FEATURE


reception, business office—everything down the list—set up to handle the additional load? If the expansion requires the addition of a new piece of capital equipment, like a C-arm, do you have the storage space for it? If not, you will need to rectify these issues as part of the expansion or remodel.” The addition of a new specialty could


have a substantial impact on the design of the entire ASC, Simmons notes. “This is a time when you would want to check with the state to determine licen- sure requirements. If your facility has 375-square-foot ORs, for example, the addition of a specialty may require all of your ORs to be larger if your ASC lacks a grandfathering clause. The need to expand your existing ORs to accom- modate a new OR may change the entire scope of the project.” Adding a new specialty might have


other effects as well, Marasco notes. “If you are an ophthalmic ASC with open block time and are approached by a gastroenterology (GI) group inter- ested in performing cases, that may seem like a great idea. But how you sterilize GI scopes versus ophthalmology trays is very different. You will need to have space and the technology to clean equip- ment particular to any new specialty.” Even a change in patient demo-


graphics can impact a project, he adds. “A situation we have seen in the past when adding otolaryngology (ENT) to a surgery center is the addition of chil- dren as patients. If you have a multi-OR ASC and are going to dedicate time in one OR to ENT, you have to be able to control the acoustics of children who tend to cry pre- and post-operatively. Do you have some enclosed space for criers? Do you have space to bring a parent in to calm things down?”


Effect on Operations Even with great planning, an addition or remodel will create discomfort for an ASC, Marasco says. “It is going to be noisy, dusty and muddy. Go by any


You need to develop a relationship with the people involved in the project where you can ask any question without them being offended.”


— LoAnn Vande Leest, RN, CASC Northwest Michigan Surgery Center


construction site and you can easily see what your situation is going to be. Whether or not that closes your facility, those ramifications are going to exist.” It is best to avoid shutting down operations as few ASCs can afford to go many days without performing pro- cedures, Simmons says. “You want to keep the cash flow going and work to limit disruptions as much as possible.” That was a significant area of focus


for Northwest Michigan Surgery Center during its project, Vande Leest says. “We spent significant time looking at how we could repurpose and flex space so we could house things temporarily and keep the flow going while remaining in compliance,” she says. “There were many times we asked for certain work to stop because it was too noisy for our surgeons to operate effectively. The workers had to be willing to find other projects they could do that were not noisy and then resume when cases were done. Fortunately, from the beginning we made sure to develop strong lines of communication and an understanding of what still needed to happen at our ASC during construction.”


That also involved taking important safety issues into consideration. “We really placed an emphasis on infec- tion control,” Vande Leest says. “This involved making sure that everything was curtained and taped off, and that we were able to maintain a clean, safe surgical environment.” For any ASC preparing to start a remodeling or expansion project, Vande Leest suggests the following: “Any research you can do on rules and regulations, the better off you will be, even if it is to confirm something you think you know. Do not be afraid to ask any questions. You need to develop a relationship with the people involved in the project where you can ask any question without them being offended. “Do not assume someone has


taken what you are asking about into consideration,” she adds. “You never know when a question you ask may prevent a mistake from happening that could cause problems down the road. When it comes to your ASC’s safety, compliance and financials, you can never be too careful.”


ASC FOCUS SEPTEMBER 2015 17


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