December 20, 2023

Though much of what this ASC needed to expand was already in-house, eight months of preparation on numerous fronts was required.

LEG UP Successfully adding a total knees program to an existing ortho line requires careful investigation and legwork regarding a variety of factors in advance.

It was a natural move for Bayou Region Surgical Center to add total knees to its existing orthopedics line in 2022.

“We have a very strong orthopedic group, and our doctors are very good at patient-centered approaches,” says Serena Ledet, RN, BSN, administrative director of the multispecialty, physician-owned ASC in Thibodaux, La. “The surgeons were able to discharge total knee patients on the same day at the tertiary hospitals, so they wanted to make the move here. We did it and, knock on wood, it’s been going very well.”

Even though the idea of adding total knees made perfect sense for the ASC, adding the procedure to its ortho line from conception to execution required eight months of work by Ms. Ledet and the center’s stakeholders before the first patient was scheduled. Some of the main factors they addressed included:

Local market support. “We started by looking at our patient population to be sure we would have patients who would be healthy enough to have a total knee procedure and go home the same day,” says Ms. Ledet.

Patient selection. The ASC established clinical criteria that patients would need to meet in order to qualify for having their knee replaced at the ASC. Those criteria included diabetic status, A1C below a certain level, previous strokes, history of falls, BMI and more.

Physical therapy services. “Our orthopedic group is also affiliated with a physical therapy group,” says Ms. Ledet. “Our surgeons wanted physical therapy to come and get the patients up for the first time after surgery.”

Capital purchases. Because the ASC already had an existing ortho line, many supplies and instruments were already on hand, but additional equipment was needed for total knees. “We purchased instrument sets,” says Ms. Ledet. “We contracted with a vendor for implants. We purchased drills. We purchased larger stretchers so the patients would be more comfortable, because their recovery times are a little longer than our typical patients.”

Staffing and training. The ASC didn’t need to hire new staff to add total knees, but its existing staff needed training on the procedure, particularly regarding the use of spinal anesthesia.

“We already had experience with many different types of blocks, but we did refreshers on that,” says Ms. Ledet. Additionally, the perioperative team attended labs with a total joints vendor, including twice conducting an entire total knee procedure step-by-step. “We trained our recovery nurses on the post-op process, and the physical therapists came to do some training with them,” adds Ms. Ledet. “Our preoperative nurses needed to learn what to educate patients on prior to surgery. It was important to be sure our patients had everything they needed when they got home.”

Once the line was activated, the ASC proceeded deliberately. “We slowly ramped up the volume, because not only did staff need to become comfortable with the procedures, but also the surgeons had to be comfortable with doing them here,” says Ms. Ledet. “We carved out more time in the OR and in recovery and had extra staff on hand to get the program going and make sure we didn’t have any hiccups.”

The ASC started with same-day total knees because its surgeons had ample experience performing them safely at hospitals, with hopes to add total hips and shoulders later. “Total knees was the easiest transition,” says Ms. Ledet, who adds that ASCs of all kinds should be similarly deliberate and practical about expansion. “Do one procedure at a time,” she says. “If you try to do hips, knees and shoulders all at once, that’s a huge investment on the front end, and a lot of different education for your staff. By picking one total joint and adding the other procedures later, it’s been much more manageable. You can start getting ROI before you get overwhelmed with all the other capital purchases.”

A potpourri of design ideas that enhance the experience for both patients and providers.

CREATE SPACE Allina Health Surgery Center - Brooklyn Park’s prefabricated modular walls were installed to make future redesigns much easier to accomplish.

Is your ASC looking to renovate or planning a new build? Here are some ideas implemented by three ASCs that could spur some of your own.

Make it colorful, easy to navigate and expansion-friendly. Allina Health Surgery Center - Brooklyn Park (Minn.), a 17,000-square-foot, five-OR ASC that opened in May 2022 on the second floor of a new 40,000-square-foot medical facility, has already performed many thousands of total joints, general surgery, ENT, urology and gastrointestinal procedures.

“When a patient shows up at the ASC, they walk in and they have a direct line of sight to the front desk,” says Robert Quickel, MD, MBA, vice president of surgery and orthopedics for Allina Health. Meanwhile, different calming colors on the walls of various areas were intentionally chosen. “They are patient-friendly and comfortable, beginning with a cool greenish blue,” says Dr. Quickel. “When the patient arrives in recovery, the colors are more of a gentle orange to indicate a sunset.” Pre- and post-op rooms offer privacy but are flooded with natural light. The ASC’s prefabricated modular walls will enable the ASC to alter its layout to accommodate future growth. “We can easily do a redesign without having to go through a huge demolition,” says Dr. Quickel.

Take advantage of your location. Steamboat Surgery Center in Steamboat Springs, Colo., a 27,000-square-foot-facility with two large ORs that is located in what was formerly a Sports Authority retail store, is the result of a partnership between UCHealth Yampa Valley Medical Center and Steamboat Orthopaedic & Spine Institute. Floor-to-ceiling windows in the ASC’s lobby and waiting room offer gorgeous 180-degree views of the Steamboat Ski Resort while bathing the areas with warm, natural light. “The most commonly heard comments about our center are about the view,” says Alexander Meininger, MD, a board-certified orthopedic sports medicine surgeon and founding partner of Steamboat Orthopaedic & Spine Institute.

Work on your core. Specialists’ One-Day Surgery (SODS) Center in Syracuse, N.Y., which has performed orthopedic and pain procedures for more than two decades, recently moved into a newly constructed facility to accommodate a wave of new total joints and spine cases. Its four 650-square-foot ORs have their own internal core, while six additional 450-square-foot ORs have a separate core. Both cores are surrounded by a larger central core. The design accommodates better infection control while centrally locating all surgical equipment, supplies and implants near the surgical and clinical teams.

On the patient side, a spacious, welcoming waiting room is intended to provide a calming experience for nervous patients. SODS also provides a 23-hour overnight wing with eight private rooms for spine and total joints patients who require extended care. They include cable TV and Wi-Fi, and patients and their families can even order meals for delivery directly through Panera Bread. Employees, meanwhile, enjoy a spacious and modern breakroom and locker rooms and even a retrofitted small room that had been underused that is now an employee relaxation room featuring a state-of-the-art massage chair, soft lights, decorations, scented oils and more, says Executive Director Geoffrey Smith, MBA.

An orthopedic surgeon’s perspective on the role of peer-to-peer education when starting an ASC.

Credit: Stryker and L37.
Lighthouse Surgery Center in Hartford, Connecticut.

The world of outpatient surgery has evolved significantly post-pandemic – new ambulatory surgery centers are being launched across the United States to address the increasing demand for outpatient care options. It’s amazing what goes into the process of opening a new center, and many who have taken that journey are willing to share their insights with colleagues contemplating a similar move.

Orthopedic surgeon, Michael Joyce MD, offered some valuable advice gained from his experience of launching the new Lighthouse Surgery Center in Hartford, Connecticut. He discussed the various strategies, challenges and attitudes – including the benefits of sharing what he and his team learned along the way with peers as they start a new ASC business.

What are the benefits of peer-to-peer education?
Dr. Joyce: Over the years I’ve had the opportunity to participate in many peer-to-peer educational discussions and they’ve all been beneficial. Anyone who is starting an ASC has unique experiences and their own strengths. Those looking to start a new ASC or expand their existing center that come to us often feel some apprehension about parts of the process because they don’t completely understand each step.

How can you help your colleagues?
Dr. Joyce: We help them fill in the blanks and share how we approach different steps in the journey. Because we have a finished, up and running surgery center, they know that although we may not be the best at everything, we do have all the pieces to the puzzle. A lot of these interactions have turned into long-term relationships. They call back and share their progress or will ask questions and we have done the same thing. If I can help educate surgeons and enable them to get their project running on their own, that’s an important mission for me, coast to coast, and getting control of patient care back in the hands of the doctors.

How has your partnership with Stryker supported your educational goals?
Dr. Joyce: I'm in a lot of orthopedic organizations. I go to lots of national meetings, but we don't have one place where you can sit down and fill in the blanks on specific challenges an individual ambulatory surgery center is having, especially when you're doing it as a physician-led directive. I belong to ambulatory surgery societies, but they're administrative heavy. As a surgeon, you can go one-stop shopping with Stryker and they will say – “Well, this ASC in Arizona, that's where you want to go to ask about this, or this place out there in Texas is where you want to ask about that” – because they've seen all those different examples. Stryker can match the needs of specific ASC projects to an educational site that had a similar experience. As physicians, we don't have another way of doing that. It’s been a great partnership with Stryker, and I’ve learned a lot with their support.

What advice do you give to those who are ready to embark on their own ASC journey?
Dr. Joyce: The most important single piece of advice is it's a big task – break it down into little, doable parts and just knock them down one at a time. People start the process and see the level of complexity and detail and the first reaction is to go with that gut instinct that this is too hard or too complicated. Take the apprehensive energy you have and channel it into a plan that creates a surgery center that works the way you want it to work. One that makes you feel like you're delivering the best care and you're doing it with a great staff in an environment where you have an entire team that sees a vision the way you've always dreamed it. That's the motivation.

For more on the Lighthouse Surgery Center journey watch link is here.

Note: for more information go to Ambulatory Surgery Center (ASC) | Stryker and Build your ASC | Stryker

Former Wells Fargo regional HQ is being transformed to a new health campus, including an ASC.

Early this year, SAC Health, a community-based health system that provides comprehensive services to underserved areas and populations in Southern California’s San Bernardino and Riverside counties, purchased a former Wells Fargo regional headquarters in San Bernardino with the intention of transforming it into an ambulatory health campus.

Renovations are ongoing to convert the space for medical use as the new SAC Health - Brier Campus, with a planned opening in 2025. The five-story, 280-square-foot structure, originally built in 2007, sits on a 14.5-acre site and was purchased for approximately $35 million.

The complete list of services to be provided at the Brier Campus are still to be determined, but it has already been announced that the site will include an ASC along with dentistry, family medicine, internal medicine, pediatrics, women’s health, behavioral health, dermatology, ophthalmology, orthopedics, urology and a community resource center. The campus will feature two parking structures to provide easy access for patients and staff.

CEO Jason Lohr, MD, says the acquisition of what will be SAC Health’s 12th location will provide much-needed space to not only expand the number of patients the system can serve, but also enable it to offer a full range of healthcare services in one location to streamline the patient experience. “Converting the space will also provide us the opportunity to outfit this location to be a modern facility with the latest equipment and technology,” he adds.

SAC Health has contracted Gafcon to provide owner's representative services, particularly involving its expertise in program and project management, construction and development. Gafcon will lead the renovation and conversion, addressing challenges in making the site suitable for health care including meeting ventilation and airflow requirements, structural issues surrounding sensitive medical equipment and accessible entryways.

“This redevelopment project is a great example of adaptive reuse,” says David Chung, Gafcon's senior vice president of healthcare, who will oversee the project. “This asset was originally designed as a Class-A building housing a sizable business unit of Wells Fargo, but it has outlived its original purpose, and a strategic renovation will imbue the structure with new life.”

A two-story surgery center will remain operational while its massive new third floor is built.

After 17 years in operation, Saint Luke’s East Ambulatory Surgery Center in Lee’s Summit, Mo., recently broke ground on a massive 113,913-square-foot expansion and renovation. The $52 million project will create the additional space needed to bring off-site medical-related services back to the ASC’s campus.

The project will more than double the ASC’s current space, which is connected to the three-story St. Luke’s East Hospital. The existing two-story, 52,000-square-foot ASC and clinical space will be renovated, while a 62,000-square-foot addition will be built on a brand-new third floor. However, the huge new space will not be simply a super-sized version of the existing ASC.

“This is not just an expansion of space. It’s an expansion of the excellent services we provide our patients,” says Bobby Olm Chipman, CEO of East and South Region of Saint Luke’s Health System. “This is our next step in that growth and our ongoing work to meet the community’s needs. This groundbreaking reflects our singular mission [that] we are the best place to get care and the best place to give care.” Mr. Chipman envisions the new space as “comfortable and inviting” for patients and their families.

The existing ASC will remain operational while the construction occurs above its two busy floors. The Kansas City, Kan., office of McCarthy Building Companies, which says it has built 1,000 healthcare facilities and renovated thousands more, is serving as the project’s construction manager. “While the surgery center and clinical space originally had been designed to accommodate a vertical expansion, it is always challenging to build above an existing structure, especially when that expansion is built above a surgery center that continues to operate without disrupting patient care,” says Seth Kelso, McCarthy Kansas City’s market leader.

The ASC is part of the not-for-profit Saint Luke’s Health System, which consists of more than 16 hospitals and campuses and more than 200 primary care and specialty offices across 67 counties in Missouri and Kansas. The renovation and expansion project is expected to be completed by the end of 2024. OSM