Ambulatory Surgery. Graphic Standards Programming and Schematic Design. June 1999

Transcription

1 Ambulatory Surgery Graphic Standards Programming and Schematic Design June 1999

2 Table of Contents Table of Contents Function 3 Staff 4 Advantages of Movable Modular Casework 5 Functional Areas 6 Waiting, Reception, Admitting, and Business Office 6 Pre-Operative Holding 7 Scrub Area 8 Operating Room 8 Post-Anesthesia Care Unit (PACU/Recovery Room) 9 Equipment Storage 10 Sterile Storage 11 Preparation and Packaging 12 Decontamination 13 Anesthesia Workroom 14 Satellite Lab 15 Satellite Pharmacy 16 Staff Conference/Locker Room 17 Supervisor or Physician Office 18 Functional Program 19 Bubble Diagram 20 Block Diagram 21 Preliminary Plan 22 Schematic Plan 23 Future Trends 24 Ambulatory Surgery 2

3 Function Function The ambulatory surgery unit is responsible for the surgical procedures, or operations, performed on patients who can be admitted, treated, and discharged in the same day. Many types and kinds of surgical procedures do not require overnight hospitalization of the patient, and these are carried out on an outpatient basis. The primary benefit derived from this unit is the reduction of costs to both the patient and the hospital. The ambulatory surgery unit may be positioned as A completely freestanding or off-site unit. A department within the hospital but separated from the surgery department. A suite of rooms, or shared rooms, within the surgery department. Because surgical procedures are performed under the strictest sterile techniques and infection control practices, the design of the unit and the flow of the patients, staff, and supplies must be rigidly controlled. Traffic Zones The layout of the ambulatory surgery unit is a similar but simplified version of the surgery department, with additional areas for administrative, family, and ambulatory patient needs. The ambulatory surgery unit includes not only operating rooms, but pre- and postanesthesia areas, dressing rooms, technical support and supply areas, and business office and administrative staff spaces. The basic zones of traffic flow will consistently include the following: Unrestricted Areas The unrestricted area is a public space, such as the business offices and waiting rooms, for visitors, families, and administrative staff attired in street clothing. Semi-Restricted Areas These areas, such as pre-operative holding, require staff to be attired in surgical garments including scrub suits or dresses and hair covers. Restricted Areas The most restricted areas of the unit are the operating rooms, requiring staff to be attired in surgical garments and face masks. Flow of Patients The patient enters the ambulatory surgery unit, reporting to admitting for data collection and the development of a medical record. The patient will move to a dressing room or cubicle for changing into hospital attire and then to a preoperative holding area for medication and intravenous fluid administration. If the unit contains laboratory and/or diagnostic radiology services, these may be performed at this time. The patient is then moved to the operating room, anesthesia administered, and the surgical procedure performed. Following surgery, the patient is moved to the post-anesthesia care unit, remaining there until ready to dress and be discharged. Ambulatory Surgery 3

4 Staff Staff Ambulatory surgery units typically have two lines of authority physicians and nurses and a support staff. Physician Staff Chief of Ambulatory Surgery The chief of ambulatory surgery (an MD or DO) will oversee the physicians and the surgical procedures, as well as medical recommendations for the unit. Chief of Anesthesiology The chief of anesthesiology (an MD or DO) will supervise other anesthesiologists, nurse anesthetists, and anesthesia technicians working in the unit. This position is responsible for policies and procedures regarding administration of anesthesia. Nursing Staff Ambulatory Surgery Supervisor The supervisor or director of ambulatory surgery (usually an RN) will be in charge of nursing procedures and practices and also will be responsible for the business aspects of the unit, such as budgets, staffing, etc. This person generally has had additional operating room experience as well as advanced education in nursing or management. Circulating Nurse This is a registered nurse (RN) working within the operating room who coordinates activity in the room for a particular surgical procedure by opening and furnishing supplies to the scrub nurse from outside the sterile field, applying dressings, etc. This position also assists in the delivery of patient care such as positioning the patient, skin preparation, and assisting in anesthesia as necessary. Scrub Nurse/Instrument Nurse This registered nurse (RN) or surgical technician maintains the sterile operating field and organizes and passes sterile instruments to the operating surgeon. Support Staff Business Office Manager The responsibilities of this position include the management of patient data gathering, maintenance of medical records, and collection of medical insurance payments and/or reimbursements. Support Staff Other administrative and medical staff will vary based on the size of the unit and may include a unit secretary, receptionist, insurance clerks, admission clerks, and vocational nurses. Ambulatory Surgery 4

5 Advantages of Movable Modular Casework Advantages of Movable Modular Casework Ambulatory surgery units may vary widely in type of unit, square footage, method of operation, and staffing, but each ambulatory surgery unit has certain functional areas in common. The following pages describe the advantages of movable modular casework, give a brief description of the functional areas of ambulatory surgery, and provide typical plan views of movable modular casework applications. Movable Modular Casework Movable modular casework offers the following major advantages and differences when compared with fixed casework or millwork: All movable modular casework components can be easily rearranged or reused by the end user, allowing ongoing changes with new technology. Movable modular casework components have been specifically designed to meet the functional requirements of ambulatory surgery units. Components are sanitizable, and every configuration can be disassembled to easily clean parts. Movable modular components can quickly and easily be relocated to the opposite wall in an operating room when a specific procedure requires that the operating table be turned around. Additional components can be added at any time. Materials Handling Components Movable modular materials handling components can be especially useful in the operating room for supporting effective and efficient delivery, storage, use, and removal of supplies. Specialized supplies can easily be transported on demand from a central location. Each component can become mobile by combining it with a wheeled component, quickly and easily making the change from storage to mobile. Specific components appropriate for use in the ambulatory surgery unit include L carts. Crash carts. Lockers. Supply carts. Case carts. Process tables. Extra-deep modular shelving units. Modular Furniture Systems Panel systems for administrative areas offer the use of less space, the flexibility to make changes easily, and increased worker productivity. The system provides cantilevered work surfaces and efficiently arranged workstations. Financial Advantages The initial cost of movable modular casework is competitive with fixed casework or millwork. However, the life cycle cost of movable modular casework is far less than fixed casework because of Longer product life. Minimal maintenance cost. Continual reuse of the components for new or different functions. Ability to install and reconfigure with little downtime. Accelerated depreciation rate, especially important to for-profit organizations. For preliminary budget purposes, movable modular casework for an ambulatory surgery unit has an average price in the range of $276 to $414 per linear foot. This range will be affected by the density of overhead and undercounter storage components and the type of support structure used (wall-mounted versus panels). Ambulatory Surgery 5

6 Waiting, Reception, Admitting, Business Office Functional Areas Waiting, Reception, Admitting, and Business Office A waiting area should be provided for patients and families or companions awaiting admission. The receptionist will greet patients and originate the paperwork. Patients will then proceed to an admitting interview area. Admitting booths, which may vary from open-counter type stations to closed cubicles, should allow for acoustical privacy. The business office staff is responsible for the retrieval of the necessary administrative, pre-diagnosis, and financial information from the patient or the patient s family. This staff also will handle accounts payable and receivable, record keeping for reimbursing agencies such as Medicare and other health insurance companies, charges and billings to patients, credits, collections, and other facility operation expenses. Movable Modular Casework and Furniture Systems Applications Movable modular casework and modular furniture systems components allow for future flexibility and change and may include Frame and/or panel system with ability to change and reconfigure for different functions. Integral computer support components, such as keyboard trays, turntables, etc. Integrated form trays and chart shelves. Task lighting where needed. Overhead shelves for manuals and reference materials. Above work surface counter or transactional work surface. Cantilevered work surfaces. Lateral filing components. Unlimited electrical capabilities. Comfortable, durable waiting room seating. Work areas in the business office should include file or chart storage, computer stations, and general work areas. Plan View of a Waiting, Reception, Admitting, and Business Office Waiting and reception areas will range in size from 20 to 35 square feet per seat. Admitting and business office areas will range in size from 85 to 110 square feet per employee. 53 linear feet work surface 64 linear feet overhead storage 800 filing inches 1500 square feet Ambulatory Surgery 6

7 Pre-Operative Holding Pre-Operative Holding Patients arriving for surgical procedures are held in this area until the appropriate operating room is ready. Patients will change into hospital attire in dressing cubicles before entering the preoperative holding area. An area should be available to store patients clothing and personal belongings. This area also may be called preanesthesia as patients may be given medications or intravenous fluids under close observation of the nursing staff. A nurses control station and medication preparation area are often an integral part of this area. Movable Modular Casework Applications A pre-operative holding area can be planned using movable modular casework and may include Small workstation. Locker to hold patient care supplies. L cart, procedure/supply cart, or railhung C frame storage unit placed near each stretcher. Procedure/supply carts. Extra-deep modular shelving units. Sink unit. Med prep area. Plan View of a Pre-Operative Holding Area A pre-operative holding area will range in size from 350 to 800 square feet. 8 linear feet work surface 6 linear feet overhead storage 40 filing inches 1 locker for medications 1 locker for IVs 2 lockers for supplies 1 C frame storage unit per bed 504 square feet Ambulatory Surgery 7

8 Scrub Area, Operating Room Scrub Area Scrub areas are placed strategically outside operating rooms. Surgical scrub sinks are generally ceramic or stainless steel with foot or knee controls. It is helpful to place shelves above the sink to hold scrub brushes and masks. Movable Modular Casework Applications Depending on the design of the scrub area, scrub brushes and masks can be housed in modular shelving hung on rail, on wall strips above the sinks, or in rail-hung C frame storage units with drawers beside the sinks. Plan View of a Scrub Area 8 linear feet overhead storage (2 feet per sink) 50 square feet Operating Room An operating room is the area where surgical procedures are performed under strict sterile techniques. For sanitization purposes, operating rooms should contain little or no built-in casework. Supplies and equipment are moved in and out as needed. Rather than using wall strips, horizontally mounted rail with rail-hung components are appropriate for hanging work surfaces for documenting/charting. Rail-hung shelves or CST units are suitable for overhead storage. Movable Modular Casework Applications An operating room can be planned using movable modular casework and may include L carts or procedure/supply carts used for Anesthesia supplies and equipment. Suction and cautery equipment. Monitoring equipment. Prep and dressing. Stainless steel case carts which can also be used as a back table. Lockers used for General supply storage. Backup supplies. Specialty procedure carts. Process tables used as Administrative/computer workstations. Back table for instruments. Plan View of an Operating Room An operating room will range in size from 300 to 450 square feet. 4 linear feet work surface 4 linear feet overhead storage 3 lockers for supplies 1 L cart 1 anesthesia cart case carts as required 336 square feet Ambulatory Surgery 8

9 Post-Anesthesia Care Unit Post-Anesthesia Care Unit (PACU/Recovery Room) This area is adjacent to the operating room. Patients are brought to this area after surgery to recover from anesthesia and regain stable vital signs. After the patients are stable, they are moved to secondary recovery before being discharged. The space is usually in an open area with patients separated with cubicle curtains. Those patients who need to be isolated are kept in a separate isolation recovery room. The isolation room also can be used for pediatric patients. Movable Modular Casework Applications Movable modular casework components appropriate for use in the post-anesthesia care unit include Nurses control station. L carts or rail-hung C frame storage units with drawers for supplies for each patient. Lockers for linen and medical supplies. Cantilevered sink units. Dictation area. The layout of this space usually includes a nurses control station with a medication preparation area, a physicians dictation area, an area for supplies and equipment, hand-washing sinks, and a patient toilet. Plan View of a Post-Anesthesia Care Unit A post-anesthesia care unit will range in size from 2000 to 4000 square feet. 26 linear feet work surface 18 linear feet overhead storage 80 filing inches 8 lockers for supplies 1 locker for medications 1 L cart for supplies 1 L cart for isolation cart 1 emergency cart 1 C frame storage unit per bed dictation area 2126 square feet Ambulatory Surgery 9

10 Equipment Storage Equipment Storage There is a large amount of equipment that needs to be stored for use in the operating rooms. A single large room for general equipment storage and/or specific smaller rooms for specialty equipment storage, such as orthopedic, can be planned. In addition to needing floor space for housing large equipment, overhead shelving can be used so equipment can be placed underneath for maximum use of space. Movable Modular Casework Applications An equipment storage room can be planned using movable modular casework and may include Extra-deep modular shelving units and/or lockers with shelves to keep smaller items off the floor. Cantilevered work surfaces. Much of this equipment must be accessible to electrical outlets to maintain battery charges. Plan View of an Equipment Storage Room An equipment storage room will range in size from 200 to 400 square feet. 32 linear feet storage 4 lockers for supplies 225 square feet Ambulatory Surgery 10

11 Sterile Storage Sterile Storage Supplies may be reprocessed within this facility or sent from an affiliated hospital and stored in a sterile storage room. Movable Modular Casework Applications A sterile storage room can be planned using movable modular casework and may require Lockers or supply carts to store clean/sterile supplies or to stage supplies for packing case carts (if assembled here). Specialty procedure carts. Space for bulk supply or wire carts to hold sterile linen, bulky supplies, and instrument trays. Wire racks for suture storage. Case carts. Plan View of a Sterile Storage Room A sterile storage room will range in size from 200 to 400 square feet. 9 lockers for supplies 3 bulk supply carts 4 case carts wire rack for suture storage 287 square feet Ambulatory Surgery 11

12 Preparation and Packaging Preparation and Packaging Also known as prep and pack, this is a clean area where items from decontamination are delivered and reassembled into appropriate sets, packaged in sterile containers or wraps, and sterilized for use. Sterilization equipment may be part of this area, and storage also is required for supplies used in assembling instrument sets and other sterilized items. Employees wear scrub attire. Other stringent management controls and work processes are observed in this area to ensure quality control. Movable Modular Casework Applications Movable modular casework components can be used to plan the prep and pack area and may require Process tables, lockers with shelves on wall strips, and/or TR3 carts used in a staging area to place items received from decontamination. Process tables with casters and C frame storage units for associated supplies where instrument sets are reassembled. Wire wrapper rack for storage of wraps. Wire carts for staging prior to and after sterilization. Extra-deep modular shelving units, lockers with drawers and shelves, and dispensing rail with subcontainers for storage of supplies and instruments. Large process tables for wrapping packs to be sterilized. Modular administrative workstation for quality control documentation and policy and procedure manuals. Plan View of a Preparation and Packaging Area A preparation and packaging area will range in size from 150 to 300 square feet. 12 linear feet work surface 8 linear feet overhead storage 2 lockers wire wrapper rack wire staging carts 177 square feet Ambulatory Surgery 12

13 Decontamination Decontamination Soiled items such as carts (including case carts), instruments, procedure trays, equipment, and used linen are brought here from the operating rooms to be cleaned or held until they are reprocessed. Decontamination is considered a restricted area with increased potential for contamination from blood or body fluid pathogens on the soiled utensils and materials. Movable Modular Casework Applications Movable modular casework components appropriate for use in a decontamination area may include Shelves on wall strips for storage of cleaning supplies. Lockers to hold sterile containers. Process table to hold small items waiting to be processed. Stainless steel case carts. If the ambulatory surgery unit processes its own instrument sets, this room may function as the decontamination area and should be large enough to accommodate washing and decontaminating equipment. Ambulatory surgery units processing their own instruments may also require stainless steel sinks (double and triple bowls) and a counter for washing instruments and utensils. This area generally is a very wet area. Plan View of a Decontamination Area A decontamination area will range in size from 150 to 250 square feet. 10 linear feet work surface 6 linear feet overhead storage stainless steel case carts cart washer 154 square feet Ambulatory Surgery 13

14 Anesthesia Workroom Anesthesia Workroom Anesthesia will have a workroom with an area for washing equipment and maintaining/testing anesthesia machines. Movable Modular Casework Applications The anesthesia workroom can be planned using movable modular casework and may require Anesthesia supply carts are generally replenished from this room, and at the end of the day, these carts may be parked and secured here. Work surfaces or process tables to receive and clean equipment. Small administrative area with work surface, file storage, tackboards, space for computer, overhead storage for manuals and binders. Cantilevered sink unit. Shelves and lockers for supply storage. Extra-deep modular shelving units. Medication storage using locked drawers and cassettes. Bulk supply carts. Specialty procedure carts. Anesthesia carts storage. Plan View of an Anesthesia Workroom An anesthesia workroom will range in size from 120 to 250 square feet. 8 linear feet work surface 12 linear feet overhead storage 4 lockers for supplies 139 square feet Ambulatory Surgery 14

15 Satellite Lab Satellite Lab Ambulatory surgery may have a satellite lab for STAT testing of blood, urine, and tissues and for creating and reading frozen section slides. Movable Modular Casework Applications A satellite lab can be planned using movable modular casework and may require Heavy-duty work surfaces or process tables to hold centrifuges, blood gas analyzers, blood glucose monitors, microscopes, and urine testing equipment. Wall strips, modules, or support panels to hold work surfaces and overhead storage. Tackboards. File storage. Flipper units, lockers, C frame storage units, and L carts for storage. Plan View of a Satellite Lab A satellite lab will range in size from 150 to 400 square feet. 43 linear feet work surface 65 linear feet overhead storage 1 locker (optional) 332 square feet Ambulatory Surgery 15

16 Satellite Pharmacy Satellite Pharmacy A satellite pharmacy may exist in the ambulatory surgery unit. This decentralization of the pharmacy function allows for more rapid response to the needs of the patient. The satellite pharmacy usually is staffed, stocked, and serviced by the primary pharmacist. Modular carts are appropriate for the transfer of medications to the satellite pharmacy. Movable Modular Casework Applications The same movable modular casework components used in the main pharmacy are appropriate for the satellite pharmacy, allowing for continual flexibility and change in the space and may include Medication locker or cart. Cantilevered work surfaces. Double-locking drawers for storing Extra-deep modular shelving units. controlled substances. Cantilevered sink unit. Dispensing rail. Plan View of a Satellite Pharmacy A satellite pharmacy will range in size from 120 to 250 square feet. 18 linear feet work surface 28 linear feet overhead storage 80 drug bins average 1 locker 1 medication cart 140 square feet Ambulatory Surgery 16

17 Staff Conference/Locker Room Staff Conference/Locker Room Staff locker rooms are provided for male and female staff to change from street clothing into surgery attire. Clothing lockers, toilet facilities, and showers are provided. A staff lounge or in-service conference room is often found adjacent to the locker rooms. This space is used primarily for in-service training, conferences, lunches or meals, and coffee breaks. Space should be provided for a refrigerator, microwave oven, and large coffee maker. Movable Modular Casework and Furniture Systems Applications This environment should be easily cleaned, offer a warm, enjoyable atmosphere, and may require Wall strips with work surface and overhead storage or heavy-duty work surface with C frame storage unit and drawers for a coffee maker and supplies. L cart for microwave. Tables and seating. Tackboards for displaying information. Lockers or wire carts for surgical attire dresses, suits, caps, shoe covers. Base cabinets for storage. Cantilevered work surfaces. Overhead storage units. Plan View of a Staff Conference/Locker Room A staff conference/locker room will range in size from 200 to 400 square feet. 8 linear feet work surface 24 linear feet overhead storage 40 filing inches 275 square feet Ambulatory Surgery 17

18 Supervisor or Physician Office Supervisor or Physician Office Private office spaces are required for medical and business management staff. Movable Modular Casework and Furniture Systems Applications These offices may be furnished with modular furniture systems and seating and may include Cantilevered work surfaces. Tool bar with accessories for paper handling. Work surface with keyboard drawer or tray to accommodate computers and printers. Overhead storage, flipper units, display shelves, and marker boards for displaying information. Task lights and personal lights. Freestanding, under-work-surface, or wall-attached drawers and files. Plan View of a Supervisor or Physician Office A supervisor or physician office will range in size from 100 to 150 square feet. 8 linear feet work surface 20 linear feet overhead storage 136 filing inches 109 square feet Ambulatory Surgery 18

19 Functional Program Functional Program Number Department Area Square Feet Movable Modular Casework Pre-Operative Holding Area Scrub sq. ft. Operating sq. ft. Post-Anesthesia Care Unit (PACU/Recovery Room) Primary Recovery Secondary Recovery Isolation Recovery Equipment Storage Room Sterile Storage Room Preparation and Packaging Area Decontamination Area Anesthesia Workroom Satellite Lab Satellite Pharmacy Staff sq. ft. Janitor s Closet Subtotal Modular Furniture Systems Waiting Area Reception Area Admitting Area Business Office Staff Conference/Locker Room Supervisor or Physician Office Subtotal TOTAL NET SQUARE FEET Net-to-Gross Conversion Factor X TOTAL GROSS SQUARE FEET Ambulatory Surgery 19

20 Bubble Diagram Bubble Diagram The bubble diagram of the ambulatory surgery unit demonstrates typical departmental relationships and interaction between areas. Necessary adjacencies within the department become clear. STERILE STORAGE CLEAN CORE PREP AND PACK OPERATING ROOM EQUIPMENT STORAGE DECONTAM. ANESTH. WORKRM PATIENT CORE DICTATION CONFERENCE/ LOCKER ROOM SCRUB BULK STORAGE ADMITTING PRE-OP HOLDING DRESSING PRIMARY RECOVERY RECEPTIONIST WAITING SECONDARY RECOVERY BUSINESS OFFICE Ambulatory Surgery 20

21 Block Diagram Block Diagram The block diagram demonstrates the adjacencies and relative sizes for the areas within a typical ambulatory surgery unit. Evaluation of the work flow and materials flow from the bubble diagram has determined this initial general layout. The size of each area is determined by combining the typical movable modular casework plans for each identified function. Traffic patterns are developed, and an overview of the general work process can be evaluated. PRE-OP HOLDING STORAGE Ambulatory Surgery 21

22 Preliminary Plan Preliminary Plan The preliminary plan clarifies the ambulatory surgery unit space requirements by showing the location of all the fixed walls and open areas and identifies entrances, exits, and exact traffic patterns. PERIPHERAL CORE PRE-OP HOLDING STORAGE Ambulatory Surgery 22

23 Schematic Plan Schematic Plan The schematic plan shows all of the specific movable modular casework, modular furniture systems, and materials handling components appropriate for a typical ambulatory surgery unit. PRE-OP HOLDING STORAGE Ambulatory Surgery 23

24 Future Trends Future Trends Procedures Ambulatory surgery, as a method of patient care, has gone through intensive growth in recent years. This growth has been fostered by related shifts in the entire healthcare field because of improved technology, emphasis on cost containment, and increased competition for patients and staff. Approximately 60 percent of all surgical procedures are presently performed on an outpatient basis, and that percentage is continuing to increase. The compounded effect of managedcare pressures, advancements in minimally invasive procedure capabilities, and the increasing miniaturization of technology has given rise to the prediction that, in the next few years, 80 percent of all healthcare services (including surgery) will be delivered in an outpatient setting. Patients The average patient of today is better informed, well educated, and more demanding of a wider range of services. Emphasis is placed on early diagnosis and new minimally invasive surgical techniques, with outpatient surgery being high on the patient s criteria. The increased volume of outpatient surgery for general, ophthalmic, gynecological, orthopedic, and oncologic procedures will continue to be enhanced by the improvement of laser and endoscopic technology, minimizing tissue damage and reducing the incidence of complications. Early post-operative ambulation, advances in anesthetic technology, a decrease in required narcotic medication, and less psychological stress with hospitalization are documented benefits to the patient. Facilities Freestanding facilities for ambulatory surgery began in the 1960s, primarily developed by surgical specialists as a method of freeing hospital beds and providing conveniences for both patients and physicians. With increased competition from freestanding ambulatory surgery centers, hospitals began expanding ambulatory services. This expansion allowed outpatient surgery to utilize existing support services, such as anesthesia, admitting, nursing staff, etc. Most hospitals, however, were planned and organized for inpatient care, and ambulatory surgical care was superimposed on facilities not designed for this function. Accordingly, hospitals are now either enlarging to incorporate an ambulatory surgery unit or building an ambulatory surgery center on the hospital campus. This satellite unit, owned by the hospital, provides the decentralized cost-effective service with the centralized backup facility as support. Some centers also are moving more toward the hospitality concept in meeting patients needs, providing recovery centers, staffed by registered nurses, and offering private rooms comparable to hotel rooms. These settings cost less to build and accommodate patients desires for convenience. Hospitals, physicians, and architects will be challenged to provide patients with yet more extensive outpatient services and advanced medical care in a noninstitutional, aesthetically pleasing facility and to do so in a cost-effective manner. Freestanding, unbundled facilities will continue to be economical. Ambulatory Surgery 24

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