4 Ambulatory Surgery Units and Specialized Care Facilities
Types of Ambulatory Surgery Units
1. Hospital-Integrated Units
Characteristics: Ambulatory patients are treated in a setting integrated with inpatients.
Advantages (for hospitals/surgeons):
Relatively low initial investment for an integrated unit.
Immediate availability of full hospital surgical support.
Surgeons may be willing to undertake more types of surgery due to readily available support.
Disadvantages (for patients/operations):
Patient Perception: Med-consumers who require or want ambulatory surgery independent of the hospital setting may feel a potential loss of market share for the hospital.
Outpatients tend to feel that inpatients have priority when integrated.
Operating Costs: Actual operating costs may be high because major surgical facilities and personnel are used for relatively minor procedures.
2. Hospital-Based Autonomous Units
Characteristics: Located within the hospital but explicitly designed as dedicated ambulatory surgery services.
Advantages:
Allows the hospital to capture important ambulatory markets.
Provides the full backup of a fully equipped hospital if these facilities become necessary.
Considerations: Licensing, code compliance, Certificate of Need (CON) issues specific to the community, and related costs must be addressed.
3. Hospital Satellite Units
Characteristics: These are freestanding units located off the main hospital campus but are owned by the hospital.
Advantages:
Outreach: Provides important outreach into areas more or less remote from the main hospital.
Resource Leverage: Utilizes the staff expertise, resources, and good name of the parent hospital.
Comprehensive Services: Can integrate a variety of services, functioning as "virtual hospitals without beds," including:
Primary care (often in an integral or adjacent Medical Office Building - MOB facility).
Urgent care.
Diagnostic imaging.
Wellness, fitness, and rehabilitation.
Ambulatory surgery.
Market Extension: Extends the suburban reach of established hospitals typically sited in downtown locations.
4. Freestanding Ambulatory Surgery Units
Characteristics: These are independent facilities.
Advantages:
Cost-Effectiveness: Can often offer the same surgical services at a lower cost.
Attractiveness: Increasingly attractive in the current medical environment, depending on the patient and procedure type.
Performance Record: The actual performance record of freestanding ambulatory surgical facilities has been excellent.
Disadvantages/Hesitations: Some individuals may feel hesitant about undergoing a surgical procedure in a facility that has:
Less extensive resuscitative equipment.
Perhaps a less specialized staff compared to a major hospital.
Concepts in Specialized Ambulatory Care
Emerging Trend: The "bedless hospital" has emerged as a very important trend in healthcare facilities.
Demand for Specialization: Freestanding and hospital-associated ambulatory facilities devoted to a single specialty are in significant demand.
High Level of Care: Within their area of specialization, these facilities offer a level of care traditionally found only in a hospital setting.
Case Studies and Examples
Texas Children's Hospital Clinical Care Center, Houston, Texas
Historical Context (according to FKP Architects): Years ago, ambulatory care was perceived as add-on, limited services designed to relieve stressed inpatient departments. Little consideration was given to convenience, cost control, or amenities.
Modern Change: This perception has entirely changed, and there is significant demand for modern, specialized ambulatory facilities.
Recognition: The Texas Children's Hospital Clinical Care Center's design by FKP Architects received a Businessweek "Good Design is Good Business" award.
Spivey Station Outpatient Surgery Center, Jonesboro, Georgia
Location and Convenience: Located next to other healthcare facilities at Spivey Station, including medical offices, digital imaging centers, and a women's hospital. The aim is to make medical visits more convenient for patients by offering a wide range of outpatient surgical procedures within walking distance.
Services: Designed to meet the immediate needs of various surgical procedures, allowing for outpatient performance of:
Ear, nose, and throat procedures.
Orthopedic surgery.
Various types of breast surgery.
Design Philosophy (CDH Partners, Inc.): Innovativeness was crucial, opting for integrated operating rooms tailored to specific surgical needs.
Patient Experience Enhancements:
Reception Area: An illuminated reception desk serves as a focal point, reinforced by a trellis stretching across the ceiling.
Lighting: Backlit acrylic panels cover the front of the desk, illuminated by the indirect light characterizing the entire waiting area.
Privacy and Aesthetics: Partial height partitions reduce noise and offer privacy, while curved translucent panels create a calming, wavy line for visual interest.
The Heart Center of Indiana, Indianapolis, Indiana
Significance: This was the first freestanding heart hospital to open in the Indianapolis area.
Size and Capacity:
Footprint: A sq.-ft., four-story facility.
Beds: Opened initially with beds, with "shelled capacity" to double that number to beds.
Services Offered:
Four surgical suites (including one specifically for vascular procedures).
Ambulatory services.
Emergency care chest pain center.
General radiology, CT scanning, ultrasound, and MRI.
Three cardiac catheterization labs.
An electrophysiology (EP) lab.
A postanesthesia care unit (PACU).
A laboratory and blood bank.
Floor Layout:
First Floor: Contains administrative offices, operating rooms, cath labs, blood bank, testing services (MRI and CT), foodservice, maintenance, and housekeeping.
Second Floor and Half of Third Floor: Dedicated to patient care rooms.
Remaining Space: Shell space is available in the other half of the third floor and the entirety of the fourth floor for future expansion.
Connected Facilities: A sq.-ft. medical office building is connected to the heart center by an enclosed walkway.
Design Approach (ESa): Reflected a "hospitality approach" throughout the interior spaces.
Reception: The reception desk resembles and functions as a concierge desk.
Atrium: A two-story atrium features natural light and foliage arranged in built-in planters.
Meditation: A meditation courtyard is located between the hospital and the medical office building, offering quiet solitude.