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By Stephen W. Earnhart, MS
President and CEO
Earnhart and Associates
I do love the Internet. Particularly, I love the instant access to just about anything you can imagine. As a result of the opportunities afforded by this medium, about a year ago I started e-mailing my peers using an unofficial and completely confidential e-mail feedback list. These individuals (who will always remain anonymous) provide feedback to me on certain issues related to ambulatory surgery. The information is geographically cross-sectional and can be hospital-based or freestanding in nature. The original list was limited to 1,000 peers, but due to new technology, we have expanded it to accommodate an unlimited number.
How does it work? Simple. A single question or series of questions is e-mailed to you. You may respond if you wish or ignore the question and not respond. Very simple. Once your reply is received, we tabulate the responses and within a few days (sometimes hours, if we have a runaway response) we e-mail each respondent the feedback from the group.
Every once in a while I publish the results of a survey in my column, such as in this one. Normally, only respondents are given the results. You can check out the details at our Web site, which is listed at the end of this column.
We last surveyed the group in early August. The response is timely because of all the ASC renovations occurring around the country. The question posed to the group was: What would you change about the physical environment of your ASC if cost and space were not an issue?
We received 354 responses within the first two hours, an additional 325 after six hours, and another 171 at the end of the day. Here are the results:
1. o. 1 request? Larger ORs! I mean big they want 600 to 700 square feet. The unofficial average operating room size in the centers I am familiar with is between 350 and 400 square feet. According to the respondents, it is one of the most frequent complaints they receive from the staff and the surgeons.
2. More storage space! The Health Care Financing Administration requires that each OR built must have at least 50 square feet of storage space. Hence, a three-OR center must have 150 square feet of storage to pass the Life, Safety Code inspection. ASC developers who don’t understand the industry will build "to code," that is, include only the required minimum space. If you triple that amount, you’ll at least start to get realistic.
3. Alcove space to park C-Arms, stretchers, lasers, and other large pieces of equipment that need to be in the surgical core without blocking the corridor.
4. Showers in the women’s locker room. Most centers have a shower, but it is in the men’s locker room.
5. Larger business office and a place to store medical records in the same area.
6. Updated computers. It didn’t really follow the question, but I received so many responses that I had to list it.
7. More parking for staff. No one mentioned patient parking.
Other top responses included office space for the nurse manager and coordinators, larger staff lounge, more patient waiting space, and phones in the lobby for patients.
Just like a new car, the newer ASCs being built have taken most of these issues into account. Incidentally, as one person pointed out, as physicians go to these newer centers for their occasional case, they come back and complain even more about your OR size. Fact is, with all the new technology, after you cram in all the equipment, there just isn’t room for the patient!
One thing I like about these unofficial surveys is that you know you are not alone out there and your situation is not unique. Does your feedback matter? Yes! That’s why the design of the newer ASCs has changed.
More and more hospitals are expanding their ASCs and for good reasons They are seeing more patients shift from the main ORs. Make sure you are involved. I cannot tell you the number of times I’ve been involved in the planning process and the ASC administrator was not included in the meetings. (They sure were after I complained about it, though!) Ask/demand depending upon your situation to be included.
Find out how savvy the project architect is by asking her or him for recommendations on OR size. Then ask about storage. I know from experience that once the initial layout of the drawings is on paper, it is very, very difficult to increase the sizes of the ORs. Like anything else, the space allowed will be filled regardless of the OR size. Again, try to get involved as early in the project as possible.
Thanks again to the survey group for their timely and useful information.
(Editor’s note: Earnhart can be contacted at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: firstname.lastname@example.org. World Wide Web: http://rampages.onramp.net/~surgery.)