perform procedures that may involve moderate sedation and more advanced monitoring requirements. These clinics require more extensive procedural infrastructure and recovery monitoring areas.

OHP Level 3:

Level 3 facilities perform more complex procedures that may involve deeper sedation or anesthesia. These clinics require higher levels of patient monitoring, recovery capability, and safety infrastructure.

The level of an OHP facility significantly affects the design requirements, equipment needs, staffing requirements, and inspection standards.

Understanding the appropriate level early in the planning process is essential, as it will influence both the regulatory requirements and the facility design.

Types of Clinics That May Require OHP Certification

Many specialty clinics may fall under the OHP program depending on the procedures being performed.

Examples include:

Interventional Pain Clinics

Pain clinics performing injections under fluoroscopy or ultrasound guidance typically require procedural rooms that meet OHP standards.

Endoscopy Clinics

Facilities performing colonoscopies or gastroscopies must comply with strict sterilization and infection control standards.

Cosmetic and Plastic Surgery Clinics

Certain cosmetic procedures involving sedation or surgical techniques may require OHP accreditation.

Ophthalmology Surgical Clinics

Ambulatory surgical centres performing procedures such as cataract surgery may fall under the program.

Fertility Clinics

Facilities performing egg retrievals or other reproductive procedures may require specialized procedural rooms.

Determining whether a clinic requires OHP certification depends on the procedures performed, sedation levels, and equipment involved.

The CPSO OHP Application Process

Physicians wishing to operate an Out-of-Hospital Premises must submit an application through the CPSO OHP program.

Applications are completed online through the CPSO and require detailed documentation about the proposed facility and clinical operations.

A key requirement is the appointment of a Medical Director.

The Medical Director is responsible for overseeing:

• clinical governance of the facility

• compliance with CPSO standards

• patient safety protocols

• physician credentialing

• quality assurance programs

• supervision of clinical policies and procedures

The application process typically requires submission of:

• facility design and layout plans

• types of procedures performed

• equipment specifications

• staffing structure

• infection prevention and control protocols

• emergency preparedness procedures

Facilities must also prepare a Policy and Procedure (P&P) Manual outlining how the clinic will manage patient care, infection control, equipment safety, and emergency response.

Preparing these materials can take several months, and many clinics begin assembling documentation well in advance of submitting their CPSO application.

The CPSO Inspection Process

Before an Out-of-Hospital Premises can begin operating, the clinic must undergo a CPSO inspection.

The inspection evaluates both the physical infrastructure of the clinic and its operational procedures.

Inspectors typically review areas such as:

• procedure room design and safety

• infection prevention and control protocols

• sterilization and instrument reprocessing

• medication storage and management

• patient monitoring and recovery areas

• emergency preparedness procedures

• clinical documentation processes

• staff training and credentialing

Inspectors also review the clinic’s Policy and Procedure Manual and supporting documentation.

The CPSO inspection process includes a comprehensive checklist that ensures the facility meets all applicable safety and operational standards before approval is granted.

Facility Design Considerations for OHP Clinics

Designing an OHP clinic requires specialized healthcare planning to ensure the facility supports safe procedural care and complies with CPSO standards.

Several design elements must be carefully considered during the clinic build-out.

Procedure Rooms:

Procedure rooms must be designed to accommodate medical equipment while maintaining safe patient positioning and staff workflow.

Proper lighting, equipment access, and infection-control surfaces are critical.

Recovery Areas:

Patients undergoing sedation or procedures must recover in a monitored environment.

Recovery areas typically include:

• patient monitoring equipment

• nurse observation stations

• emergency response equipment

• safe discharge pathways

Patient Flow:

Well-designed patient flow improves operational efficiency and reduces infection risks.

Clinics typically include separate areas for:

• patient intake

• procedure preparation

• procedure rooms

• recovery and discharge

Healthcare Construction Requirements

Procedural clinics must meet construction standards that differ significantly from standard commercial spaces.

Healthcare environments require materials and finishes designed to support infection control and long-term durability.

Examples of construction considerations include:

• seamless non-porous flooring systems

• cleanable healthcare-grade ceiling systems

• washable antimicrobial wall finishes or healthcare-grade paint

These are just some of the many factors that must be considered during the build-out of a procedural clinic.

Healthcare construction also involves infrastructure planning for:

• medical gases

• specialized electrical systems

• equipment support structures

• sterilization and reprocessing areas

HVAC and Mechanical System Requirements

Mechanical systems are a critical component of procedural clinic design.

OHP clinics must typically comply with Canadian Standards Association (CSA) healthcare facility guidelines related to ventilation and air handling.

These systems help maintain:

• proper air exchange rates

• controlled temperature and humidity

• reduced airborne contamination

• safe procedural environments

Proper HVAC design must be incorporated early in the planning phase, as retrofitting ventilation systems after construction can be extremely costly.

Infection Prevention and Control

Infection prevention is one of the most important areas evaluated during CPSO inspections.

Facilities must demonstrate protocols for:

• instrument sterilization

• equipment reprocessing

• environmental cleaning

• biomedical waste disposal

• infection monitoring procedures

Because infection control requirements are highly detailed, some clinics consult infection prevention specialists or nurse inspectors during the design and preparation stages to help ensure compliance before the CPSO inspection.

Choosing the Right Contractor Is Critical

One of the most important decisions physicians make when opening an OHP clinic is selecting the right contractor for the project.

Healthcare construction, particularly procedural clinics, is significantly more complex than standard commercial renovations.

Working with a contractor who does not understand the regulatory requirements can lead to serious problems, including:

• design errors that fail CPSO inspection

• infrastructure that does not support required equipment

• infection control issues

• costly reconstruction after inspection failures

In some cases, clinics have been forced to perform major renovations or rebuild sections of the facility after failing inspection, costing tens of thousands of dollars or more.

Selecting a contractor who specializes in healthcare facility construction and understands CPSO OHP requirements can help prevent costly delays and significantly reduce project risk.

Timeline to Launch an OHP Clinic

Opening an Out-of-Hospital Premises clinic typically takes several months from initial planning to final approval.

Typical stages include:

Planning and Feasibility

Evaluating procedures, equipment needs, regulatory requirements, and clinic location.

Design and Engineering

Developing architectural plans that comply with healthcare facility guidelines.

Construction and Build-Out

Building the clinic with specialized infrastructure required for procedural care.

Regulatory Preparation

Completing CPSO application documentation and policy manuals.

Inspection and Approval

CPSO inspection and approval prior to beginning procedures.

Proper planning and coordination between clinical, regulatory, and construction teams can help ensure a smooth launch.

Final Thoughts

Out-of-Hospital Premises clinics are becoming an increasingly important part of healthcare delivery in Ontario. These facilities allow physicians to provide specialized procedures in controlled environments while improving patient access to care.

However, developing an OHP clinic requires careful planning, regulatory preparation, and specialized facility design.

Physicians considering opening an OHP clinic should take the time to understand CPSO requirements, ensure proper facility design, and work with experienced professionals who are familiar with healthcare construction and regulatory compliance.

With the right planning and expertise, OHP clinics can provide high-quality procedural care while operating safely and efficiently.