Outfitting for Ortho With Expansion in Mind

Facility Construction and Design

By: Jared Bilski

Published: 2/3/2021

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A group of surgeons recently opened a surgery center built for an influx of hip, knee and spine cases.


When Concord (N.H.) Orthopaedics was designing its brand-new surgery center, two words dominated all discussions: future expansion. The group's leaders made every decision with growth in mind. And for good reason. "When our previous center was constructed, the surgeons thought they'd overbuilt," says Tim Paris, PMP, Concord's director of plant operations and development. "Then, 10 years in, they realized they needed more space."

The recently opened 21,582-square-foot facility is a joint venture between Concord Orthopaedics, a private physician practice, and Concord Hospital, which is located directly across the street from the center. To avoid the space problem within the new facility, surgical leaders were intentional about maximizing every square foot of space. That should pay dividends as more ortho cases — ranging from total joints to spine procedures — migrate from the hospital to the surgery center.

"We're expecting to capture 20% to 30% of the outpatient orthopedic procedures that are currently being performed at the hospital across the street," says Peter G. Noordsij, MD, a board-certified orthopedic surgery specialist at Concord Orthopaedics.

Designing a center for a service line with case volumes that are expected to explode over the next decade-plus can be challenging. That's why Mr. Paris invested time in getting input from staff at every level. He and the practice's leadership team held multiple "character sessions," during which they solicited feedback from the entire staff on anything in the old facility that could be improved in the new center. Then, they shadowed individual staff members to see what they did on a daily basis, put on scrubs and observed surgeries in action and spent time in sterile processing to watch staff workflow and note how instruments moved through the department. "We discovered team members had numerous workarounds they were doing in the existing space," says Mr. Paris. "We knew we could easily eliminate those design issues in the new facility."

ON BRAND The blue, white and gray color scheme used throughout the brand-new Orthopaedic Surgery Center matches the logo of its physician group, Concord Orthopaedics.

Concord's leadership team used a forward-thinking focus and staff-based suggestions to create a new facility filled with plenty of standout features, including:

  • A welcoming lobby. Patients form their first impressions the moment they set foot in facilities. That's why the Concord team spent plenty of time with its architects and interior designers in an effort to find the design that fit their facility's brand and created the first impression they wanted for patients. The 1,200-square-foot lobby not only features a large, open area with lots of windows and bright space, but also areas segregated with planters and outfitted with furniture equipped with USB ports for patients and family members looking for a quieter waiting experience. "We wanted to create intimate sections where families can wait without feeling like they're sitting at an airport gate," says Mr. Paris. Concord also added a few extras to the waiting area that are geared toward patients' families. "We put in patient tracking boards where they can see where their loved ones are during each phase of the care process," says Dr. Noordsij.
  • Strategic central sterile placement. One of the most significant design features in the new center involved placing the facility's five, 640-square-foot ORs around the sterile processing department as opposed to in a linear layout. This choice seemed counterintuitive on the surface, but the leadership spent a significant amount of time analyzing staff's processes and decided it was the better choice. "A more linear design would have used up less square footage, but it wasn't efficient for our staff and our processes," says Mr. Paris.

The sterile processing department's expanded physical space — 873 square feet — was a vast improvement for staff. "In our previous center, reprocessing techs would pull instrument trays out of a sterilizer and wouldn't have enough room to maneuver in order to place them on a cart," says Mr. Paris.

  • State-of-the-art ORs. Because most of Concord's capital equipment was at the end of its serviceable life, the group filled the new center's expansive ORs with virtually all brand-new platforms. They invested in two new C-arms, anesthesia machines, ultrasound units and three new OR tables, including a Hana table. The most impressive upgrades in the OR, however, weren't obvious or flashy. For instance, HEPA filters were placed at the point of air entry in the OR, as opposed to on the roof. "The filters are located where the air gets distributed over the patient, so the air entering the surgical field is as clean as it can possibly be," says Mr. Paris.

Another big decision the leadership team made in designing its ORs centered on the overhead lighting. "We specifically opted for a system that's integrated into air diffusers," says Mr. Paris. "The light in the diffusers provides a true laminar flow over the patient."

These features are helpful from an infection control standpoint because orthopedic surgeries, especially total joints, have higher infection rates than other procedures.

  • Patient- and staff-focused features. Outside of the OR, a lot of thought went into the lighting installed throughout the facility. The end goal was lighting that projected a welcoming feel for patients, like they were entering a warm, comforting space as opposed to a cold, clinical environment. Fully programmable LED light fixtures are found throughout the entire facility and are controlled with the building's automated system, says Mr. Paris. Energy-saving motion sensors automatically turn lights on when staff walk into rooms and shut them off when spaces remain empty for a period of time. Lighting can also be adjusted by staff in clinical spaces. "The majority of our lighting, especially in patient care areas, can be dimmed to provide that warm, comforting feel we're going for," says Mr. Paris.
FORWARD PROGRESS The leadership team factored in future growth when it designed the 21,582-square-foot center.

Warm lighting is one of several patient-centered design features that aim to make individuals feel as comfortable as possible throughout the entire surgical process. For instance, instead of separating pre-op patient bays with curtains, a standard practice at many surgical centers, solid walls were installed. "We want patients to feel like they're in a private room rather than a prepping space before they're brought into a sterile environment," says Mr. Paris.

While many of the design features were understandably geared toward the patient experience, leadership also made plenty of moves specifically for the staff. In addition to a layout that was created for maximizing efficiency and flow, the new center has a comfortable, picturesque space where staff can relax when they need a break from the action. The spacious 431-square-foot lounge was strategically placed in an area with lots of windows and natural light — at the behest of the staff. "A large window in the lounge was the number one thing they asked for," says Mr. Paris. "We were more than happy to provide it."

Opening during a pandemic

Of course, talk of a surgery center welcoming its first patient last month has to include mention of the global pandemic that forced a temporary shutdown of elective surgeries and caused some outpatient facilities to close their doors for good. Luckily, says Dr. Noordsij, the pandemic's impact on Concord's project was fairly minimal. "We did have to move our opening from mid-September to January, but even though there were some supply chain issues, that delay was mostly unrelated to the pandemic," he says.

We're expecting to capture 20% to 30% of the outpatient orthopedic procedures that are currently being performed at the hospital across the street.
— Peter G. Noordsij, MD

It certainly helped that the center was well into the construction phase when the pandemic hit. In fact, it might have helped. "There were probably more workers on site because our area didn't have high COVID numbers, unlike Boston and other areas south of us where construction was put on hold," says Dr. Noordsij.

With the new center up and running, Concord Orthopaedics is fully prepared for whatever the future may hold. Even if they need to expand again to meet the growing demand of same-day, non-hospital-based surgery — a trend COVID-19 is likely to expedite — Mr. Paris is confident no amount of growth will affect their ability to handle caseloads. After all, they put a lot of thought into planning for that specific situation. "We looked at what our potential future situation could look like and made sure we had the ability to add two or three ORs without interrupting our current workflow," he says. OSM

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