Case Study: NYU Langone Medical Center Opens Advanced, Streamlined Surgery Center Dedicated to Orthopedics

NYU Langone Medical Center enjoys a reputation as one of the premier academic medical centers in the country. The hospital recently opened a facility built to current technology and clinical best practices in order to provide patients with a new option for orthopedic surgery: a hospital-affiliated, free-standing ASC — right in the heart of Manhattan.

NYU Langone Medical Center wanted to open an ambulatory surgery facility so it could move a portion of its less complex orthopedic procedures to the ASC, which would function similar to an independent facility while providing the same high level of service and patient quality expected from this New York academic medical center.

David A. Dibner, senior vice president, operations and musculoskeletal strategic area, NYU Langone Medical Center, discusses the challenges surrounding the development, construction and launch of this new outpatient facility.

Developing the concept
The idea for a freestanding outpatient surgery facility with four operating rooms began with the growing need for additional inpatient surgical capacity at NYU Langone Medical Center. The hospital needed to open up more space for complex inpatient procedures such as aortic valve repair, gastrointestinal surgeries and neurosurgery in the hospital, and creating an ASC would significantly increase the hospital's ability to service more acute inpatient surgeries at the hospital.

Looking at the orthopedic caseload at the medical center, the hospital treated roughly 15,000 orthopedic patients annually, with more than half requiring procedures that lent themselves to an outpatient setting. "A non-hospital based facility can help provide the optimal experience for our patients while providing the perfect environment to integrate advanced technologies with leading clinical practices," Mr. Dibner says.

On Nov. 9, 2009, NYU Langone Medical Center opened the doors to the Outpatient Surgery Center at 333 East 38th Street in order to handle what surgeons consider "short" cases, such as hand surgeries and arthroscopies. By Jan. 2010, all four ORs were open and the center had received full accreditation by The Joint Commission.

Cultural shift
Though the Outpatient Surgery Center would benefit from being part of NYU Langone Medical Center, the team wanted it to run as close to a freestanding ASC as possible. "The facility needed to be designed — from an infrastructure, clinical and customer services perspective — for generally healthy individuals undergoing elective, short procedures. It can be a big step for surgeons and their staff trained in large academic hospital settings where the cases are more acute and complex to adjust to the setup, staff, equipment and processes in an ambulatory setting," says Joan Dentler, principal of ASC Strategies, the consulting firm which helped NYU establish the new center.

NYU Langone Medical Center quickly realized that building a facility catering to these types of procedures would require surgeons and staff to work differently. "We knew it would be challenging," Mr. Dibner says. "Initially, we planned to put most of our sports medicine cases at the center, such as knees and hand procedures that only take 30-90 minutes, but we knew that there would still be some retraining required."

This meant ensuring that surgeons were sending the right patients to the new center. "Their surgeons were used to operating in a large hospital setting that provided backup medical care, such as a critical care unit, access to additional tests and the ability for overnight stays if needed," Ms. Dentler says. "It was important to reinforce the need to understand patient acuity levels before considering them for the center."

Making sure all preadmission testing and other required clearances are completed prior to patients arriving at the ASC was a big change for both surgeons and the patients who were accustomed to accessing services around the clock. "We had to help change a process that was based on traditional hospital block-time scheduling into the finite hours setting in an ASC," Mr. Dibner says. "It took us a few months to hit our stride, but today the surgeons, staff and patients work together to ensure cases are completed on schedule with very positive outcomes."

In order to help the clinical and administrative staff more familiar with providing care in traditional inpatient settings effectively transition to the new setting, several physician information sessions were held and training and documentation on appropriate patient identification, selection and preparation was provided, according to Ms. Dentler.

Providing key physician leadership
A key component of the transition from the hospital to the Outpatient Surgery Center was using physicians experienced in ambulatory methodology help others. "We made sure our orthopaedic physicians with experience in this type of setting were available to provide guidance and direction between the surgeons and administrative staff," Mr. Dibner says.

To make this transition even more seamless, NYU Langone Medical Center created the Physician Steering Committee, an advisory panel for the Outpatient Surgery Center, which began reviewing procedures six months prior to the opening of the center. In addition to helping select the center's medical director, the committee set the tone for the center. "While learning and implementing new processes is always time consuming, the surgeons are now comfortable with their new surroundings, and everything is running harmoniously," Ms. Dentler says.

Adapting to the new facility
In order for the ASC model to fit effectively within existing operations at NYU Langone Medical Center, several other departments needed training about the unique requirements about providing care in the new setting, as well as time to adapt to the new environment and workflows.

"We also designed a unique IT infrastructure for the facility — both integrating it with the medical centers current IT system where needed while at the same time eliminating those aspects that were not relevant to the outpatient setting," Ms. Dentler says. "The system was originally set up so that physicians and staff members had to key in a lot of inpatient–specific data that was irrelevant to what was happening at the center. We simplified the screens so that our data collection more closely represented what was actually being done at the center and took staff and surgeons less time."

Bright future
With the success of the Outpatient Surgery Center, NYU Langone Medical Center is now ready to add to the floors above the center, creating what may be the largest musculoskeletal institute in the country, according to Mr. Dibner. When completed, the new institute will provide a wide variety of specialized spine, joint replacement, sports medicine, arthritis care and rehabilitation services.

"We believe that the combination of a freestanding orthopedic surgery center with a musculoskeletal institute will be an efficient, natural portal through which to provide our patients' access to orthopedic outpatient services with the world-class facilities and research associated with our medical center," Mr. Dibner says. "We are excited about being able to provide initial care at our hospital and then route them to appropriate inpatient or outpatient surgery or vice versa because our new facility allows for all care to be easily coordinated."

Learn more about NYU Langone Medical Center and the new Outpatient Surgery Center.

Learn more about ASC Strategies.