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The following article by Yair Keshet was published in the October 2021 issue of Ophthalmology Management.

Designing an office-based surgery suite

For ophthalmologists considering adding an office-based surgery (OBS) suite to their clinics, the outlook is bright to pursue what may have once seemed a moonshot vision. The cost of building an OBS is significantly less than an ASC due to a lower level of complexity and can be implemented in a fraction of the time; in our experience, an OBS may take 6 months to a year, while an ASC will take closer to 18 months to 24 months from inception. Still, an OBS requires expertise to do it right.

“It is critical to have a deep understanding of the space requirements, surgical equipment, staff training, accreditation, the entire billing process and how to set up efficient processes,” says Tony Burns, co-founder of iOR Partners, a company that develops ophthalmic OBS suites. “It all starts with space planning and design to ensure it is set up with the right accreditation requirements, safety standards and compliance protocols for implementation and long-term success.”

With the right planning and design, OBS can provide an optimal surgical experience for the patient, surgeon and staff.

FOR THE PATIENT
In order to build a reputation and brand that reflects their standard of care, ophthalmologists invest significant resources to create a comfortable environment in a convenient location. An OBS can be designed as part and parcel of the environment the physician has cultivated for their patients. From consultation to post-op, physicians want a positive and cohesive patient experience, which means every decision in the design phase is mindful of how the space is perceived and inhabited.

Controlling and calibrating the mood of the preop area and operating room to comfort the patient is a critical component in OBS design. The furnishings, artwork, daylight, artificial lighting, finishes, HVAC and more can be selected to increase the comfort level of patients, which in turn has a significant affect on their decision-making process on whether to proceed with a recommended surgery. Access to views, music, soothing colors, wood tones or other design details have been shown to lower anxiety before surgery, according to research by Laursen et al, Ni et al and Augustin et al.

 

FOR THE SURGEON AND STAFF
Designing an OBS suite gives the surgeon the opportunity to tailor the operating space to their own needs and preferences. This should be a highly collaborative process between the qualified design professional and the surgeon and consider the needs of all associated staff. A design professional will typically ask at the outset:

  • What instruments are stocked

  • Where instruments are kept

  • What type of lighting is preferred

  • What the physician wants the patient to hear and see

  • Where and how operating physicians and patients enter and leave the surgical suite

  • What is the ideal postoperative discharge — one that allows for patient privacy and comfort

  • Whether the practice needs a connected office or an entirely separate lobby desk and waiting area

Of course, ophthalmic-specific accreditation requirements must be met, but they do not prescribe the exact makeup of the space or every last detail. OBS goes beyond the safety requirement to provide the optimal environment for the surgeon, staff and patient.

FOR ACCREDITATION
An OBS suite functions under the same governing body structure as an ASC. Guidelines for operational procedures, record keeping, reporting, emergency care, required spaces, supplies and equipment must be considered during the design process. Operating rooms are defined by categories largely relating to the type of anesthesia used — Class A, B and C — all of which have different levels of standards. While ASCs must adhere to accreditation standards across multiple specialties, some standards do not apply to ophthalmic surgery. An OBS suite can be right-sized for the specific procedures being performed, which makes it much less expensive to build and occupies less leased or purchased space.

In addition to national regulations, OBS has to follow building code, fire code, state and local codes, plus CDC and OSHA operating requirements. The design professional will need to understand all of the above standards and their intricacies and relations.

ADDITIONAL CONSIDERATIONS
When considering OBS for your practice, start by answering the following questions:

  • Do I have the space? At minimum, 750 square feet is required for a Class B operating suite. Space that is unencumbered by structural columns, piping or other building services is best, but a room that is at least 15 feet wide and longer in length meets the requirement. Feasibility will depend on the available space’s relation to entrances, adjacent medical suite offices, available plumbing, heating and cooling and proximity to exterior walls.

  • How long will it take? From initial feasibility to completion is a process that might take 3 to 6 months, but complications can certainly add time.

  • How much will it cost? Urban locations are typically more expensive to build out. We typically find that OBS fit-out can cost between $90 and $150 per square foot.

  • Where can I learn more? A good first place to check on the feasibility is with your state’s department of health. Different states have varied laws on the outpatient environment, so it is best to work with an expert in ophthalmic OBS suites.

For doctors thinking about expanding their offices for OBS, now may be an ideal time to act. The future of OBS is bright, as technological improvements continue to mean that more advanced procedures can increasingly be handled by smaller facilities with greater success and equal or better safety to other outpatient options. To determine if OBS is feasible for your practice, gaining a more complete understanding of the certification process, state laws, the logistics of billing and working closely with a design professional versed in these issues are the right first steps.