Sometimes you have to change to move forward. For nearly 20 years, we'd done well in our familiar 3-OR eye surgery center. We expanded in 2003 to gain some additional space, but eventually reached full capacity and decided in 2015 to build a 25,000 square-foot center from the ground up. The new facility sits on 3.5 acres of prime real estate, roughly half a mile away from our old center. It has tripled our usable space — we have 6 operating rooms, 2 femtosecond laser suites and 2 laser treatment rooms — and effectively doubled our operating volume.

Looking back, deciding to build new was a bit of a gamble. To attract enough surgeons to justify the investment, we knew we'd have to carefully plan every detail. If we build it, we said, the surgeons will likely come. But if we equipped it poorly, we knew they wouldn't stay.

Has it worked? We're way ahead of projected case volumes and now expect to do 11,000 cataract operations this year and around 20,000 total procedures. You could say it's the apple of my eye. It was a leap of faith to build our state-of-the-art facility, but we were confident in the reputation we'd established in the region, we knew our staff was excellent and we knew our focus on technology was where it needed to be. It was a lot of work, but also a labor of love.

Although we've always done nothing but ophthalmology, we decided to hedge our bets in case somewhere down the line we couldn't fill all our ORs with eye cases. So, we designed our operating rooms to be more than 400 square feet each — considerably larger than the traditional ophthalmologic OR. That way, if at some point we decided to partner with a hospital or health system (which I don't anticipate doing), our ORs would be able to accommodate virtually any specialty.

Of course, we had to think about how we'd light those big ORs, since lighting had to be incorporated into the construction plans. We wanted state-of-the-art LED lighting, so, several months before we moved out of our previous facility, we trialed offerings from various manufacturers and got feedback from the surgeons. That gave me time to negotiate before we had to choose.

Like most eye facilities, we primarily do cataract and other types of anterior and posterior segment surgeries, so the key consideration for 4 of our ORs was to adequately illuminate the Mayo stand when the room is dark, and we need to load a lens or a needle onto a small needle driver. For those ORs, we chose LED lights that are fixed to the ceiling and centrally located.

But we also do ocular plastic surgery, which requires brighter, more traditional lighting. So, we outfitted the other 2 ORs with more traditional surgery lighting.

Early on, we wanted to provide surgeons with state-of-the-art technology, starting with our microscopes. Providing scopes for 6 ORs is a significant expense. To ease the burden, we arranged with a single manufacturer to deliver them in stages. We got the first 3 in the old facility about 6 months before moving, and the 4th, 5th and 6th spaced out over our first year in the new building.

The most important consideration for every eye surgeon is optics, and we wanted to differentiate ourselves from other facilities by offering high-end surgical scopes. Our new scopes have improved optics and different types of illumination. Two also feature intraoperative computer-assistance technology that helps surgeons pinpoint the zero axis of the eye and position toric IOLs with tremendous accuracy. For our retinal OR, one of our scopes features integrated optical coherence tomography, a diagnostic tool that provides a cross-sectional view of the retina and also has application in corneal procedures.

Planning for zero infections

We worked with an experienced ASC architect and mechanical engineers to make sure our HVAC system was top of the line. In fact, we installed the type of laminar flow system you'd typically find in hospital ORs. It's a sophisticated computer-driven system that can be managed segmentally throughout the facility, so we have almost absolute control over every room. If I'm out of town at a conference and someone calls me to say that OR 6 is too warm, I can change it remotely and make it more comfortable.

Naturally, one of the most important design decisions was where we'd locate sterile processing. We spent a lot of time with the architect, studying flow, and we got input from our central sterile staff, our nursing staff and the sterilizer manufacturer.

We did walk-throughs to figure out the most efficient way to reprocess instruments and get them back out as quickly as possible. The goal was to make sure nobody would have to travel far to transport instruments back and forth. We came up with several different design concepts, including having a dedicated sterilizer and decontamination room behind each OR. But in the end, we chose the design you might expect: We have 3 operating rooms at one end of the hall, 3 at the other end, and central sterile right smack in the middle.

Dry and cool times can be two of the most time-consuming steps in reprocessing and sterilization of instruments, but we've virtually eliminated it with an instrument container system that has zero dry and cool time. Eliminating 10 minutes of dry time per cycle and 15 to 20 minutes of cool time when you're doing 100 cases a day really adds up. The container is also approved for a year of shelf storage and use once sterilized.

One note from the you-can't-think-of-everything department: We thought we'd anticipated every possible need for central sterile, but discovered later that because we now had 4 autoclaves, we occasionally became the bakery with too many cookies coming out of the oven at the same time. Our trays needed space to cool, and if 8 or 10 happened to come out more or less simultaneously, there wasn't enough counter space for all of them. So, we reconfigured, brought in open wire racks and positioned them adjacent to the autoclaves. Now, when the trays come out of the autoclave, they can be put on the racks to cool down. If necessary, they can be stored there overnight or between cases.

A final important touch for sterile processing was the installation of a reverse-osmosis water-treatment system. The reason: At our old facility, we frequently had to replace the heating elements in our autoclaves, because the public water we were using contained minerals that would get caked onto the elements. With the new system, we're delivering deionized distilled water to the autoclaves. And in 2 years we haven't had to replace a single element. Yes, there's an upfront cost for the reverse-osmosis equipment, but in the long run, we expect it to pay off.

And there's an additional benefit. Initially, we were buying hundreds of gallons of distilled water to rinse off our instruments. That was expensive and created a storage challenge. Fortunately, about a year after moving into the new building, we discovered we could also pipe the reverse-osmosis water into our decontamination sinks. Now, every sink we use for rinsing purposes runs deionized distilled water. It was a secondary engineering thought, but I'm glad we included it in our build.

Foundation for success

We want surgeons to enjoy bringing revenue-generating procedures to our ORs. They continue to be attracted to our facility, which we believe is the preeminent eye surgery center in our area and one that's superbly equipped and expertly staffed. We've been able to add cases to fill the additional square footage and have settled into the new space, which should serve us well for at least the next 20 years. OSM

We worked with an experienced ASC architect and mechanical engineers to make sure our HVAC system was top of the line. In fact, we installed the type of laminar flow system you'd typically find in hospital ORs. It's a sophisticated computer-driven system that can be managed segmentally throughout the facility, so we have almost absolute control over every room. If I'm out of town at a conference and someone calls me to say that OR 6 is too warm, I can change it remotely and make it more comfortable.

Naturally, one of the most important design decisions was where we'd locate sterile processing. We spent a lot of time with the architect, studying flow, and we got input from our central sterile staff, our nursing staff and the sterilizer manufacturer.

We did walk-throughs to figure out the most efficient way to reprocess instruments and get them back out as quickly as possible. The goal was to make sure nobody would have to travel far to transport instruments back and forth. We came up with several different design concepts, including having a dedicated sterilizer and decontamination room behind each OR. But in the end, we chose the design you might expect: We have 3 operating rooms at one end of the hall, 3 at the other end, and central sterile right smack in the middle.

Dry and cool times can be two of the most time-consuming steps in reprocessing and sterilization of instruments, but we've virtually eliminated it with an instrument container system that has zero dry and cool time. Eliminating 10 minutes of dry time per cycle and 15 to 20 minutes of cool time when you're doing 100 cases a day really adds up. The container is also approved for a year of shelf storage and use once sterilized.

One note from the you-can't-think-of-everything department: We thought we'd anticipated every possible need for central sterile, but discovered later that because we now had 4 autoclaves, we occasionally became the bakery with too many cookies coming out of the oven at the same time. Our trays needed space to cool, and if 8 or 10 happened to come out more or less simultaneously, there wasn't enough counter space for all of them. So, we reconfigured, brought in open wire racks and positioned them adjacent to the autoclaves. Now, when the trays come out of the autoclave, they can be put on the racks to cool down. If necessary, they can be stored there overnight or between cases.

A final important touch for sterile processing was the installation of a reverse-osmosis water-treatment system. The reason: At our old facility, we frequently had to replace the heating elements in our autoclaves, because the public water we were using contained minerals that would get caked onto the elements. With the new system, we're delivering deionized distilled water to the autoclaves. And in 2 years we haven't had to replace a single element. Yes, there's an upfront cost for the reverse-osmosis equipment, but in the long run, we expect it to pay off.

And there's an additional benefit. Initially, we were buying hundreds of gallons of distilled water to rinse off our instruments. That was expensive and created a storage challenge. Fortunately, about a year after moving into the new building, we discovered we could also pipe the reverse-osmosis water into our decontamination sinks. Now, every sink we use for rinsing purposes runs deionized distilled water. It was a secondary engineering thought, but I'm glad we included it in our build.