Ambulatory Surgery Center Design Criteria
The siting of a Medicare-licensed, Ambulatory Surgery Center needs careful consideration before any commitment is made to lease or purchase a building or a suite. Some of the most critical Items to review include Zoning, Parking, Building Construction Type, headroom, elevators, sprinklers, vertical duct shaft space, generator vs. battery UPS locations, etc. The following abbreviated check list will help determine if the physical location, site, suite building, etc. is suitable for surgery center use.
Ensure the building is properly zoned for medical use by the local jurisdiction, City, etc. Sufficient on-site parking for medical use is generally required at a higher ratio than regular office use (often 5 stalls per 1000 square feet of ASC space). A complete building area/ parking ratio inventory may be required where there are multiple tenants.
For the smallest ASC’s of one or two operating rooms (max. 5 total patients) that qualify for a B (Business) Occupancy rating, the building code requirements are fairly straight-forward; Type-V construction, and fully sprinklered. This can be wood-framed construction, but is limited to a 2-storey building. The minimum size for a fully compliant Medicare-licensed ASC will obviously vary depending on the number of operating rooms, etc. but they can range on up from as little as 3,000 square feet for a small one-operating room facility.
For any ASC having a larger patient flow than the above, the Occupancy rating jumps to an I-2.1 (Institutional). For wood-framed (fire-rated) construction, these building is limited to one storey in height, with full fire rating of all the exterior walls, posts / beams and roof, and limited to a maximum 9,000 square feet in area. For all ASC’s in taller multi-storey buildings, the building must be fully fire-rated, noncombustible steel / concrete construction.
An automatic fire sprinkler system is mandatory to comply with building codes. The facility will also require a notified fire-alarm system, which should be connected to the building’s central alarm system where possible. Check to see what is in place.
Elevators in multiple level buildings: Verify the size of the elevator. If the building is to be newly constructed, it makes sense to ensure ample elevator sizing. Building codes (IBC Section 1188.8.131.52) dictate a minimum platform size of 5ft x 8 ft. with 3’-8” door opening for "routine transport of wheeled stretchers". This statement seems to be open to interpretation by individual jurisdictions for existing buildings where elevator size may be a problem. Often building departments refer such approval to the local Fire Department, and many of those will simply require space to fit a 24” x 84” gurney. Remember, the elevator should be served by a back-up generator.
Width of building access corridors / hallways should be checked; Min. 6 foot width (8 foot preferred) where emergency gurney egress is anticipated. On upper level floors you must, of course, have access to minimum two full enclosed fire-rated stairwells, which discharge on the ground level directly to the exterior.
Operating Room headroom must be a minimum of 9 feet clear height. Bear in mind there will need to be space above the ceiling for ducts and pipes, etc, so a minimum floor-to-structure height of at least 11 to 12 feet is necessary.
Waiting Room Restrooms; if fully handicap accessible compliant centrally located common restrooms are available, this will save cost.
Plumbing: Check the building sewer system is adequately sized to accommodate medical use with large number of sanitary fixtures – usually 4” sewer for smaller buildings, increasing in diameter as building size gets bigger. The building’s engineer may have capacity calculations. Some jurisdictions can require copies of such calculations and in rare cases upgrades may be required. Ditto the cold water supply.
Air conditioning: HVAC for surgery areas and OR rooms requires high efficiency filtration, with enhanced capacity rates (20 air changes per hour). Will existing HVAC systems be able to deliver this, or will new units be needed? If needed, is there adequate (screened) roof space available?
HVAC (continued): If there are additional floors located above the ASC, is there a nearby vertical duct shaft, with enough clear space to allow new make-up air ducts, exhaust ducts and condensate lines?
Electrical System. Determine if there is adequate metered power supply available for the ASC. Normally a small 2 O/R facility needs a minimum of 200Amp 120/208V 3-phase service, exclusive of elevator or site lighting. If air-conditioning is also served from the same meter, then 400Amp or more may be required.
Emergency power source for the Surgicenter - Operating Rooms, Recovery, Nurse Stations, etc - is required to satisfy requirements of Essential Electrical System, per NFPA and OSHPD. Either an emergency generator or in some cases a battery inverter system can be used. If opting for a generator, ensure there is a suitable location outdoors (about 15 feet x 20 feet screened lockable enclosure) or fully fire-rated and vent-able indoors. Considerations include access and ease of re-fueling. Exhaust pipes must be located (20 feet min.) away from any air intakes or windows and extend above any adjacent buildings or parapets. Noise may factor also, since generators can be very noisy and weekly / monthly test runs are required.