March 24, 2021

Facility Construction and Design

By: Outpatient Surgery Editors

Published: 3/24/2021

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eNews Briefs March 24, 2021

THIS WEEK'S ARTICLES

Focus on Your 'Five-Minute Space'

Taking Sterile Processing Offsite

Increasing Surgical Options for Total Joints

COVID-19 Accelerates the Future of Outpatient Surgery

Real-World Analysis Optimizes and Sustains Surgical Supply Costs

 

Focus on Your 'Five-Minute Space'

Your lobby's design can go a long way toward alleviating patients' pre-op anxieties.

WAITING IN PEACE PHOTO CREDIT: Orthopedic Associates of Hartford (Conn.)
WAITING IN PEACE At Orthopedic Associates of Hartford Surgery Center in Rocky Hill, Conn., a stunning two-story stone wall and floor-to-ceiling windows bathe the patient waiting area in natural light.

That initial moment when patients walk through a facility's doors is crucial. It's when they form the first impressions of the care they're about to receive — impressions that often stick regardless of the outcomes of their procedures. That's why it's so important for facility leaders to devote significant time, effort and resources on the design of waiting areas when building or renovating facilities.

George Tingwald, MD, AIA, a rare surgeon-architect who serves as the director of medical planning for Stanford (Calif.) Health Care, calls that first-impression area the "five-minute space." "With surgery, there's so much that patients don't see or understand," he says. "They need to grasp onto something that lets them know they're in a safe environment, that they're being taken care of."

Dr. Tingwald is a proponent of "thoughtful design," which focuses on functionality in the layout and construction of the waiting area to make patients feel at ease the moment they enter a facility. Think of it as a perfect melding of operational efficiency and premium patient experience.

"Two-thirds of aesthetics is functionality," says Dr. Tingwald. "When a patient walks through your doors, they should instantly understand the facility was designed with their needs in mind." Features like generous natural lighting, calming color schemes and even small amenities such as adequate outlets or USB charging stations go a long way toward making patients feel welcome, according to Dr. Tingwald.

If you want to take your patient-centered design a step further, steal a page from Dr. Tingwald's playbook and enlist someone who can help you see your facility through the eyes of a patient. "For the final 20 years of my mother's life, she served as my muse for every one of my projects," he says. "I made a conscious decision to see each angle of the facility from the perspective of the patient. And the patient I had in mind when I was making those decisions was my mom."

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Taking Sterile Processing Offsite

Health systems are building huge instrument reprocessing facilities miles from the ORs they serve. Could ASCs tap into the trend?

WALL TO WALL WALL TO WALL This bank of sterilizers at Northwell Health's instrument reprocessing facility on Long Island transports surgical instruments to and from five major hospitals around the clock.

Gargantuan freestanding facilities that clean, disinfect and sterilize surgical instruments are popping up across the country, replacing the cramped sterile processing departments (SPDs) often found in dark hospital basements, while third-parties are offering similar services to ASCs. The trend addresses two significant opportunities for surgical facilities. It allows surgical providers constructing or renovating their spaces to devote more precious square footage to actual patient care, while the vast reprocessing facilities allow for the one-way workflow that is optimal for cleaning instruments.

This trend among the big health systems echoes evidence that ASCs are also exploring the pros and cons of outsourcing sterile processing to similarly large third-party facilities. For example, in Chicagoland, OrthoIllinois Surgery Center recently outsourced its sterile processing to a third-party facility operated by Vested Medical, as we covered in the Feb. 24 issue of eNews Briefs.

We recently acquired more info about three large health systems' facilities to provide a clearer picture for ASC administrators about what this kind of arrangement looks like in practice, and how it might apply on a smaller scale.

Northwell Health's facility in Bethpage, Long Island, opened in 2018 at the site of a former popcorn factory. It reprocesses sets from 250 to 300 cases a day — about 15 million surgical instruments a year. Just this February, Penn Medicine moved 140 of its reprocessing techs from SPDs at five facilities to a new 110,000-square foot instrument-cleaning space. The Ohio State University (OSU) Wexner Medical Center's new $45.3 million reprocessing facility opened in February, too.

"We run an intricate, flexible and versatile 24/7 operation," says Adam Boll, Northwell's executive director of joint venture operations. "The reprocessing equipment never stops humming and our trucks never stop rolling."

The facilities feature long stretches of horizontal floor space that allow for instruments to be unpacked, washed, sterilized, high-level disinfected and reassembled without requiring placement into sealed containers for transport from nonsterile to sterile areas. This "one-way-workflow," which is the optimal way to reprocess instruments, often couldn't be accomplished at old locations that sometimes had decontamination stations on different floors of the hospitals than where the sterilizers were housed.

Other features of the new sites include the use of clean steam from reverse osmosis water to prevent water residue from remaining on instruments, airlocks throughout the building that prevent cross-contamination of air between dirty and clean areas, filtration systems that minimize dust collection on instruments, and ergonomically-designed sinks and tables for workers of all sizes. Such facilities also serve as prep sites for soft goods such as gowns, towels and gauze needed for the next day's cases, or house their own instrument maintenance and repair centers.

Some even have industrial rotomats, which are huge storage carousels that operate like garment conveyors at a dry cleaner. A prep worker simply plugs in a number for an item, and the multi-level vertical units with dozens of shelves on each level spin around and deliver it.

Kim Jones, OSU Wexner's director of central sterile supply, says her new facility has elevated reprocessing technicians to their rightful place, enabling them to work with the comfort and efficiency their mission deserves. "Surgery is the moneymaker for most health systems, and central sterile is the lifeblood of surgery," she says. "You're working against the grain if your ORs and central sterile departments don't have a strong sense of partnership, cooperation and teamwork."

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Increasing Surgical Options for Total Joints

A Rhode Island ASC launches with Stryker's ASC business partnership

Stryker Credit: Stryker™
A surgeon-owned businesses partnership with Stryker's ASC-focused business unit offers collaboration on all aspects of the operation from the build to equipment and financial services.

A brand-new ASC is set to open in Spring of 2021 in Rhode Island, a state-of-the-art, 100,000-square-foot, three-story facility that offers complete care. Ortho Rhode Island, an independent physician-owned practice with 9 locations across Rhode Island, partnered with Stryker's ASC business to make this new venture a reality.

Equipped with 38 physicians, advanced practitioners and 33 therapists and trainers, Ortho Rhode Island was determined to continue their growth.

"To us, innovation means more than technology - it means progress, with high-quality care and value as the focus. Partnering with a vendor who understands this approach has helped make our new ASC a truly innovative experience for patients," says Michael P. Bradley, MD, MBA, MS, President & CEO of Ortho Rhode Island.

Stryker worked with Ortho Rhode Island in a customized step-by-step approach that resulted in the opening of their new ASC, which is ready for business this spring.

Since every ASC has a different mission, the Stryker team starts by learning about each individual ASCs goals and tailors the solution and strategy to its specific needs. In the last 30 years, Stryker helped design and outfit over 15,000 operating rooms with a broad product portfolio of equipment for every part of the ASC.

For Ortho Rhode Island, the relationship with Stryker goes back more than a decade as Robert Marchand, MD, noted during a recent interview with The Rhode Show on WPRI Channel 12 when he shared a special anniversary with listeners.

The celebration was the 10th anniversary of the first robotic-assisted surgery in Rhode Island, introduced by Ortho Rhode Island in partnership with South County Health. Dr. Marchand detailed the way robotic-arm assisted surgery works, how it has benefitted patients and how it has changed the way orthopedic surgeons treat patients. In fact, Ortho Rhode Island is a leader in Mako SmartRobotics™ procedures.

Plans for the new ASC progressed as the collaboration with Stryker included specific equipment and targeted strategies. Stryker was able to accommodate for a procedural volume of 1,200 surgeries a year and implants and consumables to support Sports Medicine, Joint Replacement, Foot & Ankle and Upper Extremity specialties. With 4 ORs to equip, the Stryker solution included surgical tables, lights, monitors, video, SmartRobotics, power tools, waste management, tourniquet systems, surgeon stools and sterilization. The 4 pre-op bays and 4 post-op bays called for a focus on stretchers, furniture, patient warming, overbed tables, recliners and transport carts.

The collaboration continued with a review of the financial structure that minimized initial out-of-pocket capital expenses for Ortho Rhode Island. Finally, the customized project timeline gave the opportunity for a staged opening of operating rooms as new specialties are introduced and overall case volumes ramp up.

The Stryker ASC business partnership with Ortho Rhode Island offered a comprehensive, detailed project scope including financial and clinical goals and provided a multi-staged delivery for the launch of this new ASC and its future as case volumes scale.

Note: Dr. Marchand is a paid consultant of Stryker Orthopaedics. The opinions expressed by Dr. Marchand are those of Dr. Marchand and not necessarily those of Stryker. Individual experiences may vary.

Learn more about Stryker's ASC-focused business: https://www.stryker.com/us/en/care-settings/asc.html

You can also learn more here: https://www.linkedin.com/showcase/stryker-asc/

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COVID-19 Accelerates the Future of Outpatient Surgery

The pandemic has spurred builders and designers to reimagine what same-day ORs can be.

Throughout the pandemic, outpatient facilities have been the subject of increased focus within the healthcare community and among payers for many reasons. While some surgical facilities didn't survive the economic disruption that came when elective surgeries were halted, many more stepped up to provide safe patient care and assist the acute care community as much as possible, strengthening bonds with their communities at large as well as the rest of their local healthcare providers.

As a result, the pandemic hasn't halted the growth and evolution of outpatient facilities. Quite the contrary: Leaders are moving ahead with many new surgery center construction projects and renovations across the country. What's better, the stresses of the pandemic, combined with reduced patient volumes for weeks at a time, have afforded planners the luxury and motivation to reimagine and reinvent what an outpatient surgical space can be.

More cardiac procedures, as well as total hips, have been approved for ASCs in 2021. Orthopedics and spine in general are hot outpatient specialties. All of these new procedures along with the larger patient populations they provide — and the overriding requirement of efficiency and patient safety — have created a strong drive for new and renovated surgical spaces.

This dovetails into another trend: Many surgery centers built in the 1990s and 2000s are getting a bit long in the tooth. "Let's swing the wrecking ball through today's tired ORs, clear the rubble, and rebuild with efficiency and improved patient care in mind," says Scott Reeves, MD, MBA, FACC, FASE, who is part of a joint research team from Clemson University and the Medical University of South Carolina that examines every aspect of current OR standards with the goal of reinventing these spaces from the ground up.

Some of the team's key takeaways include very specific suggestions to improve placement of monitors, screens and other equipment to improve each team member's line of sight to the sterile field. When renovating or building new ORs, these improvements should be accounted for at the very beginning of the design process.

Certainly, every OR build is unique to the architecture of a building and the types of surgeries performed there. The key in planning is to configure each area of OR real estate that is available to be of optimal use, while also accounting for future flexibility. Dr. Reeves advises creating versatile, standardized rooms with steel grids housed in the ceilings to hold booms that can be repositioned and fixed as needed. He also recommends modular steel walls that provide easy access to electrical, data networking and gas lines when needed while allowing for any future changes in the room's configuration.

It's important to be realistic in your planning. The "big picture" keeps investors, architects, designers and planners up at night. What looks like a trend today might actually be a fad that costs more down the road with renovations and rebuilds. Of course, input from surgeons and staff is vital in this process.

Remember too, about technology's impact on OR design. Robotics, video integration, and other equipment and applications will require convenient and powerful data networking capabilities; for example, images from surgeries are automatically sent to EMRs, and surgeons and other clinicians outside the OR seek to collaborate during surgeries.

Finally, the safety and efficiency of both staff and patients should guide everything in your design. 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.

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Real-World Analysis Optimizes and Sustains Surgical Supply Costs

Simple algorithms can update surgeon's preference cards better and faster than traditional manual revisions could.

What if you could initiate a system — today, at little to no cost — that would enable you to achieve and sustain substantial savings on your daily surgical supply costs?

Johannon Olson, a healthcare management advisor, thinks you can. As a consultant, Mr. Olson participated in a case-controlled study focused on supply costs in a pediatric surgical setting at Stanford (Calif.) Health Care. The intervention group simply updated its surgeon preference cards, while the control group didn't. The first group saw its supply costs plummet by more than $1 million, or 8%, while costs for the second group increased by $600,000, or 13%.

That's rather cut-and-dried stuff. So how can you realize similarly huge savings? Mr. Olson says to start by selecting a member of your OR team who possesses precise knowledge of which supply items are actually used in your most commonly performed procedures. That person, he says, should lead this effort, but be careful about which qualified OR staffer you actually choose.

"Interestingly, the perfect person to review these cards often isn't the charge nurse or another team member with 20 or 30 years of experience," he says. "These leaders are often desensitized to the amount of waste that takes place daily and aren't incentivized to reduce it. The excess supplies seem to make the procedure in front of them easier to complete." Instead, tap a surgical tech. "They'll bring fresh eyes to the situation, will be honored and feel elevated about their new role, and will take the job seriously," says Mr. Olson.

That leader will quickly make it clear to you which unnecessary items have been brought to the OR and opened anyway, only to be thrown out afterward. Putting everything in a spreadsheet will make this even clearer, says Mr. Olson. Stanford Health Care used the exercise to create an automated algorithm that scours recent patients' electronic medical records to determine which supplies are crucial and which aren't. This algorithm is constantly optimizing surgeons' preference cards to create sustainable cost savings without anyone needing to manually update them.

There's a good chance you don't work with Stanford's IT department, though. Ultimately what is important is assessing the realities of your supply usage and using it to alter any needlessly wasteful aspects of your OR culture. "Conversations begin between nurses and techs about what can be done without, and whether something actually needs to be opened or not," says Mr. Olson. "At Stanford, this led to real staff education about the actual costs of supplies, which we formalized in a fun way by creating a Jeopardy-like game about product prices during daily huddles."

Mr. Olson believes this approach, done properly, can help control costs with greater impact than you would find by forming supply purchasing committees or implementing surgeon incentive programs.

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