Administrator and director: Tom Mitros, MD
Safety officer: Donna Plummer, RN
Types of surgeries: General, endoscopy, podiatric, orthopedic, ophthalmology, urology, pain management
Staff: 20 - 1 administrator/director, 9 RNs, 2 LPNs, 2 techs, 1 X-ray tech, 5 office
Procedure rooms: 1
ORs: 2
Operating surgeons: 17
Monthly case volume: 200
Years in operation: 5
Ownership: 5 operating physicians and Community Health Services

In March, the Centers for Medicaid and Medicare Services released its updated life-safety code and gave facilities six months to comply with much of the code - or risk losing their Medicare certification.

Facilities being designed or early in construction could simply incorporate the changes. But for those already Medicare-certified, the list of retro changes could be long and expensive, including having properly sized linen containers, adding smoke compartments, making emergency-lighting upgrades and possibly revamping electrical systems.

For your peace of mind alone, hiring a consultant to wade through the code books and figure out how it relates to your facility may have been well worth it. But when you're wearing as many hats as Tom Mitros, MD, the administrator, medical director and anesthesiologist at the Surgery Center of Salem County in New Jersey, why not add another to the collection?

Fire safety
Hiring a consultant was too expensive - up to about $20,000 - so Dr. Mitros took on the challenge of life-safety compliance himself.

First, he and safety officer Donna Plummer, RN, tried to find state and local officials who could point them in the right direction - but no luck there. "Wherever I called, they had no idea," says Ms. Plummer. "It was very frustrating."

They bought the 1999 edition of the NFPA 99 and the 2000 NFPA 100, the code books CMS' update requires compliance with, and joined the National Fire Prevention Association. They spent $230, about 1 percent of a consultant's cost.

"You have to be prepared to sit down and read the relevant codes - the NFPA code book is not what you grew up on," says Dr. Mitros. "I spent three weeks going over codes. I learned more than I ever thought I'd know: I can tell you how wide our hallways have to be, how big the doors have to be, how many foot-candles the lights have to be."

The largest change Dr. Mitros found he'd have to make was replacing the facility's HVAC system and adding dampers to the ducts, which required hiring a contractor, cost $100,000 and shut the surgery center down for five days. There were also several comparatively small changes: wrong-sized trash cans needed replacing, a set of emergency lighting over an exit needed to be connected to a back-up system, and automatic-door pressures had to be re-adjusted and set.

As an NFPA member, Dr. Mitros was able to call the organization for guidance when he was really stuck.

"You have to be patient - you can't expect a response right away," he says. "But they will get back to you. You can save if you're willing to buy the books and spend the time reading and making the calls."

Nurses certified
As the facility's safety officer, Ms. Plummer worked with Dr. Mitros to get Salem ASC into compliance with the new fire- and life-safety codes. It's not unusual for nurses to spearhead key projects at this facility.

"One nurse is in charge of purchasing, one is in charge of infection control, one is in charge of staff education," says Ms. Plummer. "We work independently [on these areas]. Then we'll have group discussions to run across the relevant information."

Everyone has taken on these specialized tasks with enthusiasm, says Dr. Mitros.

"Our X-ray tech who does purchasing loves to shop and is computer literate," he says. "She's never done anything like this before, but she's great at it. Want a Snickers bar for less than 35 cents? If it's somewhere in the world, she'll find it. She's totally revamped our purchasing and saved us money."

Like Dr. Mitros, the nurses are also cross-trained to work in several areas of Salem ASC. And, since taking over the job of administrator about a year-and-a-half ago, he has emphasized the importance of continuing education, paying for the necessary time off for courses, books and testing.

"Seventy percent of our nurses are specialty-certified," says Ms. Plummer. "And three more will be taking certification exams this fall."

- Stephanie Wasek