Paper on Medical Clinics \u0026 Specialist Centers - Ambulatory Surgery Center

$Page 1: Paper on Medical Clinics \u0026 Specialist Centers - Ambulatory Surgery Center$
1 MUHON: A Journal of Architecture, Landscape Architecture and the Designed Environment University of the Philippines College of Architecture Issue No. #

Medical Clinics & Specialist Centers

Ambulatory Surgery Center

UPCA MA - Healthcare Facilities 1

Richard Joseph S. Lasam [email protected]

Abstract The Ambulatory Surgery Center is a rapidly expanding and developing out patient service that in recent years have been the answer to the growing demand for quick and efficient surgery for ailments that can be resolved within 24 hours. The paper presents the design parameters and architectural features of a general ambulatory surgery center to aide the reader in designing similar facilities.

Keywords: Day Surgery, Ambulatory Patient

I. Introduction

A. Definition: Ambulatory Surgery Center Ambulatory Surgery Centers—known as ASCs—are modern health care facilities focused on providing same-day surgical care, including diagnostic and preventive procedures. ASCs are not rural health clinics, urgent care centers or ambulatory care centers that provide diagnostic or primary health care services.

ASCs treat only patients who have already seen a health care provider and selected surgery as the appropriate treatment for their condition. ASCs are not physicians' offices either. All ASCs must have at least one dedicated operating room and the equipment needed to perform surgery safely and ensure quality patient care."2

ASCs are medical spaces which caters to the needs of both doctors and patients in terms of providing an alternative and faster way of providing and giving treatment beyond the traditional in-patient system of the hospital. This also gives a hospital options on devoting resources for the Main Surgical Department and inpatient services to be more focused on long term care patients.

Medical Activities in the ASC usually does not involve extensive use of anaesthesia, with Anaesthesiologists called in depending on the requirement of the procedure.

1 Architect Richard Lasam is a graduate of the UP College of Architecture in Diliman. He completed his BS Arch Degree in 2008, graduating "Cum Laude" during the State University's Centennial Year. He worked under Architect Prosperidad Luis, fuap in her firm from 2008 to 2012, specializing in the planning, design and project supervision of Healthcare Facilities, and obtained his Professional Architect License in 2010. While continuing with professional work, he is also completing a Masteral Degree on Architectural Design (Healthcare Facilities) in UP for further studies. 2 ASC Association Website - See Reference for internet address

Surgeons are also not permanently assigned to the ASC, as it functions as a semi-independent unit from the Surgical Department, with surgeons performing procedures in the ASC as required by patient demand. In certain cases, surgeons from other hospitals can perform procedures in the ASC as long as proper coordination is conducted.

An ASC can be attached to a hospital, or be an independent center that caters to patients from various hospitals. ASCs are usually not 24 Hour operations.

B. Relationship to Other Departments Diagnostic Departments such as the Imaging Department and the Laboratory should be adjacent to the ASC. Patients obtain their diagnostic data and results from these departments, which will be necessary for their procedure in the ASC.

The ASC should have a clear and direct path to the Main Surgery Department in cases of emergencies with a patient undergoing surgery in the ASC.

*The ASC need not be directly adjacent to the Main Surgery Center as they are located in different zones, with the ASC near the Public Areas and the Main Surgery Center located in the most secluded and Deep Areas of the Hospital.

The ASC may also be adjacent and/or directly managed by other specialties depending on the type of operations done within it. Though generally an ASC provides procedures on various ailments, some can be "Specialty Ambulatory Surgery Centers" with specific spaces from the specialty.

Some of the specialties that can be included in the ASC are:

• Ear, Nose and Throat Surgery

• Eye Surgery

• Gynecology

• Orthopedic Surgery

• Dentistry

• Plastic Surgery

• Urology

Many other specialties can be included in the ASC, as long as there is patient demand for it as well specialist medical personnel who can provide the medical treatment.

C. Hospital Zoning

The ASC is located in the Integrated Zone of the hospital, defined as a department that requires to be in the public areas (Outer Zone) but have sterility requirements within the space. In terms of zoning, the ASC should be located in between the Outer Zone and the Second Zone (Diagnostic Facilities) as the ASC accepts and gives workloads from these Zones.

Medical Clinics & Specialist Centers: Ambulatory Surgery Center UPCA M Arch - Health Care Facilities - Richard Joseph S. Lasam

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MUHON: A Journal of Architecture, Landscape Architecture and the Designed Environment Univers i t y o f the Phi l ipp ines Col lege of Arch i tec ture Issue no. #

D. Definition of Terms

1. Surgery - The branch of medicine that deals with the

diagnosis and treatment of injury, deformity, and disease by manual and instrumental means. 3

2. Ambulatory or Day Surgery - any surgical procedure that can be completed without a need for an overnight stay in the hospital.

3. Autoclave - device utilized in the Medical profession for the cleaning and sterilization of equipment via the use of high pressure and heat.

II. Space Program and Spatial

Considerations

A. Typical Space Program

The ASC is in most cases, a small self contained Surgical Unit that is operationally independent from the Main Surgery Center. Patient Spaces

Waiting Area / Lobby

Patient Dressing Area - Male & Female

Consultation & Examination Room* - for the use of the Doctor for certain patients, depending on the procedure.

ASC Operating Room - Generally smaller than an Operation Room in the Main Surgery Department. Contains all necessary equipment for Surgical Procedures.

Specialty Surgery Unit* - Inclusion of this space is dependent on the Specialty of the ASC (if present in the center)

Pre-Operation Waiting Room with Nurse Station - Holding area for patients while waiting for their surgical procedure. Patients are also examined and checked by the medical staff.

Post-Operation Recovery Room with Nurse Station - Room for patients resting and recovering from the after effects of either the surgery itself or anesthesia. Recovery Rooms can either have Beds or Lazy Boys for Recovery Units, depending on the procedure to be done in the ASC

Examination X-Ray Unit* - located only in very large ASCs or Independent ASC (constructed outside of a Hospital), a small X-Ray Unit for diagnosis of the patient is an added function that can reduce demand in the Main Imaging Department by having said procedure done "in-house" in the ASC.

PWD Toilet Staff Spaces

Reception

Staff Lounge

Scrub Area - for the use of Doctors before Surgery.

Staff Dressing Area - Male & Female

Doctors Dressing Area - Male & Female*

3 http://www.thefreedictionary.com/surgery

ASC Head Office*

Conference Room*

Staff Pantry*

Records Room* Maintenance & Support Spaces

Equipment Sterilizing Room* - Autoclaves and other sterilizing equipment are located here. Can be omitted if ASC is serviced by the Hospital Central Supply & Sterilizing Department.

Equipment Clean Up Room

Equipment Storage

Sterile Instruments & Supply Room

Clean Utility

Dirty Utility

Medical Gas Storage* - required if the ASC is not part of a Hospital unit and is an independent medical unit.

Service Corridor* - a separate corridor that connects to the Operating Rooms without crossing the clean surgical corridors of the ASC. Necessary to provide separation of clean and dirty materials in the ASC.

Electrical Room

*Indicated space can be omitted in case of space constraints for the ASC. Size and complexity of the Center is the factor in the inclusion of indicated spaces as well as specific hospital policies where the ASC is located in.

Due to the variable nature of the spaces of the ASC, a Table of estimated floor areas per end-user for important rooms are provided below:4

B. Major Equipment Layout

Figure 1. Typical Distances between Recovery Beds

4 DOH 2004 Design Guidelines



Figure 2. Typical Layout of an ASC Operating Room

III. Flow Diagrams

A. Patient Flow Diagram

Patients who use the ASC are generally mobile individuals who can bring themselves to the Center independently. PWD patients on wheelchairs or stretchers can also be brought to the ASC.

The primary requirement of the ASC Patient is that the procedure to be done must be completed "within the day", from the Pre-Operation, Surgery and Recovery without the need for a stay in the hospital. 1. Patient is scheduled by his or her attending doctor for

the time and date of the procedure in the ASC. Patient arrives a few hours before the operation and waits for his or her turn in being processed by the ASC Reception.

2. Patient enters the Pre-operation waiting area and proceeds to the dressing area to change into medical gown

3. Patient is examined and prepared by the Staff for operation. Examination may happen in the consultation room or in the pre-op area, depending on type of medical procedure.

4. Patient enters the semi-sterile surgical corridor and proceeds to assigned Minor O.R. for Operation.

5. After Operation, patient is brought to the Recovery Room and monitored by Staff for any problems. Time in recovery room dependent on procedure.

6. After being cleared in the recovery room, Patient goes back to dressing area to change back to street clothes.

7. Patient proceeds back to waiting area lobby to pay for his or her procedure.

Figure 3. Patient Activity Flow


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B. Medical Staff Flow Diagram

The medical staff involved in the ASC would be a mix of Nurses and technical staff, with the Nurses trained to have a specialization in Surgical Support and Recovery. 1. Medical Staff enter thru the staff entrance of the ASC.

2. Staff change into Medical Attire in the Staff Dressing Area and proceed to their designated positions (Reception, Pre-Operation, Surgical Support, Recovery Room or Maintenance / Sterilization) to perform their tasks

3. Reception Staff manages the arrival and scheduling of patients and doctors who will use the ASC

4. Pre-Operation Medical Staff prepares, checks and monitors patients who will undergo a medical procedure in the ASC.

5. Surgical Support staff aide the Surgeon during the medical procedure.

6. Recovery Room staff monitors patients after the operation and alerts the department if there is an emergency.

7. Maintenance/Sterilization duties are done by staff. Involves cleaning of equipment, removal of medical waste, organization of supplies and other activities to maintain operations in the ASC.

8. Staff goes to back to Staff dressing area to change back into street clothes.

Figure 4. Medical Staff Activity Flow

C. Doctor Flow Diagram

Surgeons are the most common specialists to be found in the ASC. Other doctors may be called into the ASC depending on the procedure to be done. Anesthesiologists are also called into the ASC depending on the procedures. 1. The Surgeon coordinates with the ASC for schedule of

his procedure and arrives at the designated date and enters the ASC via the staff entrance.

2. Surgeon changes to medical attire in the Staff Dressing Area.

3. Depending on procedure, doctor will do a preliminary check of the patient before the procedure in the Pre-Op Waiting area.

4. Surgeon goes to his designated Operating Room and proceeds with the Medical Procedure.

5. After operation, Surgeon checks the patient in the recovery room and gives the patient clearance once medical checks are complete

6. If the surgeon has no other patients scheduled for the shift, Surgeon leaves the ASC after changing back to street clothes.

Figure 5. Doctor Activity Flow

IV. Sample Plan Diagrams

A. Sample Plan 1 - Small ASC

An Ambulatory Center can be a small operation with only 2-3 OR Units comprising the ASC. Sterilization and Supply requirements are provided by the hospital's central supply and sterilization department and as such are not included in the sample plan See Figure 6 for Sample Plan 1

B. Sample Plan 2 - Large ASC

A Large ASC will operate essentially as a secondary surgery department of the hospital, with a complete set of all necessary support spaces to support its operations. Multiple Operation Room Units are located in the ASC, with Service Corridors supporting the ORs so as to maintain the sterility of the space. The sample ASC presented in this paper is a semi-independent ASC that is still within the Hospital Premises. See Figure 7 for Sample Plan 2

V. Architectural and Engineering

Considerations

A. Control of Activity Flow

The ASC should have clear activity flows and signage to ensure efficient service quality in the place. Patients must have a circular activity flow that allows them to effectively traverse the ASC in a manner similar to an assembly line.



Figure 6. Sample Plan - Small Ambulatory Surgery Center


6 MUHON: A Journal of Architecture, Landscape Architecture and the Designed Environment

Univers i t y o f the Phi l ipp ines Col lege of Arch i tec ture Issue no. #

Table 1. Space Program of Small Ambulatory Surgery Center



Figure 7. Sample Plan - Large Ambulatory Surgery Center


8 MUHON: A Journal of Architecture, Landscape Architecture and the Designed Environment

Univers i t y o f the Phi l ipp ines Col lege of Arch i tec ture Issue no. #

Table 2. Space Program of Large Ambulatory Surgery Center



B. Infection Control - Sterility

The risk of infection for both staff and patients in the is very high due to the nature of the procedure being done in the area, which involves invasive operations into the human body, increasing the chance of contamination.

Infection via accidental contact with contaminated Blood, air or microbes is a risk that must be addressed by the ASC. Adequate hand washing areas and efficient patient and staff flow can reduce the chance of infection

It the budget and the types of patients will allow it, the ASC should have positive air pressure to prevent airborne infection originating from outside of the ASC.

C. Infection Control - Medical Waste

Separation of Clean Areas from Waste areas is a paramount design concern in the ASC. If possible, medical waste must exit the ASC from a separate access from the staff and patient access to prevent possible infection and contamination.

D. Medical Gas

Medical Gas is a necessary element in the ASC and should be included as much as possible in the design. Piped-in Oxygen, Vacuum and other such gases must be available in the ASC.

E. Future Expansion of the Center

The varied types of surgical activities would require spaces designed with a high degree of flexibility in mind. An ASC will also expand in the future as more patients and doctors utilize the space.

F. Finishes

All finishes and materials must prevent infection and contamination in the ASC, minimizing chance of injury to patients and damage to equipment.

Antistatic Materials should be considered in the operating room of the ASC to prevent damage to equipment during operations.

Materials should also reduce noise coming from the outside as well as prevent unnecessary noise and vibrations from disturbing the patients.

Due to the very large number of possible materials, below are a list of some sample materials that can be specified: 1. Sample Wall Finishes

Water-Based Antibacterial Paint - Acrylic odorless, low VOC, water based interior coating with anti-bacterial formulation.

Gypsum or Fiber Cement Board - Increases noise control of exterior sources for the space, either as part of a dry wall system or extra acoustic treatment to a CHB wall. Rockwool and other insulation materials can also be used.

2. Sample Ceiling Finishes

Painted Gypsum or Fiber Cement Board

Aluminum Ceiling Tile on T-Runners

Regardless on what type of Ceiling one specifies, the important element is that it should be very clean, low maintenance and have high durability.

3. Sample Floor Finishes

2mm Thick 5 x 45ft Vinyl Sheet - for medical areas of the Center. Antistatic, Antibacterial, High Durability, Low Maintenance and very clean material. 4. Other Sample Specialties

PVC / Stainless Steel / Vinyl Baseboard - for damage protection of wall and floor terminations

Granite / Solid Surface Acrylic / Laminate Counter Top - for built-in furniture in the center, such as nurse stations and other counters.

PVC / Stainless Steel Corner and Wall Guards - for damage protection of walls from movable medical equipment.

References

ASC Association. What is an ASC? http://www.ascassociation.org/ASCA/AboutUs/WhatisanASC

Meuser Philipp (2011). Construction and Design Manual - Medical Facilities and Health Care. DOM Publishers. Mailkin, Jain (2002). Medical & Dental Space Planning. Wiley Publishers

Department of Health (2004). Guidelines in the Planning and Design of a Hospital and other Health Facilities.

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