What is your most noted ASC?

One of our latest and the most noted ASC’s is the Conejo Valley Surgery Center LLC, in Thousand Oaks, California. It is approximately 7,200 SF with Two O.R.’s and two Procedure Rooms and 14 Recovery and Pre Op Beds.

What are the Design tips that improve operational efficiency and patient flow (improving bottleneck)?

One of the most critical design decisions is made during the initial planning stages when spaces are being ‘bubbled out’ setting the stage for all preliminary design concepts. At this juncture, it is extremely important to pay close attention to patient, Staff/Physicians and Services circulation. The most ideal situation would be to design a facility in a loop where the patient enters and exits without going back over the same space travelled earlier. Separate staff entry and exit through independent entry/exit points helps in keeping these areas free from overlapping with patients flows. Service spaces such including delivery of supplies, collection of infectious waste and soiled linen should be kept completely separate from staff spaces and sterile areas. Cross contamination is also a major design component. The dirty instrument trays from an O.R. should not cross paths with cleaner and duly sterilized instruments. Such design is easily achievable through proper creative planning. Regulatory agencies including OSHPD, Medicare, AAAHC, AAASF or JCAHO have a common goal. That is to make sure that the ASC’s deliver quality patient care in a safe environment. Many facilities today, either due to lack of proper planning or lax agencies or costs, do not provide quality care. As a result, infections among patients are common but largely go unnoticed.

What are the advantages of planning improvements rather than a new development?

A ground up facility, built from scratch, always takes time and costs more to build in today’s market than an existing building that may be available for a good price. Renovating a new/old medical building is far easier and less time consuming. In many markets, ASC’s are location driven based on patient and physician convenience. Where such medical buildings are not available, a ground up facility may be the only option.

If a building is available, it may yet not qualify to hold an ASC mostly due to its fire resistive requirements. Larger ASC’s require higher fire standards than an ASC with less than five patient capacity (a patient is one when the sedation rendered to the makes them incapable of self preservation in case of an emergency even if it is for one minute) at any given time including all pre-op, recovery and O.R.’s. For example, if the recovery and Pre-Op has three gurneys/beds and there are two O.R.’s, the ASC meets the five-patient threshold. Beyond this, if a shell building qualifies under fire resistance ratings requirements, there is no limit on the number of beds.

What are the basic considerations given when building or expanding your facility?

When building an ASC, experience is the key. Most Architecture/construction firms are not familiar with all the intricacies of building an ASC. A Physician should first verify or visit ASC’s designed or built by the architect/builder. In many cases, certain firms are experienced in offering both design and construction all under one roof. While this may not be the best concept for all projects, it is one of the best for building an ASC. The main reason is that the ASC Design/Builder cannot blame anyone other company and is responsible for all work under one roof. The construction costs and specifications can be established at the outset and the Design/Builder can be made to hold their price based on the specs. Financially, this concept works very well since base costs are established ahead of time. The Physicians on the other hand can verify construction costs from general market tends. Overall, the costs of the ASC’s built in the Design/Build manner have resulted in over 20% savings as compared to design and BID process. In a Bid process, you may get the best price for the design but the design may not be the one that saves cost. A good design/builder is fully aware of the costs and can save in efficiency, direct costs and time. A tour of completed facilities of a Design/Builder gives the Clients a clear idea of what to expect when the ASC gets completed. One thing remains certain, in a design/Build process, experience plays a very important role and allows for a MEDICARE/AAAHC certified facility without long delays typically found in ASC’s built by inexperienced companies.

How should you develop with future expansion in mind?

When a core group of Physicians lead an ASC, the chances of growth are high. In almost all cases, where Physicians are majority Owners, the ASC has the highest chance for growth. Under such scenarios, one must keep expansion in mind. The most ideal ASC is one that is designed in a manner that allows future expansion without disruption to the existing operations, Expansion is usually needed in Recovery/Pre-Op areas along with Supply/Storage areas. Number of O.R.’s may need to be increased also depending on the cases. Designation of a pre planned expansion area is a must where such spaces are available. In the future, it is likely that ASC’s will see an increase in the number of cases as more and more of the insured population seeks surgeries.

How and when to delay or accelerate a project?

When detailed financial analysis and proforma’s done by experts in the field finds that an ASC is feasible, delaying commencement is nothing short of direct loss. On the other hand, it is a bigger setback if the project is commenced with an unqualified Architect/Builder. Involvement of inexperienced players sets back projects substantially adding to lost time and opportunity. There are many codes that govern ASC’s and compliance is required by certifying agencies such as MEDICARE and AAAHC. Since all codes are not black and white and involve different agencies (not all of them under a Building Department jurisdiction) it is likely that the pitfalls of ‘not knowing’ can come to haunt later into the project and either cost a lot to repair or delay the opening and Accreditation itself. Experienced ASC developers / Architects / Builders / Contractors hold the key to successful and timely completion of a project.