November 2, 2023

AORN’s Guideline for Design and Maintenance of the Surgical Suite provides useful advice for projects large and small.

GROUND UP AORN’s new guideline provides a wealth of knowledge, experience and recommendations for leaders who are reimagining or enhancing their facilities.

When upgrading or renovating your surgery center, design of your perioperative space is obviously a top priority. AORN’s new Guideline for Design and Maintenance of the Surgical Suite is intended to help you get started on that vital task.

AORN says the new evidence-based guidelines help teams who are updating ASCs explore and address key components of these projects. The idea is to better enable ASC leaders to engage in advanced planning, cost-conscious design and sustainable maintenance strategies using evidence-based guidance and tools.

Here are five helpful highlights from the guidelines:

Work together. The guidelines emphasize that a perioperative nurse should be included in renovation projects to bridge the gap between non-clinical and perioperative staff. One important scenario for clinical input is to “facilitate a safe, efficient and low infection risk working environment when construction occurs adjacent to functioning patient care areas,” says AORN Senior Perioperative Practice Specialist Mary Alice Miner, PhD, RN, CNOR.

Know your space requirements. ASCs must recognize the differences between function and requirements. For example, the minimum space requirements for an outpatient OR can be smaller than for an inpatient OR. However, Dr. Miner notes, space requirements for hybrid OR equipment and sterile processing areas in outpatient environments should be the same as for inpatient spaces.

Dial in efficiency and costs. The guidelines can assist ASC design teams in devising a layout that maximizes efficiency while also keeping costs in check. For example, one study cited in the guidelines examined two different layouts for a facility’s surgical suite: a “center-stage” layout with all patient rooms centered around one staff workroom and patient entrances, and an “onstage-offstage” layout where patient and staff entrances lead into separate corridors. “Both had positive and negatives, but the authors concluded that creating functional zones was necessary to stimulate workflow and teamwork as well as patient-centeredness,” says Dr. Miner.

Understand and address air quality. Perioperative nurses should be familiar with, and help planners address, issues relevant to air quality and movement in the OR, including HVAC system design and function; the number of air changes a system is set to execute; humidity range parameters; temperature and humidity levels in the OR when procedures are being performed in the room; and airflow direction in the OR.

Build sustainably. Managing energy usage not only can protect the environment but also lead to significant cost savings. The guidelines say a ventilation setback strategy during the planning phase that is incorporated into the HVAC system could slash energy costs by reducing the number of air exchanges during periods when an OR is unoccupied, says Dr. Miner.

To successfully grow volume, leverage relationships with the surgeons in your market — including those who have never set foot in your center.

The Center for Advanced Ambulatory Surgery
BEFORE YOU LEAP Growing patient volume or adding new procedure types can be enticing, but getting a realistic view of market conditions from local surgeons and others is key to profitable expansion.

Centers that are planning to renovate or expand their perioperative suites to grow their surgical volumes should first perform a meticulously realistic competitive analysis of their local market and get full buy-in from surgeons and staff. Honest forethought and solid strategic planning are keys to success in this endeavor.

Growth-minded facilities should consider not only how but why they should grow, and whether that growth would be profitable. A huge component of that task is developing relationships with and gleaning information from surgeons in your area, including those who don’t work at your facility — yet.

Sean Rambo, a 20-year industry veteran who is president and cofounder of ASC management and equity partner Compass Surgical Partners in Raleigh, N.C encourages administrators of his partner ASCs — both physician-owned centers and those affiliated with health systems — to embody a growth mindset every day.

“Something we preach a lot, both to our administrators and our regional operators, is embedding your growth strategy and your physician recruitment strategy into the fabric of how you run your facility,” says Mr. Rambo. That philosophy should apply whether you’re looking to grow an existing specialty or add an entirely new service line at your center, he says. Mr. Rambo calls growing volume in an existing specialty “low-hanging fruit” for ASC expansion. “If you grow with your existing partners and existing specialties, that’s the easiest, fastest way to constantly create growth,” he says.

However, he notes that a well-managed growth strategy is not just a decision to add more surgeons, open more ORs, expand operating hours or bring in more patients. It requires an analysis of your current business and providers, with a heavy focus on whether the financial numbers will work.

Mr. Rambo suggests engaging your current surgeons first. “The easiest thing to do is what I call ‘selling behind the red line’ — having an ongoing dialogue with your existing physician partners to see if you’re getting 100% of their business,” he says. “They’re already operating at your ASC, so you want to capture as much of their business as possible. Are they bringing every case they possibly can? If not, why? What’s leaking out, and why? Is it availability? Equipment? Turnover time? Convenience to the hospital? What is driving it?”

Growth-minded ASC administrators should always be looking for new physicians who fit well with their existing caseload, adds Mr. Rambo. That can minimize new equipment costs and require little or no changes to your policies and procedures, he says.

Mr. Rambo believes marketing and surgeon recruitment should be integrated into the daily duties of an ASC administrator. “Yes, you’re managing within the four walls, making sure the trains are on time and all that good stuff, but recruiting should be ingrained in what you think about every day, every week, every month, to build the business,” he says. “A lot of administrators are used to showing up, managing cases and going home, but you need to really get out and market the center.”

He suggests developing a target list of the other physicians of your specialty in your market and tracking your interactions with them. “Are you talking to them?” says Mr. Rambo. “Are you setting up meetings with them on a regular basis? They may not always be interested, but there needs to be a constant cycle of just showing up and talking to their office manager. Have a relationship with them, whether they’re going to come to your center or not. If you make that a regular part of your job, at some point you’ll run across a new physician, or one who is disenchanted with where they are. Maybe they can’t get OR time. Now you can tell them, ‘I’ve got availability on Tuesday at 1:00.’”

The reimagination of a retail space gave this Phoenix community a new option for total joint and hip surgeries.

Stryker-L37 Creative
From the lobby to the ORs to the physical therapy area, Integrated Surgical Services in Phoenix is a prime example of reimaging a retail space and bringing a state-of-the-art surgical space to the community.

Ambulatory Surgery Centers (ASCs) seem to be cropping up all over in communities across the nation as savvy owners investigate their neighborhoods for the best locations and opportunities to invest in one-day surgery facilities. The demand for a wide range of services – from GI procedures to more complex orthopedic surgeries – is growing as an aging population as well as younger generations seek convenient, safe and efficient procedures in their neighborhoods.

The choice to renovate a former space, instead of taking on a new build, is one that some owners and their stakeholders make to revitalize a certain location, make use of existing structures, and accommodate an ambitious renovation plan that results in a new thriving ASC business. However, this is still a daunting task that requires careful planning and choosing the best vendor partner to accomplish the mission.

One such renovation involved the transformation of a grocery store in Phoenix, AZ, and a collaborative partnership between the owners and Stryker’s ASC Business, consisting of a team that has deep experience in the ASC landscape from the beginning of a concept through to the final launch. Included in this plan are regular business review follow ups and check-ins to ensure the success of the ASC as the market evolves.

Integrated Surgical Services started out in 2014 under the direction of Dr. Brian Gruber, who had plans to serve the growing community with orthopedic procedures. Once started, he never looked back as he looked for new opportunities to expand. In 2019, partnering with Stryker, Dr. Gruber set out to transform a vacant grocery store into a state-of-the-art ASC. Utilizing an existing structure, this was a massive renovation and reimagination of the space.

“We chose to work with Stryker because they were best-in-class,” says Dr. Gruber. Combining renovation strategies and key collaboration for capital equipment provided hospital sized ORs for the new facility. Dr. Gruber explains that the state-of-the-art ORs attract surgeons to his ASC and allows the OR team to provide the best for the patients they serve. Included in the renovation, for example, was a full SPD area that provides safe and efficient reprocessing of equipment, allowing for up to 20 surgeries a day.

From the lobby to the ORs to the physical therapy area, Integrated Surgical Services is a prime example of reimaging a retail space and bringing a state-of-the-art surgical space to the community. Dr. Gruber outlines the process in a video where he talks about the Stryker partnership and how he overcame “barriers to entry” by working together to find solutions for the renovation, the equipment needs and the path to the best patient care and experience.

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

To learn more about Integrated Surgical Services, click here.