I've been performing gynecologic procedures in my office suite for 12 years. Though I didn't know it at the time, a few of my design decisions during its construction have turned out to be invaluable to the success of my practice. Here are some of my top tips for building an office suite that works.

1. Don't skimp on size. The size of procedure rooms needs to strike a balance between space efficiency and having enough room to move. I built one procedure area alongside two exam rooms. The procedure room is 20 feet by 14 feet, a size that works for my practice. Keep in mind that the room has to be big enough for your staff and surgeon to work together comfortably in the space around the patient's bed and necessary equipment.

Another important measurement to keep in mind: the size of the procedure room's doors and hall space just outside those doors. You need to get the patient's stretcher bed in and out of the room with ease. Plan for maneuvering an average-sized patient transport, one that is six feet, six inches long and about 30 inches wide. If the door to your procedure room opens into a hallway running straight ahead, the size of patient transports is obviously less of a concern. In most office settings, however, patient transports must immediately turn a corner after they are wheeled out of the procedure room's door. Remember that the door and the turn space in the hall must be big enough to accommodate such a maneuver.

2. Allow for storage. While finding adequate space to store supplies is a major concern for any surgical facility, it is perhaps more so for those working in an office, as space is limited in the smaller footprint of most office-based designs.

One of the smartest design decisions I made turned out to be the walk-in storage closet connected to my office's procedure room. The closet is large, approximately five feet by eight feet. Two of its three walls are covered with 18-inch wide shelves. The closet's remaining area is big enough for the temporary storage of clinical equipment when it's not in use during a case. Being able to quickly and easily stash unneeded equipment in the walk-in closet has essentially expanded our clinical space, making the procedure room more comfortable for staff and patients without having to change the room's footprint.

The closet doesn't have a door; a curtain instead separates the supplies from the procedure area. That decision was based on the space available; a standard door would have interfered with valuable clinical space when opened and shut throughout the day. The curtain partition turned out to be an effective and space-saving design feature.

3. Remember patient comfort. Some of the main benefits of office surgery from the patient's perspective — efficiency, relative privacy — must be incorporated into your office's physical design. Each of our exam rooms is connected to a private changing area. The changing areas aren't large — about three feet by five feet — but they offer privacy for our female patients. Walking in on a patient who is in the midst of changing before or after an exam is an unfortunate and uncomfortable situation. Private changing areas eliminate that possibility.

The office's procedure room is attached to a bathroom that is used by patients to change out of their street clothes. It's a good size (six feet by eight feet) with a small storage chest and bench, clothes hooks and mirror. Patients can place their clothes in the chest during the procedure; we also stock the chest with feminine hygiene products as a service to our all-female clientele.

A lot of thought went into including the procedure room's bathroom in the facility's final design. It would have been easier to not include that bathroom if my practice wanted to gain office accreditation and bill using Medicare codes. As it stands now, the door to the bathroom would have to remain locked at all times if we want to be office-accredited.

I hemmed and hawed when deciding whether or not to include the bathroom, ultimately figuring that our case mix didn't necessitate using Medicare codes to achieve case reimbursements. Turns out that decision was the right one. My patients have expressed their extreme satisfaction with having a bathroom and changing area connected directly to the procedure room. Having the bathroom available to my patients is just too advantageous to ever consider going without it. When patients are happy, you'll know the design is right.

4. Consider the caseload. Match your office suite's design to the number and types of cases you host. Since I also operate at a full-service surgery center, I've decided to limit the complexity of the cases hosted in my office. We occasionally administer pre-ablation doses of local anesthetics, but we avoid procedures that require conscious sedation. Our caseload, then, consists of hysteroscopy, cystoscopy, minor vaginal cases and laser procedures for cervical dysplasia and urodynamic testing. We've tried to ramp up the number of minimally invasive sterilization procedures we host but the volume is not yet substantial. Adding cosmetic procedures is also a possibility, but this market is already flooded with physicians performing those cases.

My office's procedure room is therefore used frequently — about three times a day — but our caseload is such that we don't perform serial procedures. Pre-op and post-op bays were not key design considerations. I did purchase a mechanical table for the procedure room. Patients are raised to a sitting position at the conclusion of cases, recovering for 15 to 20 minutes until they're ready to change and go home. If we truly need to move patients immediately at the conclusion of a case, we transport them to one of the two exam rooms for recovery.

A strong alternative
Office surgery is convenient for the patient and surgeon, and a more efficient and cost-effective way to perform cases that do well outside of a full-service ASC or hospital outpatient department.