Putting Plans in Place for ENT

Facility Construction and Design

By: Susan Hickey, Jacki Voltz

Published: 2/19/2020

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An inside look at the development of central Virginia's only dedicated ear, nose and throat surgery center.


When our ENT practice decided to build a standalone surgery center in late 2017, we knew it would be a significant project. Although our surgeons had access to high-quality and efficient ambulatory surgical facilities, a number of the younger doctors backed the idea of opening our own surgery center. There were a number of factors contributing to our overall hesitancy to build new, not the least of which was being able to find a suitable location that was easily accessible to our patients and surgeons. Finally, the stars aligned. The same general contractor who built most of our clinical offices was gutting and reconstructing a 3-story office building in an excellent location. We eventually leased 13,500 square feet on the second floor and began framing out what would become the Virginia ENT Surgery Center. The facility opened in December 2018 and continues to be the only dedicated ear, nose and throat surgical facility in central Virginia. We're sharing what we learned while designing and building our surgery center with the hope that you find our insights useful as you break ground on an ENT facility of your own.

  • Expert advice. The first thing we did when starting this project was to partner with a healthcare architectural and design firm. Building a successful surgery center demands working with professionals who fully understand federal, state and accreditation standards and requirements.

The firm brought in an engineering firm to manage the mechanical, electrical and plumbing (MEP) design. Very early in the design phase we also hired a nurse consultant to assist us with preparing for our accreditation survey. When four of our physician board members volunteered to participate in the design and construction of the center, the design "dream team" was complete.

CHILD CARE A kids waiting room distracts children from worrying about their upcoming surgery and frees pre-op bays for more patients.   |  Virginia ENT Surgery Center

Having surgeons participate in the early planning phase of the facility was critical because they know what works and what doesn't in other facilities in which they operate. They understand the significance of things like which way a door opens and where the "hand wave" automatic door-opening pad should be positioned much better than people do.

At the beginning of 2018, our team started meeting on a regular basis. We knew we wanted two ORs, six pre-op bays, six PACU bays, six stepdown recovery bays and an ample storage area. During the design phase, we decided to cut back to three stepdown bays to ensure there was plenty of storage space in the perioperative area. Knowing a large percentage of our patients would be children also factored heavily in some of our design decisions. We created a kid-friendly space for children to wait with their parents before going into the OR. We also created space for a slushie machine in PACU for the post-tonsil and adenoidectomy kids.

  • Capital purchases. The expertise of MEP engineers was of paramount importance for ensuring the electrical design is sufficient to meet the facility's current and future power demands. This meant we had to identify very early on the makes and models of all the large equipment — OR lights, microscopes, image guidance platforms, anesthesia machines and sterilizers — we intended to purchase.

We invested in two video towers for endoscopic sinus surgery and one image guidance/navigation system. The image guidance equipment is on a rolling cart, so it can be moved between ORs. Surgical microscopes are critical for ENT procedures and our doctors knew exactly which type they wanted. We bought one new microscope and one refurbished unit from a local vendor. One of our doctors is a neurotologist who performs a lot of tympanoplasties and mastoidectomies. We were able to purchase a different head for one of the microscopes that lets him move the microscope as needed for his specific cases.

  • Space and flow. Having ORs that are sufficient in size is important in any facility. One thing that is different about ENT compared with other surgical disciplines is that a large number of the procedures performed are done bilaterally. This, along with considering the ideal locations of the anesthesia machine and other equipment, factored into how much space was needed in our ORs (about 400 square feet each).
CALMING EFFECT An interior designer used colors and wood to make the facility feel less sterile and foreboding to nervous patients.   |  Virginia ENT Surgery Center

We studied the flow of patients, equipment, instruments and supplies into and out of the ORs, and decided to design two doors in each room. The patient goes into and comes out of the OR through one door. At the conclusion of the cases, and after the patient is out of the room, staff remove soiled instruments and dirty items through that same door. Sterilized items are brought into the ORs through the second door, which is connected to the sterile storage area. It's a very good flow.

  • Sterile fields. Maintaining positive air pressure in the ORs is imperative. Our MEP added a sensitive detection system to the ORs to ensure the air pressure is properly maintained. Once we started operating in the center, the staff quickly discovered an alarm would sound if the OR door was held open for more than 15 seconds. At first, the alarm was annoying (although very useful). However, it quickly changed our behavior. Staff no longer hold OR doors open.
  • Outside opinions. During the planning phase, we visited another ENT-only surgery center to see how they were set up and how they operated day to day. This was very helpful because it helped us to think about some useful design elements we'd overlooked to that point.
  • Keeping tabs. During construction, the entire design "dream team" visited the space frequently to see how the facility was shaping up in real life. This allowed us to address opportunities for improvement that we couldn't have noticed by looking at the plans. For example, the first time we entered the women's locker room we realized it was way too small. We also started thinking about the fact that we had zero extra space for an office or an area to hold staff meetings.

Fortunately, we were able to lease another contiguous space (approximately 1,000 square feet) to accommodate an office, a conference room and a much larger women's locker room.

We were able to move into our new surgery center in early November 2018. We started off slowly, doing only basic procedures (tubes, tympanic membrane repairs, and tonsils and adenoids) for the first two to three months. This allowed staff, surgeons and anesthesia providers to familiarize themselves with the equipment and the workflow. This staged development worked well for us.

After we were operational for a few weeks, we identified a couple concerns that needed to be addressed. One was in the central sterile area. Two large sterilizers created a lot more heat than the HVAC unit could manage. As a result, a separate AC unit was added in that room. There was also a heat issue in the room with the vacuum equipment and similar adjustments had to be made to resolve that problem. We also noticed an electrical issue related to the suction/vacuum system. Luckily, it was remedied quickly by simply increasing the facility's amperage.

Our surgery center has been in operation for over a year now. To get it up and running took an incredible amount of work, from design to construction to daily operation. However, it was also a truly rewarding experience. The surgeons are thrilled to operate in their own facility. Their only regret is not deciding to build it sooner. OSM

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