Está en la página 1de 25

Ambulatory

Surgery

lc

Graphic Standards
Programming and Schematic Design
June 1999

Ambulatory Surgery

Table of Contents
Table of Contents
Function
Staff
Advantages of
Movable Modular Casework

lc

3
4
5

Functional Areas

Functional Program

19

Waiting, Reception, Admitting,


and Business Office

Bubble Diagram

20

Pre-Operative Holding

Block Diagram

21

Scrub Area

Operating Room

Preliminary Plan

22

Post-Anesthesia Care Unit


(PACU/Recovery Room)

Schematic Plan

23

Future Trends

24

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

Ambulatory Surgery 2

Ambulatory Surgery

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

Flow of Patients

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 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.

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:

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.

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.

Following surgery, the patient is moved


to the post-anesthesia care unit,
remaining there until ready to dress and
be discharged.

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.

lc

Ambulatory Surgery 3

Ambulatory Surgery

Staff
Staff
Ambulatory surgery units typically have two lines of authority physicians and nurses
and a support staff.

Physician Staff

Nursing Staff

Support Staff

Chief of Ambulatory Surgery

Ambulatory Surgery Supervisor

Business Office Manager

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.

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.

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.

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.

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.

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.

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.

lc

Ambulatory Surgery 4

Ambulatory Surgery

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

Materials Handling Components

Financial Advantages

Movable modular casework offers the


following major advantages and
differences when compared with fixed
casework or millwork:

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.

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

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.

Longer product life.

Ability to install and reconfigure with


little downtime.

Accelerated depreciation rate,


especially important to for-profit
organizations.

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.

lc

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.

Minimal maintenance cost.


Continual reuse of the components
for new or different functions.

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

Ambulatory Surgery

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.

Movable Modular Casework and Furniture Systems Applications

Movable modular casework and modular furniture systems components allow for
future flexibility and change and may include

The business office staff is responsible


for the retrieval of the necessary
administrative, pre-diagnosis, and
financial information from the patient or
the patients 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.

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.

lc

53 linear feet work surface


64 linear feet overhead storage
800 filing inches
1500 square feet

Ambulatory Surgery 6

Ambulatory Surgery

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.

Procedure/supply carts.

Locker to hold patient care supplies.


L cart, procedure/supply cart, or railhung C frame storage unit placed
near each stretcher.

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

lc

Ambulatory Surgery 7

Ambulatory Surgery

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

Lockers used for

Monitoring equipment.

Prep and dressing.

Process tables used as

Anesthesia supplies and equipment.


Suction and cautery equipment.

Stainless steel case carts which can also be


used as a back table.

General supply storage.


Backup supplies.
Specialty procedure carts.

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

lc

Ambulatory Surgery 8

Ambulatory Surgery

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

lc

Ambulatory Surgery 9

Ambulatory Surgery

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

lc

Ambulatory Surgery 10

Ambulatory Surgery

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.

Wire racks for suture storage.

Space for bulk supply or wire carts to


hold sterile linen, bulky supplies, and
instrument trays.

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

lc

Ambulatory Surgery 11

Ambulatory Surgery

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.

Wire wrapper rack for storage of


wraps.

Wire carts for staging prior to and


after sterilization.

Process tables with casters and


C frame storage units for associated
supplies where instrument sets are
reassembled.

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

lc

Ambulatory Surgery 12

Ambulatory Surgery

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.

Process table to hold small items


waiting to be processed.

Lockers to hold sterile containers.

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

lc

Ambulatory Surgery 13

Ambulatory Surgery

Anesthesia Workroom
Anesthesia Workroom
Anesthesia will have a workroom with an
area for washing equipment and
maintaining/testing anesthesia machines.

Movable Modular Casework Applications

Anesthesia supply carts are generally


replenished from this room, and at the
end of the day, these carts may be parked
and secured here.

The anesthesia workroom can be planned using movable modular casework and may
require

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.

Extra-deep modular shelving units.

Bulk supply carts.

Medication storage using locked


drawers and cassettes.

Specialty procedure carts.


Anesthesia carts storage.

Shelves and lockers for supply


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

lc

Ambulatory Surgery 14

Ambulatory Surgery

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

lc

Ambulatory Surgery 15

Ambulatory Surgery

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.

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 sink unit.

Double-locking drawers for storing


controlled substances.

Cantilevered work surfaces.


Extra-deep modular shelving units.
Dispensing rail.

Modular carts are appropriate for the


transfer of medications to the satellite
pharmacy.

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

lc

Ambulatory Surgery 16

Ambulatory Surgery

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.

Tackboards for displaying


information.

Lockers or wire carts for surgical


attire dresses, suits, caps, shoe
covers.

L cart for microwave.

Base cabinets for storage.

Tables and seating.

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

lc

Ambulatory Surgery 17

Ambulatory Surgery

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.

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.

Tool bar with accessories for paper


handling.

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

lc

Ambulatory Surgery 18

Ambulatory Surgery

Functional Program
Functional Program
Number

Department Area

Square Feet

Movable Modular Casework


Pre-Operative Holding Area
Scrub Areas @________ sq. ft.
Operating Rooms @________ 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 Toilets @________ sq. ft.
Janitors 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

TOTAL GROSS SQUARE FEET

lc

Ambulatory Surgery 19

Ambulatory Surgery

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.

CLEAN CORE

STERILE
STORAGE

PREP AND
PACK
OPERATING ROOM

EQUIPMENT
STORAGE

DECONTAM.

PATIENT CORE

DICTATION

ANESTH.
WORKRM

CONFERENCE/
LOCKER
ROOM

SCRUB

PRE-OP
HOLDING

BULK
STORAGE

DRESSING

PRIMARY
RECOVERY

ADMITTING

RECEPTIONIST

SECONDARY
RECOVERY
WAITING

BUSINESS
OFFICE

lc

Ambulatory Surgery 20

Ambulatory Surgery

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

lc

Ambulatory Surgery 21

Ambulatory Surgery

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

lc

Ambulatory Surgery 22

Ambulatory Surgery

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

lc

Ambulatory Surgery 23

Ambulatory Surgery

Future Trends
Future Trends
Procedures

Patients

Facilities

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.

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 patients criteria.

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.

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.

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.

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.

lc

Ambulatory Surgery 24

For the location of the sales facility or dealer near you, visit www.hermanmiller.com/healthcare
or call (800) 628 0058.

1999 Herman Miller, Inc., Zeeland, Michigan

Z, Y, Action Office, Aeron, Ambi, Arrio, Beirise Collection, Co/Struc, Custom Choices,
Eames, Equa 2, Ergon 3, Ethospace, E-Wall, Frottage, Ground Cloth, Harmonics, Hollington, Intersite,
Kinemat, Liaison, Meridian, Milcare, Mosaic, Newhouse Group, Pellicle, Perspectives, Proper, Pulsar,
Rapid Response, Relay, Response Plus, Scooter, Super Room, Systems Bridge, Timepiece, V-Wall,
and Wild Card are among the registered trademarks of Herman Miller, Inc.

lc

Y, Aeron Chair Configuration, Ambassador, Burdick Group, Chadwick, CLT, CoActive, DIAMOND,
Flex-Edge, Florence, ID, Iota, Milafin, Myriad, Passage, Potomac, Puzzle, Q, Raleigh, Rapunzel, and
Traverse are among the trademarks of Herman Miller, Inc.
SM

OASIS is a service mark of Herman Miller, Inc.