Focus On: ASC Build: Optimization Is Everything

DISC Sports & Spine Center further hones its outpatient approach for complex spine cases with its third ASC.

One evening this August, more than 350 local doctors, athletes, celebrities and business leaders attended a cocktail reception in Marina del Rey, Calif. The occasion? The grand opening of DISC Surgery Center at Marina del Rey, the third ASC in DISC’s portfolio. Visitors toured the custom-built 11,000-square-foot facility and viewed hands-on demos of its cutting-edge technology.

For Robert S. Bray, Jr., MD, FAANS, DISC’s CEO and founding director, the event culminated a years-long process that required enormous investment, planning, adaptability and effort, and furthered his mission to expand access to DISC’s mix of minimally invasive spine surgery, orthopedics and pain management to the Los Angeles region and beyond. The new center, joining DISC’s existing ASCs in Newport Beach and Valencia, features two 600-square-foot ORs, a PACU bay, four private patient rooms including a luxury suite, a family lounge, a private consult room, a modern waiting room and ample spaces for staff.

Overcoming challenges

Establishing the center presented Dr. Bray with a significant challenge: finding space. “It’s easier to acquire a piece of land and build from the ground up, but there was simply nothing available here,” he says. He would have preferred room for a third OR but wanted to be in Marina del Rey for very specific reasons, especially its proximity to LAX airport. “It’s a central access point for the valley and the LA basin, and a destination that enables people to come to us from many areas,” he says.

He ultimately leased space in an existing office building. “It was not the easiest thing to deal with,” says Dr. Bray. “Building codes differ by state, by cities within the state, and you have to take CMS codes now. They don’t always agree on what needs to be built.” The site’s location on LA’s coastal corridor triggered even more regulations. “The building had to be upgraded for power, water and drainage, with external paths put in for the backup generator,” says Dr. Bray. “We built a huge air processing facility that exchanges the air for the entire center every three minutes.”

Ceiling height was yet another obstacle. “It’s a massive challenge to build out when you’re putting all the infrastructure in the ceiling, because you need the clearance for all the ducts, pipes and fiber optics and yet still be able to close it off and maintain 10 feet, six inches for the OR height,” says Dr. Bray. Factoring in the pandemic’s impact on the timeline, it took more than two years to build the ASC. “The lease negotiation alone took over six months, not to mention the incredibly extensive build-out,” says Dr. Bray. For retrofits like this, he recommends performing due diligence for your architect by running a 3D analysis on the building to learn what needs to be converted, and how much it will cost.

Thoughtful design

The ASC’s design is strategic and well-honed from prior experience. “We built around the core of surgery first — the ORs and the sterile processing department (SPD),” says Dr. Bray. “The ORs are large because no one said ‘minimally invasive’ means ‘minimal technology’ when it comes to the high-acuity cases we perform.” Both ORs feature the latest operating microscopes, 3D imaging for implant placement, digital C-arms and other devices, as well as elaborate ventilation systems. Each piece of equipment enjoys dedicated space in the ORs, which are built to maximize flow and efficiency.

The SPD, centered around the ORs to supply them seamlessly, features hospital-grade sterilizers, washers, sterilization rooms, packing and supplies. “We might have 14 or 16 trays of instruments for a complex case, so we needed an SPD that can handle that volume,” says Dr. Bray.

SPINE SPACE The new ASC’s large ORs provide the space and infrastructure to perform anything from the simplest to the most complex and delicate spine procedures.

Branching off the surgical core is the rest of the facility, starting with rooms for overnight-stay patients, of whom there are plenty given the complexity of the cases DISC surgeons regularly perform. “Many ASCs are built to handle just microdiscectomies or simple decompressions or one-level anterior cervical discectomies,” says Dr. Bray. “We’re built to handle almost all aspects of spine other than pediatrics or full scoliosis.”

The DISC patient experience makes families not only feel welcome, but part of the surgical process. “Typically when you go to a surgical center, you drop your loved one off at the front desk, sit in the waiting room, and hours later the patient is returned to you in a wheelchair,” says Dr. Bray. “We don’t believe in that. We keep the family with the patient. They wait with them until they go to the OR and are called when they come out. They see every bit of the mobilization process, the pain management, the wound care, the nurses educating the patient — they’re a part of every piece of it. The family stays engaged and feels comfortable they can take this person home.”

As a result of DISC’s pain management program, which includes selective use of regional blocks, comprehensive nursing protocols and advanced pain management techniques, patients are up and walking a few hours after their procedures. “That’s just not seen in the hospital environment, and it reduces complications, risk of blood clots and a lot of other things that happen when you just lay people in bed and don’t mobilize them,” says Dr. Bray. “Early mobilization is key, and it’s a team approach.”

Other space in the facility is built for DISC staff — changing areas, locker rooms, a lounge. “We treat our staff nicely because they’re an incredibly important part of the whole picture,” says Dr. Bray.

Build for the future

Dr. Bray says the ASC’s design required considerable work with both architects and staff who possess significant ASC experience, particularly in meeting certifications for CMS, AAAHC, state and local agencies. He recommends staffing well in advance. “Our staff has a national reputation on just how to build to code for CMS,” he says. “We hired our nurse manager, ASC manager, OR nurses and chief of staffing long before the center ever opened. That investment was critical in making this a reality.”

Dr. Bray accomplished his goal of creating an ASC that is equipped with the massive infrastructure and experienced personnel needed to safely and effectively perform complex spine cases in an outpatient setting, while feeling personal, comforting and simple for patients and families. “This was built to be a showcase center, and that’s what’s attracting so many physicians,” he says, noting 17 surgeons have contracted to work at DISC Surgery Center at Marina del Rey. “It’s a far better experience than patients or surgeons will get elsewhere.” OSM