A Site for Sore Eyes

A large workstation divides the pre- and post-op space. Nurses have clear views of patients from the station and easily float between the areas if their help is needed. A medication administration room that sits adjacent to the workstation is where drugs are stored and eye blocks are prepared. It's a very convenient set-up.

• Staff involvement. Our staff spent a significant amount of time deciding on a standardized head wall design for the pre- and post-op bays. We focused on determining the optimal locations for light switches, glove boxes, hand sanitizer dispensers, power outlets, vital signs monitors and hook-ups for oxygen and medical gases.

We even asked our contractor to mock-up a wall design and rolled a stretcher bed against it. Nurses then ran through the motions of taking care of a patient to ensure the locations were convenient and helped them deliver efficient care. This might sound like an inconsequential detail, but easy access to hook-ups and supplies — eliminating the need to constantly walk around the patient to connect vital signs monitors and oxygen lines, for example — saves valuable minutes, which is especially important in a high-volume specialty such as ophthalmology.

The lesson here is to engage staff members to determine if designs will be functional in practice. Let physicians and staff work with mock-ups of the areas in which they'll operate, and provide constant feedback to architects and contractors to ensure the spaces fit their needs. Previewing proposed plans before building began helped us avoid costly post-construction modifications.

• Standardized ORs. Each of the facility's 400-square-foot ORs feature power outlets and medical gas hook-ups built into the ceilings, a feature that eliminates cord clutter and tripping hazards. They're also equipped with the same equipment — a surgical microscope, phaco machine and vitrectomy platform — because we perform a wide variety of procedures and wanted the flexibility to schedule them in any of the rooms. The microscopes are standard floor-based models; two are equipped with retinal viewing systems, so we can run two retina rooms simultaneously.

The surgeons prioritized being able to record videos of procedures and transmit them wirelessly to a large flat-screen monitor hung on an OR wall. Surgical team members track the progression of cases, and ready needed instruments and supplies. That's been an important factor in our ability to perform efficient procedures.

• Physician feedback. When purchasing capital equipment, you'll have greater purchasing power and negotiate better deals — and ensure staff become experts in using the new technology — if the medical staff can come to a consensus on the devices they'll use. Ask surgeons to trial the machines they're considering and have them vote on which ones they want to add; a simple majority determines the brands you'll purchase and install. Investing time in a group decision-making process pays off.
• Surfaces that last. Don't focus solely on the sticker prices of the finishes you're considering. Instead, consider the cost of upkeep and possible replacement, and choose materials that will remain useful over the lifespan of your facility. In our old center, we installed laminate countertops and had to replace them several times. The second time around, we opted for solid-surface countertops made of Corian and ORs outfitted with stainless steel, which is durable and easy to wipe down between cases.
• Laser treatments. Capsulotomy and iridotomy ?are revenue-generating cases that can be performed in minutes, making YAG laser procedure rooms some of the most profitable square footage in an eye center. We placed our YAG laser in an exam-size room just off the waiting area. It's a convenient location for patients, and it prevents overcrowding and patient flow disruptions in surgical care areas. Surgeons schedule laser cases between surgeries and have plenty of time to perform the procedures while their ORs are being turned over.
• Instrument care. Pay attention to layouts that will enable your staff to reprocess instruments efficiently and effectively. In our facility, a sub-sterile room sits between every two ORs, and the instrument decontamination room is located in a centralized area. Instruments cleaned on the "dirty" side of the room are passed through a window to the "clean" side, where they are placed into one of four 24-inch x 24-inch autoclaves. We also installed a water purification system to treat and soften the facility's hard water supply, an addition that helps to ensure instruments are properly cleaned and have a longer useful life.

• Redundant air flow. We first explored expanding the original surgery center's footprint, but ran into cost and practicality issues because a single HVAC system regulated air flow in all four of the facility's ORs. Installing multiple units would have necessitated a complete shutdown of the center for several months, making it impossible for the surgeons to run viable practices. In the new facility, three individual HVAC systems control air flow for two ORs per unit. That way, we can still run four rooms if one unit goes down.
• The right amount of rooms. Deciding on how many ORs to build can be challenging. We ran extensive utilization projections based on the number of cases the surgeon-owners generated when we were planning the new facility. The practices are large and active, so we also spoke with each one to understand their plans for long-term growth. We looked at population estimates, particularly among the aging patient population who would need eye care, and ultimately decided to build six ORs. We're currently running and staffing five of the rooms, and will likely open up the unused OR in a few years — maybe even sooner.

When planning a new facility, carefully balance not overbuilding with having room to grow. You have to be able to immediately support the cost structure with enough cases and staff. That's what we've done. We have reasonable expectations of using our new space efficiently today and have plenty of room to expand as our case volumes grow over the next decade and beyond.