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25 Little Things That Matter a Great Deal
Design and construction tips you can't afford to overlook.
Donna Quinn, Nancy Burden
Publish Date: January 10, 2009   |  Tags:   Facility Construction and Design

One of the biggest challenges in designing and building a new surgery center is identifying all the little details that will help your center run smoothly. Often great ideas don't come to you until you've moved in and started using the building. By then it's too late to get deeper cabinets, wider doorways and more storage space or to relocate the nursing station — and you're left with painful reminders of what could have been. Here are 25 construction details that you may not have thought about, but will pay off in the long run.

1. Soundproofing. For compliance with HIPAA rules, make sure that consultation rooms are soundproofed so that other patients and visitors can't hear the conversations. Because consultation rooms are typically positioned near the waiting area, have a solid door that closes. In the business office, which usually has more than one person on the phone at the same time, install sound-deadening material on the walls and, if possible, partitions between employees.

2. Light with daylight. Natural light can improve the mood of staff and patients. Add windows wherever possible. In rooms where patients require privacy, high windows let the sun shine in.

3. Large cabinets. A cabinet's most important dimension is the inside. Cabinets should be deep enough to hold three-ring binders.

4. Equipment footprint. When working on the plans, make sure that your architect makes space for all of the equipment that will be in each room. Don't forget carts, portable devices and other equipment on wheels. You'll also need to plan for the storage of movable equipment such as C-arms, lasers, towers for scopes and cribs for children.

5. Parking orientation. Design the parking lot so that cars park perpendicular to the exit. This will let patients walk directly down the aisle to their cars, rather than having to walk over a curb or median. With fewer things in a patient's way, there's less chance for a patient to fall.

6. Staff lounge. Make sure that the staff lounge is far enough away from patient areas so that patients don't smell food or hear the staff's conversations and laughter. Employees should have a pleasant, relaxing place for lunch breaks, but their fun shouldn't disturb the patients.

7. Exit awning. Patients shouldn't leave through the main entrance. Neither should they feel as if they're being scooted out the back door into an alleyway. Install an awning at the patient exit door to shelter patients while they're waiting to be picked up. An awning will also help the person picking up the patient find the pick-up area.

8. Bathroom doors. Although they may increase costs, consider bathroom doors that open outward as well as inward. If a patient falls in the bathroom and leans on the door, you'll be able to open the door without harming the patient.

9. Centralized nursing station. Place the nursing station in the middle of everything, so that it can be used by pre-op and PACU nurses. This saves nurses' steps and time, and helps for cross-training since all the nurses are working in the same area.

10. Decentralize the heat. Not everyone has to freeze in a surgery center. If you divide the climate control into zones, you can keep the clinical areas cooler and the visitors' area and break room warmer. Each OR should have its own temperature control because some patients, especially the elderly and very young, require a warmer environment.

11. PACU lighting. Have individual light controls for each PACU bay. You'll be able to make patients, especially those with migraines or other pain, more comfortable during recovery.

12. Colors to fit the mood. A surgery center is not the place to get radical with colors. Patients are often anxious, so you should use cool colors (blues and greens) and neutral colors (beige, tan and cream) in care areas. If you really want to use friendly colors, do it in the waiting area.

13. Medication prep area. Create a designated area for medication prep and storage — a clean, quiet spot not too far from the nursing station, but not in the middle of everything either.

14. Handwashing stations. Keep handwashing stations in plain view of patients. If patients can see you washing or sanitizing your hands, it helps relieve their stress.

15. Wheelchair storage. Create a space to store wheelchairs on the discharge side of the center, so they're close when you need them and staff don't have to push them very far after patients leave.

16. Automatic doors. Install automatic doors wherever possible to increase security and make patient transport easier. In a renovation, convert doors as well, especially the discharge door to the outside. Doorways throughout the center should be wide enough for wheelchairs to easily pass through.

17. Anesthesia office space. Everyone seems to be going paperless, except anesthesia providers. They still have a lot of paperwork to do, so give them the room to do it. Some centers have built an 8x10 room, while others have included an alcove or a desk somewhere between the OR and the recovery area.

18. Headwalls. In each patient's bay, design a ledge or cubbyhole behind the head of the bed. Here you can store the monitor, sharps container, tissues and other clinical supplies. This spot keeps you from having to add a table to each bay.

19. Consider the flow. Think of more than patient flow when designing a surgery center. Think about the flow of everything that comes into the building. How will contaminated instruments get to the reprocessing area? Where does the trash and medical waste go once it leaves the OR?

20. Back exits. Staff shouldn't enter or exit the same way patients do. Create an exit for employees somewhere outside the sterile area. This is a good escape route for the physicians, too.

21. Security lighting. It'll be dark when the first employees arrive in the morning and the last leave in the evening. Follow the flow of employees to and from their cars and make sure there's adequate lighting in the parking lot and walkways.

22. Lock it up. You'll need to lock up more than medications and needles. Remember to have locked storage for medical records and expensive portable equipment. You should also have a lock system on doors leading to the sterile areas of the center. Don't forget a room where you can lock and chain medical gases. If you don't have indoor storage, you'll need a locked cage outdoors for the gas bottles. Finally, consider hiring a security monitoring company for protecting the building at night.

23. Rub rails. Pushing stretchers and beds around is going to ding up the walls. Install a wide synthetic rub rail at the height where stretchers would come in contact with the walls. It will save you plenty of money on plaster and paint.

24. Electrical outlets. Although local codes dictate where electrical outlets are placed, add outlets where they're needed. Think about the height of the outlet. Down near the floor may not be the best place. Locate additional outlets based on where the equipment will be in the room so that staff's not tripping over electrical cords.

25. Lower counter. Design your check-in counter with a lower surface suitable for patients in wheelchairs. It's practical, more welcoming and will help put those patients at ease.