• High-end instrument care. Complex cases require stacks of trays full of complex instrumentation, and our sterile processing department will be equipped to handle the load. Because we'll be performing joint replacements and spine procedures, we felt it was critical to outfit our department with reprocessing equipment traditionally found in large hospitals. Our facility's instrument reprocessing area will feature a full-size cart washer, 2 washer disinfectors, 2 steam sterilizers and an ultrasonic cleaner. Including a full-service sterile processing space in the design added considerable cost and extra square footage to our project, but we feel that budgeting for additional instrument care space is essential.
• Block rooms. The opioid epidemic is forcing us to look for alternative ways to control post-op pain. Our current data show that nearly 30% of patients who receive long-acting nerve blocks don't require oral opioids after surgery. That's why we were sure to include procedure rooms in the pre-op area that are large enough to comfortably accommodate patients, anesthesia providers, and the ultrasound equipment and supplies they need to place image-guided blocks.
• Optimal recovery spaces. Standardized pre- and post-op recovery rooms in our new facility will form a circle around a central core, a layout that promotes continuity of care by letting the nurses who prep patients for surgery care for them as they recover.

Getting joint replacement patients up and moving soon after surgery is one of the keys to preparing them for same-day discharge. Our nurses expressed concerns that standard-sized post-op areas in most surgical facilities don't have enough open floorspace for patients to ambulate safely and confidently. That's why we'll create a 450-square-foot physical therapy area adjacent to our recovery bays. There, physical therapists will guide joint replacement patients through mobility exercises and teach them the basic skills they need to master — getting up and down from a seated position and walking up and down stairs — before we discharge them. Patients who meet discharge criteria will exit the facility directly from the physical therapy area.

• Expansive ORs. The facility's 600-square-foot standardized surgical suites will function as multipurpose spaces where our surgeons can perform a wide range of procedures, from basic knee arthroscopies to complex hip arthroplasties.

We didn't skimp on size when designing the ORs, supersizing them in order to give surgical team members more room to maneuver around the additional equipment — C-arms, mobile fluid waste management units and robotic platforms — we'll need to perform increasingly complex joint and spine procedures. Each room will house a robust IT system that will support electronic medical records and inventory management software. The ORs will also include adjacent observation rooms, where guests can watch surgeries in progress. The viewing spaces will let us share outpatient surgery's ever-changing advancements with visiting healthcare professionals.

• Smart storage. We decided against adding built-in storage cabinets that are found in many ORs today. Instead, we'll stock procedure- and surgeon-specific supplies in rolling storage carts, which we'll keep in a sterile core adjacent to the ORs. The carts will be filled with needed items at the start of the day and rolled into ORs before each case.

We hope the carts limit the need for members of the surgical team to leave ORs in the middle of procedures to retrieve missing supplies or instruments. Limiting foot traffic should improve surgical efficiencies and limit the number of times OR doors are opened during cases, which is one potential way to lower surgical site infection risks.

• Hanging equipment. Adding booms to each OR was another high-priority for our surgeons, who wanted to avoid stretching cords across the floors. We invested in easy-to-maneuver equipment booms, which will hold high-definition video monitors, arthroscopic instruments and power tools. Surgeons will be able to move the equipment directly from the boom to the surgical table and position monitors in optimal sight lines. The booms are another design feature that will add functional flexibility to our oversized ORs.

Our physician group's under-construction surgery center is scheduled to open in 9 short months, which doesn't leave us much time to trial and purchase the equipment that will fill its 6 ORs. It's also been a challenge to get surgeons from different private practices and who have varying levels of experience and expertise — not to mention strong opinions — to agree on which instruments and equipment to buy for the new facility.

To foster a meeting of the minds, we first scheduled comparison trials of needed equipment, which each surgeon rated based on their assessments of its functionality and usability. For example, they might give a high-definition video system strong marks for image quality, but low grades for user intuitiveness.

After the trials, we met as a group to discuss the average ratings for each item under consideration. We tried to focus the discussions on data-driven surgical results achieved through the use of the equipment and emphasized how devices could help us provide cost-effective care and improve outcomes.

Each surgeon then voted to move forward with the purchase of proposed equipment or nix it from consideration. If a product scored well on surgeons' surveys and was less expensive than competing products, it's fairly easy for us to agree on approving the purchase. When a consensus cannot be reached among the group, we work with the equipment's vendor to address issues surgeons raise about the device. If surgeons still remained unconvinced, we identify another option and repeat the trialing and voting process until a majority rules in favor of adding the device.

So far, the democratic decision-making procedure has been an invaluable part of our equipment planning strategy. Making purchasing selections with this method is time-consuming, but we've found it to be the most effective way to fill our new facility with instruments and devices that all of our surgeons have agreed to use.

— Michael E. Joyce, MD