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lc
Ambulatory
Surgery
Graphic Standards
Programming and Schematic Design
June 1999
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Ambulatory Surgery
Ambulatory Surgery 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 7Scrub 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 16Staff 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
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Ambulatory Surgery
Ambulatory Surgery 3
Function
Flow of Patients
The patient enters the ambulatory surgery
unit, reporting to admitting for data
collection and the development of amedical record. The patient will move to
a dressing room or cubicle for changing
into hospital attire and then to a pre-
operative 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 theoperating 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.
Function
The ambulatory surgery unit is
responsible for the surgical procedures,
or operations, performed on patients who
can be admitted, treated, and dischargedin 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 areasfor administrative, family, and
ambulatory patient needs.
The ambulatory surgery unit includes not
only operating rooms, but pre- and post-
anesthesia areas, dressing rooms,
technical support and supply areas, and
business office and administrative staff
spaces.
The basic zones of traffic flow willconsistently 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-operativeholding, 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.
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Ambulatory Surgery
Ambulatory Surgery 4
Staff
Staff
Ambulatory surgery units typically have two lines of authority – physicians and nurses
– and a support staff.
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.
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 anesthesiolo-
gists, nurse anesthetists, and anesthesia
technicians working in the unit. Thisposition is responsible for policies and
procedures regarding administration of
anesthesia.
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 reimburse-
ments.
Support Staff
Other administrative and medical staff
will vary based on the size of the unit andmay include a unit secretary, receptionist
insurance clerks, admission clerks, and
vocational nurses.
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Ambulatory Surgery
Ambulatory Surgery 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 providetypical plan views of movable modular casework applications.
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 centrallocation. 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.
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, allowingongoing 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.
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 anambulatory 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).
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Ambulatory Surgery
Ambulatory Surgery 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 companionsawaiting 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.
Work areas in the business office should
include file or chart storage, computer
stations, and general work areas.
Movable Modular Casework and Furniture Systems Applications
Movable modular casework and modular furniture systems components allow forfuture flexibility and change and may include
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.
· 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.
53 linear feet work surface
64 linear feet overhead storage
800 filing inches
1500 square feet
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Ambulatory Surgery
Ambulatory Surgery 7
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 pre-
operative holding area. An area should
be available to store patients’ clothing
and personal belongings.
This area also may be called pre-
anesthesia 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 rail-
hung C frame storage unit placed
near each stretcher.
· Procedure/supply carts.
· Extra-deep modular shelving units.
· Sink unit.
· Med prep area.
Pre-Operative Holding
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 inches1 locker for medications
1 locker for IVs
2 lockers for supplies
1 C frame storage unit per bed
504 square feet
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Ambulatory Surgery
Ambulatory Surgery 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 ishelpful to place shelves above the sink to
hold scrub brushes and masks.
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
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 wallstrips above the sinks, or in rail-hung
C frame storage units with drawers beside
the sinks.
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 workstation
· 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 storage3 lockers for supplies
1 L cart
1 anesthesia cart
case carts as required
336 square feet
Plan View of a Scrub Area
8 linear feet overhead storage (2 feet per sink)
50 square feet
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Ambulatory Surgery
Ambulatory Surgery 9
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.
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.
Movable Modular Casework Applications
Movable modular casework components appropriate for use in the post-anesthesia
care unit include
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 supplies1 L cart for isolation cart
1 emergency cart
1 C frame storage unit per bed
dictation area
2126 square feet
Post-Anesthesia Care Unit
· 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.
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Ambulatory Surgery
Ambulatory Surgery 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/orspecific 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.
Much of this equipment must be
accessible to electrical outlets to
maintain battery charges.
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.
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
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Ambulatory Surgery
Ambulatory Surgery 11
Sterile Storage
Plan View of a Sterile
Storage Room
A sterile storage room
will range in size from
200 to 400 square feet.
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.
9 lockers for supplies
3 bulk supply carts
4 case carts
wire rack for suture storage
287 square feet
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Ambulatory Surgery
Ambulatory Surgery 12
Preparation and Packaging
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 surface8 linear feet overhead storage
2 lockers
wire wrapper rack
wire staging carts
177 square feet
Preparation and Packaging
Also known as “prep and pack,” this is a
clean area where items from decontami-
nation are delivered and reassembled into
appropriate sets, packaged in sterilecontainers 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. Employ-
ees wear scrub attire. Other stringent
management controls and work processes
are observed in this area to ensure quality
control.
· 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.
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.
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Ambulatory Surgery
Ambulatory Surgery 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 becleaned or held until they are repro-
cessed.
Decontamination is considered a
restricted area with increased potential
for contamination from blood or body
fluid pathogens on the soiled utensils and
materials.
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.
Movable Modular Casework Applications
Movable modular casework components appropriate for use in a decontamination
area may include
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
· 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.
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Ambulatory Surgery
Ambulatory Surgery 14
Anesthesia Workroom
Anesthesia Workroom
Anesthesia will have a workroom with an
area for washing equipment and
maintaining/testing anesthesia machines.
Anesthesia supply carts are generally
replenished from this room, and at the
end of the day, these carts may be parked
and secured here.
Movable Modular Casework Applications
The anesthesia workroom can be planned using movable modular casework and may
require
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
· 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.
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Ambulatory Surgery
Ambulatory Surgery 15
Satellite Lab
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
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.
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.
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Ambulatory Surgery
Ambulatory Surgery 16
Plan View of a Satellite Pharmacy
A satellite pharmacy will range in size
from 120 to 250 square feet.
18 linear feet work surface28 linear feet overhead storage
80 drug bins average
1 locker
1 medication cart
140 square feet
Satellite Pharmacy
A satellite pharmacy may exist in the
ambulatory surgery unit. This decentrali-
zation 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
Satellite Pharmacy
· Medication locker or cart.
· Double-locking drawers for storing
controlled substances.
· Cantilevered sink unit.
· Cantilevered work surfaces.
· Extra-deep modular shelving units.
· Dispensing rail.
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Ambulatory Surgery
Ambulatory Surgery 17
Staff Conference/Locker Room
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
· 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.
Movable Modular Casework and Furniture Systems Applications
This environment should be easily cleaned, offer a warm, enjoyable atmosphere, and
may require
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 areprovided.
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.
· 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.
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Ambulatory Surgery
Ambulatory Surgery 18
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
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
· 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.
· Cantilevered work surfaces.
· Tool bar with accessories for paper
handling.
· Work surface with keyboard drawer
or tray to accommodate computers
and printers.
Supervisor or Physician Office
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Ambulatory Surgery
Ambulatory Surgery 19
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.
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
Functional Program
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Ambulatory Surgery 20
Bubble Diagram
Bubble Diagram
The bubble diagram of the
ambulatory surgery unit demon-
strates typical departmental
relationships and interaction betweenareas. Necessary adjacencies within
the department become clear.
PRE-OP
HOLDING
BULK
STORAGE
OPERATING ROOM
ANESTH.
WORKRM
DRESSING
SCRUB
WAITING
RECEPTIONIST
ADMITTING
BUSINESS
OFFICE
CONFERENCE/
LOCKER
ROOM
PREP AND
PACK
CLEAN CORESTERILE
STORAGE
DECONTAM.
PATIENT CORE DICTATION
EQUIPMENT
STORAGE
PRIMARY
RECOVERY
SECONDARY
RECOVERY
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Ambulatory Surgery
Ambulatory Surgery 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.
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Ambulatory Surgery
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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.
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Ambulatory Surgery 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.
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Ambulatory Surgery
Ambulatory Surgery 24
Future Trends
Future Trends
Procedures
Ambulatory surgery, as a method of
patient care, has gone through intensive
growth in recent years. This growth hasbeen 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 managed-
care 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.
Facilities
Freestanding facilities for ambulatory
surgery began in the 1960s, primarily
developed by surgical specialists as amethod 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 andorganized 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 willbe challenged to provide patients with yet
more extensive outpatient services and
advanced medical care in a non-
institutional, aesthetically pleasing facility
and to do so in a cost-effective manner.
Freestanding, “unbundled” facilities will
continue to be economical.
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.
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lc
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