Outpatient Spaces: Ambulatory Surgery Centers

Certain spaces like specialist outpatient departments require architects to have a creative and flexible outlook to be able to provide an optimal design solution. In designing Ambulatory Surgery Centers, we architects need to adjust the design to the specific requirements of the end user. There is no cookie cutter solution to it!

What are Ambulatory Surgery Centers (ASCs for short)? They are outpatient spaces that are as defined by the ASC Association as “modern healthcare facilities focused on providing same-day surgical care, including diagnostic and preventive procedures.” In this case, same-day surgical care usually means that medical services provided to a patient should be completed within 24 hours of admittance to the Ambulatory Surgery Center. Patients who are served by ASCs are NOT emergency or walk-in cases; they are patients who have already consulted with their doctors and have been diagnosed, assessed, and scheduled for a procedure in the ASC.

Medical specialties associated with ASC usage are usually the following:

· Otorhinolaryngology (Ear, Nose and Throat Surgery)

· Ophthalmology (Eyes)

· Minor Orthopedic Surgery

· OB-GYNE (Non-pregnancy related cases)

· Dentistry

· Plastic Surgery

· Urology

· Endoscopy

In terms of architecture, ASCs should have adjacency with diagnostic departments (i.e. imaging and laboratory services) and the Main Surgical Department, in case of emergency cases. ASCs are often located in the perimeter of the healthcare facility (if it is part of a medical center) for ease of access of patients and visitors. Or they can also be standalone complexes. An ASC is also classified as being an Outpatient Department that requires semi-sterile to fully sterile operating suite areas depending on their patients and services.

Architectural and Engineering Considerations:

1. Control of activity flow. The primary design concern of an ASC is the activity flows of the patients, medical staff, supplies, and waste—the way people and materials are moving and interacting in a given space. These four activities define how a space should be designed for ASC use. Specifically, it is the control of movement and separation of the activity flows that need to be addressed by the layout so as to reduce potential infection risks in the space, an element of healthcare design I have discussed before. The goal of the architect in the case of the ASC is to remove any point in which potential infection may happen in the space (i.e. you do not want medical waste to cross the patient waiting area).

2. Medical support. Support systems such as medical gas, wireless connectivity, and coordination with either the rest of the healthcare facility or adjacent medical services are essential for the continued functionality of the ASC.

3. Expansion. Ambulatory Surgery Centers are outpatient spaces—demand will inevitably increase over time as more patients avail of the services provided. Areas should be identified for potential expansion and addition of future services so as to make sure the ASC can continue to provide optimal service well into the future.

4. Finishes. All specified materials that will be used in the ASC should focus on reducing or removing potential contamination (sterility) and physical injuries (non-slip surfaces to prevent falls). Noise control and anti-static properties should also be considered depending on the specific space within the Ambulatory Surgery Center.

Above is a schematic plan for a 7-Minor-OR Ambulatory Surgery Center. Note that activity flows are distinct in the plan so as to allow for movement without cross traffic. Another element of healthcare facility design presented here is the need for direct wayfinding, i.e. the movement within the facility should be intuitive and easy to understand, especially for patients and visitors.

For those who want to read further, more detailed and extensive version of this article is found here.

"Ambulatory Surgery Centers are outpatient spaces—demand will inevitably increase over time as more patients avail of the services provided. Areas should be identified for potential expansion and addition of future services so as to make sure the ASC can continue to provide optimal service well into the future."