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When ASCs begin to plan an expansion or major renovation, leaders should consider five key areas of focus for the optimal design and operational efficiency.
The goal is to create a space that works well for staff workflow, patient aesthetics, regulatory compliance, and clinical outcomes. “You need to know how to support the patient population, surgeon, family members, and support people in attendance to make sure there is safe transport to and from the surgery center’s pre-op and post-procedure,” says Deb Sheehan, ACHE, EDAC, LEED, executive director of firm strategies for CannonDesign.
• Optimize efficiency and effectiveness. “The design should optimize movement and flow in the OR and ASC proper,” Sheehan says. “With renovations, this is a primary concern, so we start with simulation software and model in a virtual build first.”
This model is tested against the supply chain, staff movements, patient intake, recovery, and outbound activities.
“It’s a nice way to understand behavior and situational awareness,” she says.
The model works well with both new buildings and in cases of repurposed space and incremental expansion. “We’re looking at the sweet spot of turn time for throughput, calculating from the volume of services how the movement is,” Sheehan adds.
• Optimize clinical outcomes for health and safety. New OR space should be designed to provide access to all necessary information, including an integrated digital display, Sheehan says.
“We’ve all seen and heard about some of the errors that occurred with wrong site of surgery,” she says. “You need confirmation and validation. In the pre-op condition, the ASC needs to make sure there’s a transparency of information.”
Design assists with this because it shows where the staff will have access to information on visualization screens in the pre-op phase, in flight boards, and in monitors. “When we get into the OR, it really becomes critical,” Sheehan says.
Design also can contribute to optimizing clinical outcomes through designing space to effectively handle congestion and to provide optimal visibility to monitors throughout the surgery center. “It’s all about the placement and proximity to make sure there are good visuals to that monitor at all times,” Sheehan notes.
• Optimize a positive experience for all users. “Too often, I see designs that are myopically centered around the surgeon or myopically centered around the patient,” Sheehan laments. “How do you support the patient population, surgeon, family members, and support people in attendance to make sure there is safe transport to and from the ASC, pre- and-post-procedure?”
Optimal design also includes space for staff respite time. “There often is not enough space for staff to have areas where they can step away during the day,” Sheehan says. “While we maximize time in the OR, there needs to be accommodations for lockers and food for clinicians.” For patients’ family members, there might be suitable accommodations in waiting areas and interactive space in pre-op and post-op rooms. With attention to renovation design, an ASC can create comfortable space in post-op areas so family members can stay with patients, helping them with dressing and ambulation.
With the help of ASC staff, designers can create flexible space and add features, such as natural light where desired or add dimmers to patient room lighting.
• Optimize sustainable practices. ASC owners should remember that as daunting as capital investment seems, this expense is less than operating costs, Sheehan says. Architectural designers cannot control staffing costs, but the design plan can help ASC leaders control energy consumption and minimize surfaces that harbor airborne contamination.
To optimize sustainability, the design plan should outline how to reduce the draw of energy consumption in the buildings, ensuring good stewardship. Maximizing daylight and installing lighting time sensors are two ways to help control energy costs.
“Even though 70% of the operating cost is payroll, we do have an influence on energy draw on systems and can focus efforts on that,” Sheehan says. This includes addressing electrical systems, water usage, plumbing and mechanical, ventilation, and building maintenance.
To reduce surface contamination, leaders should consider the type of finish selected for counters, which can affect how easy it is to clean spaces, Sheehan adds.
• Optimize the ability to change over time. Design the space to be adaptable to different case mixes. A surgery center’s case mix can evolve and transform. “I’m not designing a room that only can be used for orthopedics, for example,” Sheehan says. “You design the layout of the room so that you can schedule universal OR cases in any room.”
Look at the size and stature of each room, including flow and layout of equipment. “This is something we do based on planning criteria,” Sheehan says. “Don’t reduce the size of the room to a specific need because the anticipated case mix can change over time. In a year or five years from now, [case mix changes] may put a different demand on the use of that room than what was anticipated at the time of the opening.”
Sizing space for one type of equipment or case is limiting.
“The evolution of case mix moving into the ASC and the innovation happening is driving far more complicated cases into the ASC environment than we ever saw over the past five years. We need to anticipate future changes,” Sheehan explains.
Financial Disclosure: Consulting Editor Mark Mayo, CASC, MS, reports he is a consultant for ASD Management. Nurse Planner Kay Ball, PhD, RN, CNOR, FAAN, reports she is a consultant for Ethicon USA and Mobile Instrument Service and Repair. Editor Jonathan Springston, Editor Jill Drachenberg, Author Melinda Young, Physician Editor Steven A. Gunderson, DO, FACA, DABA, CASC, Author Stephen W. Earnhart, RN, CRNA, MA, Accreditations Manager Amy M. Johnson, MSN, RN, CPN, and Editorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.