10 Cardinal Sins in Surgery Center Design

Lee Chester, a healthcare architect and vice president of L3 Healthcare Design in Altamonte Springs, Fla., lists 10 cardinal sins in ambulatory surgery center design.


1. Obsession with a small footprint. Many people assume the smallest footprint makes for the most efficient ASC. "In fact, flow and proper balance between pre-op treatment and recovery appropriate to the specialty yields the most cases in the least amount of time," Mr. Chester says.


2. Assuming every square foot costs the same. While investors rightly need to guard against creating too much space, particularly in the expensive OR, some spaces cost relatively little and should not be scanted on. These spaces include storage, business office and instrument processing spaces. "Lack of enough space here is generally the most direct cause of citations," Mr. Chester says.


3. Not getting other perspectives. If surgeon-owners don't get input from other members of the ASC staff, the design may skimp on features they are not directly involved in, such as sterilization, storage and business office requirements. "When you design, you have to walk in a lot of people's shoes," Mr. Chester says.


4. Too few sterilizers. Surgeon-owners unfamiliar with the sterilization process are likely to skimp on the number of sterilizers, with drastic consequences for ASC efficiency. "If you plan for just one sterilizer, it slows down everything," Mr. Chester says. "You are constantly having to wait for sterilization to catch up."


5. Too little storage space. Surgeon-owners may allow too little storage space in the pre-op and post-op storage areas. Adequate storage is necessary not just for nurses' supplies but also for a variety of creature comforts of patients who have to endure long waits there.


6. Cramped business office. Surgeon-owners underestimate how many people are needed in the business office and give each one too little space to work in. They may fit business staff into Dilbert-like cubicles with small desks that have no room to spread out claims-processing paperwork. "These cramped conditions can create a great deal of turnover," Mr. Chester says. He would ban cubicles and break up business staff into two rooms, one for insurance and another for the medical records.


7. Ignoring staff needs. "Enhancing the work environment is the one factor that can most easily be accomplished," Mr. Chester says, "and yet this is very often overlooked." Designers can often meet staff needs with very little effort, such as introducing some natural light and ordering ergonomic seating. "Nurses may have a 10-hour shift in recovery," he says. "Do they want to work in a cave?"


8. Not leaving room for expansion. If volume grows, the ASC needs room to expand. But when a self-standing surgery center is placed on a tiny plot of land, it becomes "landlocked," with no room to grow. And an ASC in an office building is "plan-locked" if it cannot add ORs within its sterile zone. "You should always be planning how you are going to grow," Mr. Chester says.


9. Looking institutional. Warm, happy, personal environments have a dramatic effect on patients. "When you have access to an amazing array of finish materials and patterns, allowing an institutional look is really an unforgivable sin," Mr. Chester says.

10. Not noting specialty differences. "We often see the mistaken assumption that an ASC designed for one specialty efficiently serves another," Mr. Chester says. In fact, each specialty has a different patient flow that affects design. For example, ophthalmology takes 15 minutes of surgery and 30 minutes recovery, so there are two patients in recovery for each one in surgery. The recovery time for spine, on the other hand, is about the same as the operating time, so patients don't stack up in recovery. However, spine patients need more room in the recovery area.


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