THIS WEEK'S ARTICLES
New Jersey Patient Survey Finds Overwhelming Support for ASCs
The industry can take heart that patients are confident in facilities’ safety and quality of care.
Results of a study conducted by SPH Analytics for the New Jersey Association of Ambulatory Surgery Centers (NJAASC) released last month exemplify the high regard patients hold for safety at Garden State ASCs, and show that those feelings held strong throughout the darkest days of the pandemic.
According to the NJAASC/SPH Analytics Patient Experience Survey, among more than 15,000 patients who had a procedure performed at New Jersey ASCs between September 2020 and March 2021, more than 99% strongly agreed (87.8%) or agreed (11.9%) that they felt safe when they visited one of New Jersey's 320 ASCs. These numbers exactly correspond to those from a pre-pandemic survey conducted between August 2019 and February 2020.
"The ASC industry in New Jersey was hit hard when the COVID-19 pandemic was declared," says NJAASC President Jeff Shanton. "Since the vast majority of procedures performed at ASCs are for elective surgery and diagnostic procedures, visits to New Jersey's ASCs came to a screeching halt. This, coupled with the fact that New Jersey and the surrounding areas were impacted more severely by COVID-19 than other parts of the country, made the pandemic an even more challenging period for ASCs in the state. In spite of this, New Jersey's ASCs took purposeful steps to ensure that patients and staff alike could be treated and go to work in a healthy and safe environment."
The nearly unanimous positive response among surveyed patients regarding safety held similarly when patients were asked whether they received good care at their ASC, and whether they would recommend the ASC to family and friends. NJAASC notes that willingness to recommend is a key indicator of consumer confidence in ASCs.
It would be difficult to imagine that these stellar survey numbers are an outlier, and that the situation in terms of consumer confidence is significantly worse in other states Many patients clearly have positive feelings for the care ASCs provide and their important impact on the overall well-being of local communities.
Gameplan for the Stress of Surgical Construction
Preparation, a collaborative mindset and an ability to react well to unexpected challenges are keys to project management success.
Byron Burlingame, MS, BNS, RN, CNOR, says the most valuable lesson he learned about managing surgical construction during a renovation project is this: "You need allies in your corner, and you need to do your homework. From determining how many new ORs we needed and where the rooms needed to go to figuring out how the project would affect other areas of the hospital, every phase of the renovation journey was a learning experience for me."
Mr. Burlingame, a recently retired senior perioperative practice specialist for the Association of periOperative Registered Nurses (AORN), says he worked closely with his charge nurse and his facility's head of sterile processing to create what at first glance would be a straightforward project. One OR would be turned into part of the sterile processing department, while two brand-new ORs would be built in an adjacent space that had served as a medical records area. The pre- and post-op departments would receive facelifts, and the endoscopy procedure room would be converted into a pre- and post-op patient room.
Plenty of challenges presented along the way, however. "During the renovation, I stood up to a pushy architect who tried to tell me what to do," he recalls. "I dealt with a maintenance manager who, two weeks into the project, left for vacation and effectively said, 'Good news! The project is all yours.'"
In the middle of the construction, a two-foot concrete pillar that supported the floor above it had to be removed one egg-sized piece at a time. Weeks into the project, an electrician asked why plugs were placed 18 inches off the floor in one OR and 30 inches off the floor in another.
"As I reflect on my time heading up the project, I wish I would have known about the guidelines established by organizations such as AORN and the Facility Guidelines Institute, but I'm proud of the work that I did," he says.
Mr. Burlingame advises surgical leaders involved in facility construction or renovation projects to get heavily involved in the entire design and construction process from day one. "You know what patients need, and you're the resident expert on surgical processes that have to be mapped out and everything that happens behind the scenes," he says.
To drive that point home, he gives the example of a center in his hometown that was originally constructed without a sterile processing area. "A surgical leader's perspective would've saved a lot of time, money and headaches," he says. "Needless to say, the builders scrambled to do some major remodeling before the project was even finished."
While the nature of these projects varies widely from facility to facility, there are some universal truths that Mr. Burlingame imports: "Ask plenty of questions, get to know the construction and design team, and use all the resources at your disposal. Finally, be prepared for everything. In the world of surgical construction, anything is possible."
Building and Expanding ASCs With Stryker's Eight-step Approach
This customized, flexible program supports growth and expansion in today’s evolving healthcare environment.
Over the past several years, procedural volumes, particularly with total joints, have been migrating from the hospital outpatient department to ambulatory surgery centers (ASCs) at an accelerated pace. With the potential to provide over $55 billion annually in healthcare cost savings in the U.S., this rapid shift in site of care is expected to continue over the next few years in the post-pandemic environment.
To meet the unique needs of this emerging customer, Stryker launched an ASC-focused business in mid-2020.
"By offering ASCs access to the breadth and depth of Stryker's portfolio, teams who understand the ASC landscape, and ongoing support to help build and grow their business, we are committed to delivering tailored solutions for ASCs to achieve their mission and goals," said Andy Pierce, Stryker's group president of MedSurg and Neurotechnology.
With thousands of unique products spanning more than 20 procedural specialties, and a wide range of flexible financial options, Stryker has positioned itself to meet the complex needs of ASCs while continuing to add value to healthcare.
Every ASC has a different mission and set of goals. The Stryker team starts by learning about each individual ASC. In the last 30 years, Stryker helped design and outfit over 15,000 operating rooms, and their broad product portfolio has the right equipment for every part of the ASC. As they work with customers, the team shares their expertise every step of the way and creates tailored solutions that help maximize clinical, financial and operational outcomes.
A Customized Eight-step Approach
With its new ASC business, Stryker has developed an eight-step process to offer ASCs access to a deep portfolio of products, guides who understand the ASC landscape and ongoing support that makes building and growing feel simple.
The Stryker team's guidance and partnership, however, go well beyond a single purchase. As an ASC expands to new specialties, their team also helps business grow by conducting regular business reviews to help evaluate current usage and future needs; increases product efficiency and eliminates downtime with the ProCare service solutions; and provides customized, flexible financial options, ensuring the facility has the equipment and technology required to meet the needs of patients.
The first step of this eight-step process starts with Phase 1 at 24 months from opening a new ASC, and it entails the all-important Property Acquisition. While new construction may seem ideal for some, existing structures can often be retrofitted into highly-functional ASCs, and they tend to offer more flexibility in location in highly-developed areas.
In either case, Phase 2 is defining the Initial Project Scope, which Stryker defines as "right-sizing your facility from the very start" to achieve opportunities for future expansion. This important step occurs 20 months from opening and utilizes the company's market data and experience to make the right decisions for the specific facility being launched.
Choosing an architect may be the biggest single decision in the ASC design process. Stryker finds a partner who shares the vision using trusted partners who have ASC design experience. This Contracting an Architect step is Phase 3, and it is timed 18 months from opening.
Scheduled 14 months prior to opening is the Equipment and Budget Planning phase, which Stryker defines as Phase 4, and it requires strategies for financial flexibility. Smart financing options are the key to providing cash flow by balancing the initial investment with options and the flexibility to pay by procedure, choose leasing options or create a customized plan.
Next is the critical Room Layout Design and Clinical Specifications, Phase 5 and 6, which occurs 12 months from opening and goes to the heart of Stryker's products and capabilities. The company has been equipping operating rooms for almost 30 years and their broad product portfolio has the right equipment for every part of the ASC, providing value across the top specialties in the ASC setting including orthopedic surgery.
For the next steps, the Phase 7 and 8 execution begins 6 months before opening, and they involve the Construction Documents and Install as the final steps of an ASC construction or expansion. After months of careful planning, the Stryker team will help make sure that the final steps in ASC construction all go according to plan. Their network of trusted partners have experience fabricating operating rooms and installing Stryker's equipment as the building or renovating of the ASC takes final shape.
Learn more about Stryker's ASC-focused business: https://www.stryker.com/us/en/care-settings/asc.html
Momentum Continues to Build for Cardiovascular ASCs
A new project in Phoenix has one eye on the present and the other on an expanded future.
As more cardiovascular CMS codes come online each year, the buzz has been building in the ASC world over the business and clinical potential surrounding this specialty. While ASCs are limited largely to diagnostic cardiovascular procedures at this time, the groundwork is being laid for cardiovascular ASCs to gradually expand their service levels.
The latest example is a partnership among Banner Health, ASC development/management group Atlas Healthcare and cardiovascular services provider Cardiac Solutions to open a freestanding cardiovascular ASC. "The partnership marks a crucial step in the development of a cardiology specific strategy for Banner Surgery Centers and is the result of an important provider and health system alignment," the companies announced.
The surgery center, scheduled to open this year, will be the first Banner Cardiovascular Center of its kind. It will offer outpatient cardiology-specific care to patients in the west valley of Phoenix, with three cath labs and capabilities for conducting diagnostic heart catheterizations, heart stenting (PCI), electrophysiology device implants such as pacemakers, loop recorders and AICDs, and peripheral arterial disease (PAD) treatment.
All parties stress the ability the cardiovascular ASC will have to provide more convenient but consistently excellent care for patients and providers, enhancing patient experiences and saving the healthcare system money due to lower costs. Atlas will oversee the development and operations of the ASC, including continued growth strategies for the cardiovascular service line within the Banner Surgery Center network.
"This is a great opportunity to bring lower-cost outpatient cardiovascular care to Banner patients and we're happy to utilize our ASC development and management expertise to contribute to the evolution of cardiovascular care," says Aric Burke, CEO of Atlas Healthcare Partners.
An ASC With All the Modern Trimmings
The design of TMC's Healthcare's upcoming ASC incorporates valuable features that go far beyond the OR.
Abulatory surgery centers (ASCs) are breaking ground seemingly every week, which is no surprise because they offer excellent patient care at more affordable costs than traditional hospitals. As more of these facilities are built, the concept of building something more than an architecturally sterile medical facility is gaining favor.
For example, construction recently started on a state-of-the-art surgery center at TMC HealthCare's Rincon campus in Tucson, Ariz. The $8 million, 17,000-square-foot ASC is designed to accommodate a 3,000-square-foot expansion for future growth. The ASC is part of a 44,000 square-foot medical office building that will integrate primary and specialty care, including cardiology, family medicine, imaging, lab services, orthopedics, rehabilitation, urgent care and, soon, surgery.
In addition to all of the usual bells, whistles and requirements that go into building a safe and functional surgery center, the clinicians, administrators, architects and designers took a broader view of what a surgical facility should look like, with a focus on sustainable features such as:
- Solar panels
- Low and no water use landscaping
- A cool roof system to reduce heat island affects
- Trees to shade building and glass
- Use of reclaimed water for irrigation
Strong infection prevention measures are integrated in the design of the building as well, including:
- Maximized air changes throughout the building with high filtration rates
- A compartmentalized lobby and waiting area for proper social distancing
- Handwashing stations
- Solid surface counters and plexiglass screens at registration
All of these features, which virtually telegraph to the community that the ASC will be a good and responsible neighbor when its projected opening occurs next spring, were prominently featured in the announcement regarding the facility. In that vein, the health system says the building itself is designed to tie into its community's distinctive look, with "landscaping that reflects the surrounding desert."
As ASCs become more integrated into multipurpose building projects like these, as well more visible in the communities they serve, architectural and functional design flourishes. Those displayed by this project show that building great ORs is just one function of designing a 21st-century surgery center.