Build or renovate: How do you decide?

(In this first part of a two-part series on adding space to your SDS program, we offer advice on how to decide whether to build and discuss the role that case mix plays. In next month’s issue, we’ll tell you how to select an architect and construction costs to consider.)

You are adding new physicians to your medical staff. Your facility’s new managed care contracts mean new day-surgery patients. Physicians are threatening to leave your facility because it is too hard to get operating room time.

Whatever the reason for your expansion, making the decision to add operating rooms by renovating existing space or by building from the ground up is not a simple decision to make. There are a number of factors to consider, says Michael L. Gordon, AIA, of Gordon and Associates Architects in Mount Dora, FL. The ability to meet federal building codes as well as local building codes is a key consideration when you are renovating existing space, he says. Meeting these codes may require expensive construction to renovate a building, he adds.

Renovation costs are hard to predict without a thorough study of the building, says Steve Dickerson, AIA, principal architect at Eckert Wordell in Kalamazoo, MI. For this reason, Dickerson recommends hiring an architect who is experienced in surgery center design to conduct a survey of the space you want to renovate.

"An architect can see if the hallways are wide enough to handle stretchers and wheelchairs or if the building’s support columns are placed in such a way that they will impede traffic through the area," he explains.

Ceiling heights are important, too, he says. "Ceilings must be at least 9 feet tall, with a minimum of 2 feet of space above the ceiling to hold the mechanical and air filtration systems."

Several years ago, Kay Kern, RN, BSN, MSBA, administrator at the Michigan Surgical Center in East Lansing, oversaw a renovation project in a medical office building. "A set of fire stairs that ran through the center of the building was directly next to the area where the sterile hall of the operating suites would be located," she says. "It took several creative design ideas and an additional hallway within the surgical suite to come up with a design that enabled people to use the fire stairs without compromising our sterile area."

In 1998, her current employer gave her a chance to build a surgery center from the ground up. "We didn’t even consider renovation because there was no space to renovate," Kern says. "The multispecialty group of physicians building this center already owned the land adjacent to the medical office building, so there was no issue of finding and purchasing land."

There are several advantages to consider with a new building, says Gordon. "You can make sure that all local and federal building codes for surgery centers are met with no problem." Aesthetically, a new building can easily be designed to meet the outpatient surgery patient’s expectations for a quiet, confidential, and noninstitutional atmosphere, he adds.

The addition of a day-surgery center within a hospital is easy from the code requirements, but can be tricky when trying to present the environment you want, says Dickerson.

"People want to go to outpatient centers to avoid the institutional feel of a hospital." If they have to walk through hospital hallways to get to the center, you haven’t created a good atmosphere, he explains. "If the center can be located in a part of the building that provides a separate entrance for the outpatient center, it will be more successful."

New buildings give you the opportunity to plan for future growth, says Dickerson. Adding a day-surgery center within an existing medical office building or a hospital means fitting into existing space, sometime eliminating the luxury of "empty space" for future growth, he explains.

Planning for future growth was one benefit the staff at Michigan Surgical Center enjoyed, says Kern. "Not only did we include two procedure rooms for future use, but we have storage space we don’t even use yet," she says.

However, some states, including Illinois, don’t allow empty space for future expansion.

A new building may be the dream of every day-surgery program manager and surgery center architect, but the reality is that renovation is a common solution, says Dickerson. "Fifty percent of my clients renovate and 50% build." Many times an urban facility is renovating, and rural facilities are building simply because the land is available. As long as your pre-planning process is effective, both approaches can work, he adds. (See story on thinking ahead, below.)

Choosing an architect that has experience with surgery centers will also help you ensure a design that is functional and aesthetically pleasing, says Gordon. Make sure you involve people who work within the areas in the initial design phases. Gordon points out that major changes in the center’s design should be made in the planning stages, not the construction phase, "It is much easier to erase pencil than it is to break up concrete."

For more information about renovating or building ambulatory surgery space, contact:

Michael L. Gordon, AIA, Gordon & Associates Architects, 730 East Fifth Ave., Mount Dora, FL 32757. Telephone: (352) 383-6505. Fax: (352) 383-6130. E-mail: Gordonarchitects@earthlink. net.

Steve Dickerson, AIA, Principal Architect, Eckert Wordell, 161 E. Michigan St., Suite 200, Kalamazoo, MI 49007. Telephone: (616) 388-7313. Fax: (616) 388-7330.

Kay Kern, RN, BSN, MSBA, Administrator, Michigan Surgical Center, 2075 Coolidge Road, East Lansing, MI 48823. Telephone: (517) 319-9000. Fax: (517) 319-0049. E-mail: klkern@aol. com.