Spine surgery accounts for about half of the new ambulatory surgery centers designed by L3 Healthcare Design in Altamonte Springs, Fla. Lee Chester, L3's vice president, itemizes eight design specifics for spine ASCs.
1. Aim higher than the code. Most state inspections use American Institute of Architects guidelines for ASCs. While the current edition of AIA guidelines does not specifically address spine ASCs, architects should aim higher than AIA minimums for spine. "You can't simply rely on the code minimum," Mr. Chester says. "Spine surgeries require a higher reliability of the sterile field than current codes require."
2. Install pressure indicators. Mechanical pressure indicators at the doors of the OR show whether the pressure within the OR is being maintained, thus assuring a sterile field. "Traditionally, people assume that once pressure systems are installed, they will continue forever," Mr. Chester says. "You can't think that way for spine."
3. Use automatic monitors. Spine ASCs need to be alerted right away if the atmosphere in the OR starts changing. Mr. Chester recommends installing automatic monitors for temperature, humidity, pressure filters and components of the air conditioning system. For example, these systems can detect when a belt starts to slip. Staff members are alerted by flashes on a laptop in the corridor outside the OR and then an e-mail is automatically sent to the repair company to come and fix the problem.
4. Generators need more fuel. Standby generators need more fuel because spine surgery takes longer and with spine patients' particular condition, it is more difficult to move them in mid-surgery when the power fails. The AIA code calls for fuel for at least eight hours, but Mr. Chester says spine ASCs should have 24 hours of fuel. A spine operation can last eight hours and then the patient needs eight to 10 hours for recovery.
5. Assure air conditioning for power outages. Code does not require generators to power the air conditioning systems, but in long surgeries such as spine, it is a necessity for the surgery team and the patient. "In places like Arizona, it would be unthinkable to perform surgery for many hours without air conditioning," Mr. Chester says.
6. Separate spine from other procedures. To assure sterility, doors to the spine OR and rooms for other procedures should not open into the same corridor. "Let's say you get urine on the floor in a urology procedure," Mr. Chester says. "You don't want that to be tracked out into the same hallway that the spine OR uses."
7. Customize recovery room space. Recovery rooms vary by specialty. While ophthalmology patients are sitting up in their street clothes in the recovery room and don't stay for very long, spine patients are in beds that are rolled in and they stay for hours. Spine patients need segregated space that can be darkened so that they can sleep.
8. Business office should be larger. Billing operations for spine are more extensive than for other procedures because claims tend to be out-of-network. "You're going to need more people in the billing office," Mr. Chester says. "All kinds of material have to be collected for each case."
Learn more about L3 Healthcare Design.
Read more about outpatient spine:
- 5 Considerations for Surgery Centers Before Adding Outpatient Spine
- 7 Strategies to Negotiate In-Network Carve-Outs for Outpatient Spine
- 10 Established Best Practices for Increasing Spine Surgery Center Profits