Before we discuss how to design and outfit your facility for ENT surgery, just a quick word about how the first physician-owned ambulatory surgical center in North Carolina specifically designed for patients requiring ENT surgery came to be.

In 2010, North Carolina launched a statewide project to determine if single-specialty surgery centers increased patient access to certain surgical sub-specialties. For our ENT docs, the timing was perfect. The local hospital rarely scheduled their cases during their preferred block times. Granted, ENT wasn’t the hospital’s biggest revenue-generator, but the physicians of Piedmont Ear, Nose & Throat Associates (PENTA) were growing increasingly annoyed (PENTA-up frustration!).

As they say, necessity is the mother of invention. Our surgeons jumped at the chance to show that that a smartly built facility can improve patient care and broke ground on the 9,849-square-foot, 2-room Piedmont Outpatient Surgery Center. Since performing our first case in February 2012, 3,000 patients have come through the facility’s ORs each year. Our current success can be traced back to before the center’s doors opened, when we focused on designing and outfitting a facility that would set us up for future growth and innovation.

We began the planning process with a construction budget of $4.1 million, with around $1 million earmarked for equipment. Because the construction process is so time-consuming, there’s a tendency to jump in before you’ve accounted for each and every cost consideration that could crop up. That’s a mistake. Double- and triple-check every aspect of your budgeting and add some padding to account for inevitable and unforeseen oversights — the medical gas line that needs to be rerouted mid-project or the electrical wiring issue that needs to be sorted out — before moving forward.

Equipment purchasing is where you have the most wiggle room — and where a clinical perspective is paramount. In the early stages of our construction, an administrator with no clinical experience listed the wrong-sized sterilizers on the budget. The estimate was off by thousands: $6,000 compared to the $30,000 that we actually needed to spend.

We focused on efficiency when planning the facility, and that attention to detail is evident in the final design. The U-shaped layout of the building was created for maximum patient flow and minimal staff excursion.

It’s only about 5 steps from pre-op to the ORs, which each measure about 480 square feet. Because we don’t have a lot of extra storage space — not to mention time between cases — the ORs are big enough to house all the equipment we need for cases. Each OR’s set-up is standardized, which speeds turnover times and limits our need to move equipment into and out of the rooms. We also added modular cabinets for extra storage capacity. Those features are a big part of why our average OR turnover time is just 7 to 9 minutes.

After surgery, patients are moved another 5 steps to PACU. The pre-op and post-op rooms were designed exactly the same way to accommodate overflow during busy days. The rooms can be used interchangeably, so we avoid scheduling problems.

Breaking ground on a new facility involves complying with complex state regulatory burdens that are often difficult to understand and time-consuming to manage. You can access all the information you need to make sure your construction project is done by the book, but interpreting the regulations is the tough part. Our team went to accreditation seminars, made endless phone calls to experts and spent hours creating and maintaining all of the mandatory records.

If you do decide to take on managing regulations, make sure the point person has clinical experience. After all, there’s a big difference between understanding how a regulation works in theory and complying with it on a daily basis.

Going it alone isn’t for everybody. If you have any doubts about your ability to dedicate the time and resources necessary to meet the stringent regulatory requirements of opening a new facility, you may want to bring on a consultant. But you’re going to pay for their services — somewhere around $30,000 for help throughout the process. In the end, it might turn out to be worth every penny. OSM