Building the Future of Outpatient Surgery

In the past tumultuous year as the pandemic raged across the country, outpatient facilities have been the subject of a renewed focus within the healthcare community — for many reasons. It was certainly not "business as usual" as medical professionals and related organizations and industries grappled with the heart-wrenching challenges of the past 12 months. These medical professionals have pivoted, even daily, to manage the crisis and they continue to do so in the face of the ongoing COVID-19 pandemic.

The pandemic couldn't stop the growth and evolution of outpatient facilities. Leaders are moving ahead with construction projects across the country.

While resources and logistics have been impacted, design and construction projects have continued with added precautions and reevaluations of the immediate situation on a project-by-project and state-by-state basis. In this climate, the reimagination and reinvention of surgical spaces is an ongoing focus of ASC and hospital leaders who have their eye on the future of these facilities.

One of the reasons for the renewed focus on ASCs in particular is the continued growth of new procedures such as cardiac surgeries. Business is also booming in orthopedics, and physician-owners are looking to capture the increasing number of spine procedures and joint replacements moving from inpatient hospitals to outpatient ORs. There is a constant need for new and renovated spaces as well as an appetite for investment in standalone facilities that cater to a diverse patient population seeking a variety of procedures. That trend will continue moving forward.

Another trend is the desire for renovating older facilities. As Scott Reeves, MD, MBA, FACC, FASE, wrote in Outpatient Surgery, "Let's swing the wrecking ball through today's tired ORs, clear the rubble, and rebuild with efficiency and improved patient care in mind." As part of a joint research team that included faculty from Clemson University and the Medical University of South Carolina (MUSC), he and the team examined every aspect of current operating room standards with the goal of reinventing the space from the ground up.

Like many projects across the country, their intent was to reevaluate the current environment to build a better OR. Some of the key takeaways that will influence future design included some very specific suggestions to improve the placement of monitors, screens and other equipment to improve each team member's line of sight to the sterile field. As ultra-high definition touchscreen technology improves, placement of these tools called for them to be hung throughout the OR to allow for better team communication. And these improvements start at the very beginning of the OR's initial design.

Certainly, every OR build is unique. Its personal design depends largely on the available square footage and the types of surgeries to be performed there. Each area of real estate must be reconfigured to be of optimal use to the team. This requires pre-planning in the construction phase to allow for future flexibility. One tactic Dr. Reeves advises is to create versatile rooms that are standardized at the outset, with steel grids housed in the ceilings to hold booms that can be repositions and fixed as needed. Modular steel walls also allow for access to electrical and gas lines if needed and allow for replacements and changes in the room configuration.

Look to the future

The average life of an OR is about 20 years, but a lot can happen during that time with equipment, technology and surgical products. While smaller incremental changes can be accommodated over time, it's the "big picture" that keeps investors, architects, designers and planners up at night. What looks like a trend today, in fact, may be a fad that costs more down the road with renovations and rebuilds.

Building so-called "relevant ORs" with staying power requires a surgical team that works together and takes the time to review what standardized plug-and-play designs will allow for over time. Firms need to devote the time and resources to train employees — and their potential customers — in the very specialized environment of surgical process and patient care.

Technology will have an even greater impact on the design of the OR in the near future as some of surgery's hottest technologies become common, including robotics and smart-imaging capabilities that wirelessly stream videos on big-screen, 4K high-definition monitors. This high-end equipment points to a need for great flexibility in the design process as new procedures enter the outpatient space.

Efficiency and good workflow, of course, should be accommodated in any design and keep the safety of both the patient and the employee top of mind. Antiquated ORs are a hazard to the profession. Fortunately, new building projects are addressing these concerns with a focus on patient-centered care from the moment patients enter the facility until they leave. There is a new emphasis on the sense of well-being throughout the patient journey as facility leaders and staff strive to meet high patient expectations. Staff expectations are also high as workers' quality of life issues will also be factored into newer designs. Owners and teams who will work within these new walls hope to make lasting impressions on the communities they will serve. OSM