Outfitting for the Ortho Boom

The surgery center is 28,500 square feet and on the first floor of the new building. In all, there are eight pre-op bays, six surgical suites, eight PACU bays and six discharge rooms. The facility’s features were designed and built with intended purpose, beginning as soon as you walk through the front door. 

• First impressions. The lobby has a wood floor and ceiling lights that make it look more like the entry to a high-end hotel than a medical facility. Lobbies like this are becoming the norm in ASC design, says Suraj S. Soudagar, MS, MBA, LEED AP, principal and project executive at IMEG, a healthcare engineering firm in Naperville, Ill., that was not involved with the Albany Med Health project.

Reimbursements are tied in part to patient satisfaction, so having an appealing and comfortable common area of a facility is a hospitality-based design feature that helps achieve that. “These designs also reduce the anxieties and fears in patients and that warmth gives them confidence in what’s about to happen during their surgical procedure,” says Mr. Soudagar. “A cozy and homey first impression in the lobby stays with patients as they transfer to the clinical areas of the facility.”

The front third of the center also includes the reception area, pre-op and PACU bays, and discharge rooms, which feature sliding glass walls for privacy, a stretcher, a lounge chair for a visitor and a TV.

• High-tech suites. The middle section of the facility houses the sterile corridor, which includes the row of six ORs. The center is outfitted with a robotic-assisted knee surgery system, tables for hip replacements that allow for hyperextension and external rotation, which play a role in faster discharges, and advanced tools and devices for spine surgery. It cost more than $1M to outfit each ortho OR, says Dr. Quinn. Mr. Soudagar says it can cost about $300,000 per OR for instruments alone.

The ORs have doors at the front of the room that open to the sterile corridor and back doors that lead to the rear section of the facility, which is where the sterile processing and storage areas are located. “From a process and cleanliness standpoint, we really like it that way,” says Dr. Quinn. “The patient goes in and out at the front of the room, and the instruments always go through the back.”

The ORs are 24-by-24 feet, as opposed to the more standard 20-by-20 rooms. “The extra room isn’t crucial, but in terms of space, more is better,” says Dr. Quinn. “It’s also just cleaner overall, so you’re not pinched and trying to work your way around a sterile back table, equipment and other staff members.”

• Imaging and lighting. Large monitors mounted on the walls in each suite display EHRs, anesthesia information, and other picture-archiving and communication systems. One of the rooms is outfitted with high-end lights and a camera system, which is important because the facility occasionally links to other locations for teaching and research purposes. “But in general, I’m not sure that investment makes sense for every room. I’m not sure the bang for the buck is there,” says Dr. Quinn. Regular surgical lights are about the only thing the facility opted to mount to the ceiling. Arthroscopy equipment, for example, which are often attached to a ceiling-mounted boom, are on carts instead. “Equipment on booms seems to end up in the way and not exactly where you want it,” says Dr. Quinn. “We keep mounted equipment to a minimum because most of it changes a lot, and it works better on carts anyway.”

Mr. Soudagar agrees with this design choice. “You don’t need bells and whistles in terms of lots of lights and booms,” he says. “Eliminating them and opting for a more focused, minimalist design will save you a lot of money.”

• Dedicated storage. Dr. Quinn says it was important for the facility to dedicate lots of room for storage. In the middle section of the facility, just across the corridor outside of the back doors of the ORs, lies a large alcove that runs almost the entire length of the building. Tools, implants, fluid management devices and other gear is stored there. Having that dedicated space eliminates the need to store equipment in the corner of an OR, which could present possible tripping hazards for staff.

• Room to reprocess. Sterile processing equipment needs to be larger for a facility performing total joints. At Dr. Quinn’s facility, for example, case carts the size of dishwashers are rolled into cleaner-sterilizers the size of refrigerators. “Adequate sterile processing equipment isn’t cheap, but it’s absolutely critical,” says Dr. Quinn. “You shouldn’t be afraid to dedicate space, money and staff to it.” One more tip: Dr. Quinn suggests keeping areas such as physician dictation rooms, locker rooms, break rooms and rest rooms close to each other. It’s inconvenient to have to walk the length of the facility to get from one common area to another. 

Dr. Quinn says the new facility was important to build because of the increased volume of total joints cases the Saratoga County area will see in future years. Designing it was difficult as they tried to hit the sweet spot of building a properly sized center that will run at full capacity. Picking the right layout and outfitting it with the correct equipment that will keep the center well-positioned for the next 25 years was equally tricky.

Dr. Quinn feels his team created a blueprint for the future of outpatient hip, knee and shoulder replacements and spine procedures for the region. Through it all, they never lost sight of the fact that the physical space is the least important part of the equation that leads to the kind of care they provide.

“We have a shiny new coin that cost a pretty penny and will be worth every cent,” says Dr. Quinn. “That said, people are more important than places. With the right team in place, amazing work can be done in a two-OR facility that appears to have suboptimal physical circumstances. Caring staff members — eager to learn, fun to work with and serious at the same time — combined with excellent processes will always make for a very successful surgery center.” OSM