Get Your State's Blessing Before You Build
Send your architectural plans to your state agency (in Idaho, for example, that's the Bureau of Facility Standards) for review to determine if the facility meets state and CMS specifications before you finalize the plans. If you don't do so before your architect finalizes the design, change orders will result in costs outside of your construction budget. Most states offer this service free of charge or at a nominal fee.

Kris Sabo, RN
Clinical Director
Pend Oreille Surgery Center
Ponderay, Idaho
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Keep Your Hard Hat Handy
I can't stress enough the importance of frequently visiting your construction site. I went every day and talked with the construction manager. That way, if anything wasn't looking quite right, we could address it right away. This helped keep change orders to a bare minimum.

Marti Potter, RN, CNOR, MHCA
Jersey Shore ASC
Somers Point, N.J.
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Mock Up Your New Space
Some people are better at spatial relationships than others. Create a mockup of your new space, in as much detail as possible. It doesn't have to be elaborate; take an existing space and use tape and other materials to locate table, light and boom positions. Don't forget to mark electrical outlets and medical gas locations. Note both location and height. Look for return vents and evaluate how they impact equipment placement. Then have as many team members as possible walk through and evaluate the space they will soon claim as their own. It's easier to make changes in the drawings than in the middle of construction.

Thomas Fender, RN, MSN
Huntsville Hospital
Huntsville, Ala.
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Troubleshoot from the Architectural Drawings
I noticed on the layout that the door from the soiled utility room opened in to the sub-sterile room and blocked the sterilizer on the counter top. We moved the counter several feet to allow the sterilizer door to open free from any obstruction. It's much easier to erase lines than to knock down drywall.

Mary Wilhide, RN
Carroll County Eye Surgery Center
Westminster, Md.
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Tour Other Facilities (Yes, They'll Let You!)
When our physicians started talking seriously about building an outpatient endoscopy center, I visited a center in a city similar to ours. I was surprised at how well I was received and the wealth of information that they shared with me. Our administrator and I visited three other facilities before we started building. We found that our colleagues love to share their knowledge and the things they wish they had done. The most cost-effective information we received was to install a wall-mounted suction drain. We no longer pay for costly disposal of containers full of fluids. It just drains into the sewage system.

Jana Beasley, RN
Assistant Administrator
Wichita Falls Endoscopy Center
Wichita Falls, Texas
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Make Wide the Path for Gurneys
The halls that we must travel through to go to the endoscopy suites aren't wide enough for us to easily turn a gurney into the rooms. We frequently end up bumping the walls and doorjambs. This isn't good for the patient in the bed nor is it good for the walls. We wish we had another two feet in addition to the standard hall width to prevent this problem.

Mary Ann Henry, RN, BS
United Surgery Center
Cottonwood, Ariz.
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Which Way to the Staff Lounge?
We had to convert one of our post-op areas into our lunchroom because a staff lounge wasn't in the builder's plans. You probably won't want your staff to leave the facility for lunch on surgery days, so they'll need a place to eat and relax. We ask everyone to take a turn providing lunch. It's worked for us, but the space is extremely limited.

Tina Harrison, RN
Nurse Manager
Meredyth Eye Surgery Center
Albany, Ga.
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Delivery Drops
Keep in mind that you must have a non-sterile corridor that is easily accessible to the OR for shipments of boxed inventory and an area that is accessible for large trucks to drop off inventory.

Danielle Miesner, RN, CNOR
Ireland Grove Center for Surgery
Bloomington, Ill.
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What's Irked and Annoyed You?
Think about everything you disliked at every place you ever worked. How far to a sink? How crammed is a bay after all equipment and stretchers are in place? Here's more.

• Storage. It always looks like enough on paper, but it never is. It's like a patient telling you how much he drinks. Double it. And don't forget about strategic storage spots here and there for warm blankets and gowns.
• Patient comfort. Think of yourself as a patient. What would you like, from the moment you enter the building until you're lying on a stretcher half-naked in pre-op? A nice touch: small TVs on swing arms in each pre-op bay.
• Boardroom. Staff and physicians deserve some down-time and a comfortable place to gather. Plan for a meeting room that accommodates at least 10 people.
• Patient monitors. Consider monitors that travel with the patient.
• Coffee. Invest in a very good coffeemaker for the staff lounge.
• Family members. Wireless access would be nice for them.

Ann Turner, BSN, RN, CGRN, CCRN
AdministratorSurgery Center of Columbia County
Evans, Ga.
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Let It Be Written, Let It Be Done
When our surgery center was being built, I kept a binder (that's it above!) that became my daily organizer and stress reducer. Within its tabbed sections, I tracked permits we needed, equipment I had to order and when it had to be installed. It included all the contact information, deadlines that were due, delivery dates that were promised, costs and contacts. This not only kept me organized, but also gave me one source to access specific information, no matter where I was or who I was talking with. A lot of people keep stuff on their laptops — but when you're driving, they're hard to use.

Kim Thornton, RN
Clinical Director
Timberlake Surgery Center
Chesterfield, Mo.
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Open Floor Plan
An open floor plan between pre-op and PACU lets staff work together as the workload shifts from one area to the other. Staff is expensive; working between departments will help the bottom line.

Janie Ellison, RN
Director of Surgical Services
Southeastern Surgical Center, Atlanta, Ga.
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Consider All Your Customers in Designing the Facility
Is it patient friendly? Can the surgeon and anesthesiologist work easily in the space with the equipment they will need? Is it designed for the nurses to perform well?

Mike Ramsay, MD
Baylor University Medical Center
Dallas, Texas
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Booms Done Right
If you're installing booms, make sure the structural engineers and boom manufacturers work hand in hand. Our facility decided to change vendors in midstream. When the booms went into service, there were structural issues, like having to move patients under the light versus the light coming to the patients. After two years of moving the booms to and fro, the wiring began to fray and had to be repaired.

Myra Jo Beach, RN, BSN, MBA
Director of Perioperative Services
West Virginia University Hospitals
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Make Your Waiting Room Big
Plan for success: Build out patient waiting space in anticipation of your volume three years out. The first impression on your patients is your waiting room. Plan for plenty of space to accommodate escorts and family.

Brien Fausone, MA, MBA
Michigan Endoscopy Center
Farmington Hills, Mich.
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You Can't Have Too Much...Storage Space
ASCs are known to boast that they don't have any wasted space — yet this can be a real problem as you grow. Please plan for some storage space. You'll need it for charts, drinks for the patients and even small things like your Christmas tree. Having adequate storage space also helps to keep the center appearing uncluttered.

Lisa W. Harrison, RN
Administrator
The Surgery Center of Athens
Athens, Tenn.
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Electrical Outlets
Check the number and location of your electrical outlets on the blueprint and before the electrician closes the walls. Building codes for commercial spaces in our state require outlets every few feet. When we opened, we didn't have outlets in the hall to plug in the blood pressure and EKG machines.

Helen McGrain
Center Director
White Marsh Surgery Center
Nottingham, Md.
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Separate Clean and Dirty With Walls
You'll hear talk from inspectors about the invisible walls that separate clean and dirty areas. When we started construction on our endo center, we decided to separate those areas with actual walls.

• Dirty. When you're planning this area, make sure you work closely with construction managers so you get exactly what you need. They tend to place standard sinks in your cleaning areas unless you tell them what your specific needs are. I had to change out the sinks twice. Even though I told them what I wanted, they kept bringing me what they thought was acceptable.
• Reprocessing. Washers are located in the reprocessing area, which is an aisle away from the dirty and clean areas. Techs are able to remove the scopes, walk over to the washers and place them in without crossing into any other areas.
• Clean. The clean area, where the scopes are stored in cabinets, is located around a corner. A wall keeps the clean separate from both the dirty and reprocessing areas. Our cleaning room is located between our procedure rooms, so we have four doors in the cleaning room to keep us from having to walk through an area of contamination.

Susan Theobald, CGRN
Nursing Supervisor
The Endo Center of Elgin Gastroenterology
Elgin, Ill.
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Where to Position the Anesthesia Equipment?
If you're looking for quick turn-over times, it's best to have the OR situated so that the anesthesia machine is to the right and the anesthesia equipment is on the back wall to the right. The stretcher is then brought in, the patient is transferred to the OR table to the right and the stretcher is taken out of the room. If the anesthesia machine is placed anywhere in the room, the OR and anesthesia folks are climbing over each other to get to the patient and their equipment, and to avoid the gas machine.

Ann Sikes, CRNA
Bridgeport Hospital
Shelton, Conn.
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Don't Forget About Patient Conference Rooms
Have at least two patient conference rooms for post-op discussions. Otherwise, you'll have an awkward time discussing post-op care with the family. You also might be violating HIPAA.

Steven D. Williams, MD, FACS
Riverside Ambulatory Surgery Center
Bourbonnais, Ill.
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Hire Experienced Architects and Builders
One of the greatest aids to making a new ASC work is having an architect and builder who are familiar with Medicare Life Safety Codes and any state ASC licensure rules and regulations. Once this is accomplished you must work with them so that you construct the facility with tentative plans for future expansion already built into the concept. The most frequent thing left out of most projects is adequate storage; this, too, must be part of your expansion plan. Without proper preplanning, you will end up unhappy with your design down the road.

Steven A. Gunderson, DO
CEO/Medical Director
Rockford Ambulatory Surgery Center
Rockford, Ill.
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Circles of Influence
Sit down with the architect and draw circles of who works together. Talk about the process flow and about how information gets from one circle to another. You can then plan the office spaces around those whose work functions make sense to be in closer proximity than others. This concept has worked great for me in developing many site buildouts.

Barb Wegener, RN, BSN, MPA, CHE, CNAA
Lakewood Ranch Medical Center
Lakewood Ranch, Fla.
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Easier to Erase a Wall
Than to Knock One DownWe have a beautiful new building, but the layout leaves much to be desired. For example, you must pass through public waiting areas to get to locker rooms and break rooms. Electrical outlets were up to state safety codes, but not up to OR standards for potentially wet procedures. Medication refrigeration and patient nutrition refrigeration were not accounted for in initial construction. Cupboard and shelf space for the storage of basic pre-op and post-up supplies were not optimal. We didn't notice these critical defects, which delayed our opening, until we were stocking the facility. The lesson: Be sure to involve a physician, or other medical service personnel who will be using the facility, in the architect's plans.

Susan Kubota, MD
Anesthesiologist
The Portland Clinic, Alberty Surgical Center
Tigard, Ore.
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Strategically Place Sinks and Doors
Put the scrub sinks in the core where masks are required so you won't have traffic around the scrub area. Install recessed sliding doors with push plates for hall access and use them only for patient movement. Use the core access doors for all other traffic. Access the equipment and supply rooms off the core.

Sally Patterson, RN, BSN, CNOR
St. Joseph Hospital
Bangor, Maine
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