Make your ASC a reality

When you decide to build an ophthalmic ambulatory surgery center (ASC), proceed carefully, advised Katie Jacobs, AIA.

Jacobs, an architect with the Kalamazoo, MI-based firm Eckert Wordell, made a presentation recently called, "Designing the Ophthalmic ASC: Making Your Vision a Reality."

The first step in developing an ASC, Jacobs said, is a financial feasibility study. Remember the bottom line: Can you make your venture profitable? Jacobs recommended hiring a consultant to evaluate feasibility, determine local regulations, and learn accreditation rules and inspection procedures.

Ground rules

At the main entrance, a covered drop-off area may be required. Jacobs said that, in addition to protecting patients from the elements, the entry can also provide an identity for your building. Signage should be clear and free from obstruction.

"When patients enter, they should have a clear view of the reception desk," Jacobs said. The waiting room and restrooms should also be visible. "Consider traffic patterns. You don't want paths to cross as patients enter the facility, and then move between the waiting room and pre-or postop areas."

To determine the number of chairs needed in the waiting room, Jacobs said to think about the number and types of cases, the number of pre-and postop beds, and the number of family members accompanying patients. A play area could be added, if appropriate, either integrated with the waiting area or separately.

The business area should include the reception desk, chart storage, staff spaces, the office manager's office, billing and insurance staff, and a consultation room.

The central nurses' desk should include a place to lock and distribute medications, a nourishment area, a sink for hand washing, an office for the nursing administrator, and patient restrooms. The nursing staff will monitor patients from this location.

Pre-and postop cubicles can be integrated around a nurses' station for flexibility, or they can be separated. "Preop cubicles could surround the nurses' station and postop cubicles could be more remote. However, that arrangement makes it harder to share bays," said Jacobs. Different cubicle formations allow different circulation patterns in and out of the surgical suite.

Jacobs explained that cubicles can be one of three sizes: bed, recliner, or post-anesthetic recovery. State requirements dictate the sizes of these cubicles. "Plan on three to four cubicles per operating room (OR)," said Jacobs.

Where should the YAG laser be located? Jacobs said it could be positioned in the pre-or postop area if a more surgical environment is desirable. For a less surgical feel, the YAG laser could be placed off the waiting room.

Locating the laser in a central area might provide an opportunity to market the technology. "In a center that does primarily cataract surgery, you probably won't get much marketing bang. But in a practice that does orthopedics on younger, active patients or one that does a lot of cosmetic plastics procedures, it could be a good strategy to make the excimer laser more visible," Jacobs said.

Will refractive procedures occur in the clinic or the ASC? "How integrated do you want these patients?" Jacobs asked. "Some practices cater to LASIK patients in a suite and provide amenities for patients having elective surgery. Other practices prefer not to make any distinction."

Surgical suite(s)