so we had a lot of trouble controlling humidity and temperature.”

Building New Versus Converting an Existing Space

It is easier to design a space from scratch than to convert an existing space, Scott says. “When we were trying to double our space, we had to move the ORs in our renovation to a different location,” she says. “We made our existing ORs the postop area and the procedure room for our femtosecond laser. Putting all of the pieces together in a renovation can be challenging. “Building the ASC was the smart- est decision I made to improve patient satisfaction, efficiency and financial stability,” Scott adds. The cost of building an ASC com- pared to an office space is roughly twice, Marasco says. “There are cer- tain requirements for fire ratings, automatic sprinklers and building construction types and, therefore, not all existing buildings are suitable to house ASCs,” he says. “So, often there are upgrade costs when you convert an existing space.” For example, ASCs must be sepa-

rated by a one-hour fire separation, vertically and horizontally, from other tenants, he says. And as pre- viously mentioned, ASCs also need more comprehensive HVAC systems. “So, when you convert a space, you typically have to add a mechani- cal unit that feeds those specialized areas,” Marasco says. “The question becomes, does the existing build- ing have an area on the roof for that. Does it have a shaft to connect to the suite that the ASC will be in. Is it structurally suitable to handle an additional HVAC unit?” An ASC also requires an emer-

gency power source, Marasco says. It can be done through a battery-backup system, however, the current stan- dards require the system to run the air handlers of the mechanical sys-

An OR in CEI Vision Partners' ASC in Cincinnati, Ohio. Eckert Wordell renovated the space.

tem. “Therefore, it is typically less expensive to go with a diesel-pow- ered generator than a battery backup system,” he says. “These generators are fairly large and very loud, and you are required to test them once a month. Some existing buildings might not have space to place an emergency generator and some might be unwill- ing to accept the noise.” In addition, there are elevator requirements in the Facility Guide- lines Institute guidelines that are unclear. “Within the


which they update approximately every four years—there is an eleva- tor section that calls for a 5-foot-by- 5-foot clear space in the elevator,” Marasco says. “There has been dis- cussion from state to state whether that means moving patients from one floor to another within an ASC or within the overall building.” These are potential impasses for

an existing building, he says, so make sure to check off all those boxes before deciding on an existing space. “Have an experienced ASC architect review any space before you lock in on an existing building. With a new building, none of these issues are a problem.”

Choosing an Architect There are many architects who spe- cialize in hospitals, which is just as bad as those with no ASC expe- rience because they tend to bring everything they do in a hospital to the ASC, Marasco says. “So, you end up with an overly expensive ASC. But hiring your brother-in-law who designs houses is even worse. Hir- ing an expert is not more expensive; this is what we do, so, we don’t have to charge more for doing it, you just need to find us.” Jared VanderWeele, principal and senior architect at Eckert Wordell agrees. Choosing an architecture firm with extensive ASC experience and the services of a medical business/opera- tions consultant to assist with deter- mining the best option from a financial perspective are the two best decisions an ASC owner can make to ensure suc- cess, he says. “These two groups pro- vide guidance regarding which option to choose based on critical data, like surgical volumes, ownership model, financial feasibility, evaluation of existing facility conditions—if appli- cable—site selection, compliance and regulatory research, and design.”


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