Building a New ASC? Expect the Unexpected

Working with the right team of experts will help you navigate the complexities and create a facility that delivers high-quality surgical care.

Atlantic Health System of Morristown, N.J., opened its Morristown Medical Center Rockaway Pavilion Ambulatory Surgery Center in November of last year, a 15,000-square-foot facility that boasts four 450-square-foot operating rooms as well as 15 preoperative and post-anesthesia care unit bays. The ASC was slated to open in early 2020, but the sledgehammer known as COVID-19 put hiring and opening efforts on pause. 

Even without the risk of a global pandemic, opening a new ASC can be a long, complex and challenging proposition for any surgical leader. Learn how the health system’s leaders managed to get the new surgery center up and running despite delays and setbacks caused by COVID-19.

Keep your end goal in mind

Atlantic Health purchased the property in 2019 that now houses its state-of-the-art surgery center, and it took about a year from the beginning of construction to receiving the certificate of occupancy for the facility to be complete, recalls Robert Peake, vice president of facilities management, construction and real estate for Atlantic Health. “Everything was new from the exterior walls to build this ambulatory surgery center,” he says. “Right when we were ready to open, COVID came and shut things down,” says Mr. Peake.

Pam Mestel, RN, MSN, CNOR, executive director of surgical services at Atlantic Health, says that the state of New Jersey’s executive order that restricted elective procedures combined with the necessary manpower and focus that was needed to care for COVID patients in the hospital meant that hiring for the ASC needed to be put on pause.

“Once the executive order was lifted, we resumed our plans for the entire facility, which took a lot of time,” she says. Once the ASC was completed, the Department of Health did a thorough inspection, not only of the facility, but also of the policies and procedures. “When the state comes, their goal is to make sure that you are patient ready, and we were,” says Ms. Mestel.

Located on the third floor of what was once an office building, the multispecialty ASC offers operative services including orthopedics, podiatry, plastics, general, ENT, vascular, gynecology, breast and urological surgeries as well as endoscopic services, such as colonoscopies. Mr. Peake says having the ASC on the top floor of the building is ideal. “When we first moved into Rockaway Pavilion, opening an ASC wasn’t part of our original plans. We already had an urgent care on the first floor, and a range of services including vascular and cardiac on the second floor, but having an ASC on the top floor works so well, because it provides the ability to have ventilation through the roof.

When you build any type of operating room, you need a lot of air exchanges to keep the air sterile, and it is a lot easier if you’re on that top floor to penetrate through the roof, rather than running ductwork through the entire building,” notes Mr. Peake.

Design for providers and patients

HAND IN HAND Before purchasing equipment, tap into your physicians’ knowledge and expertise.

To provide the best care for your patients, tap into your surgeons’ knowledge and expertise. “Our patients always come first, and our physicians are also our customers, because they bring the patients to us,” says Ms. Mestel. “We work hand in hand with them and closely collaborate with them to make sure they feel comfortable and have the equipment, tools, supplies and staff needed to safely and effectively care for the patients.” She adds that if there is a gap between what your physicians are asking for and what the health system may already have, it’s important to negotiate with your surgeons and see whether it’s reasonable to purchase the additional equipment for them.

Among the latest technological advancements offered at the new Morristown ASC is non-invasive prostate tissue ablation, the first and only robotic platform using high-intensity focused ultrasound (HIFU) technology. The platform allows urologists to control precise targeting and destruction of only a small portion of the prostate, sparing healthy surrounding tissue and minimizing side effects. “Before this technology, prostatectomies were a more invasive procedure that required patients to spend at least one night in the hospital to recover,” says Ms. Mestel. “Now, at the ASC, our patients can go home the same day and recover much more quickly. We are incredibly proud to be the first in New Jersey to offer this breakthrough non-invasive focal therapy technology to our prostate cancer patients,” she says, adding that the latest innovations, combined with the exceptional clinical staff’s skills, help bolster the brand-new ASC facility itself.

‘Warm and welcoming’

How your patient feels when they walk into your ASC is almost as important as the quality of care they will receive.

To that end, “welcoming and warm” is how Mr. Peake describes his New Jersey-based ASC. “We wanted to give it that modern look that reflects the innovation and the technology that we bring to the community,” he says. “At the same time, we also wanted to create this welcoming, warm feeling right when you walk through the door. If you’re going into surgery, you’re going to be nervous, so we want to try to help people relax and feel as comfortable as possible.”

Ms. Mestel says soothing colors line the hallways as well as the pre-op and PACU bays to help put patients at ease, a concept leaders also kept in mind when furnishing the facility. “We have comfortable chairs in the waiting area for patients and their families, as well as a TV and a space for families to get a cup of coffee while they wait,” she says.

The care is much more personalized, and the space itself is smaller and simpler to navigate than a large hospital.
Pam Mestel, RN, MSN, CNOR

When the project was complete, Ms. Mestel reached out to the health system’s project managers to help create a blueprint for future ASC projects. “They made a book like a roadmap, so if we ever plan to create another ASC, we can review what we previously did,” she says. “Instead of reinventing the wheel, we have it all mapped out, so we can just follow the plans like a recipe.”

Bottom-line benefits

Morristown Medical Center Ambulatory Surgery Center’s opening comes at a time when multiple factors are driving the demand for new ASCs.

For one, notes Ms. Mestel, many inpatient surgeries can now be safely performed in an ambulatory surgery center environment, leading to greater satisfaction from surgeons and patients. “The care is much more personalized, and the space itself is smaller and simpler to navigate than a large hospital,” she says. “We’re also not competing with the inpatient tertiary cases that can be unpredictable.”

For stakeholders, an ASC is also going to be better for your bottom line in many ways, reimbursement rates aside. “At the end of the day at the ASC, we shut off the lights, we lock the doors and we leave,” says Ms. Mestel. “Whereas a hospital is open 24 hours a day, seven days a week, and we are paying for all those utilities and the overhead.”

Technology is another big driver for ASC migration, says Ms. Mestel, as the trend toward less invasive cases, smaller incisions and easier recoveries continues to grow, thanks to improvements in anesthesia throughout the perioperative process. “Along with the advanced technology is the availability of faster-acting and more effective anesthesia,” she says. “ASC patients wake up from surgery without many of the negative side effects they had just a few years ago.”

As with any successful new project, the rewards are substantial. “Our focus is always on our patients and our community. So being able to bring this type of quality and innovation to the community is very satisfying,” says Mr. Peake, a sentiment with which Ms. Mestel fully agrees. “We had a ribbon cutting in November, and all our staff attended,” she says. “You could just see them beaming with such pride, knowing they are an integral part of this new center. And once you are invested like that, your staff will treat the facility like it’s their own home.” OSM