Constructing a Functional Narrative for an ASC: Q&A With Amy Mowles of Mowles Medical Practice Management

A functional narrative is a detailed, written description of a surgery center, used to request approval to construct a new facility. Since this item is essential to gain license approval for a new surgery center, administrators and surgery center leaders must have a thorough grasp of the elements required for a successful document. Here, Amy Mowles, president and CEO of Mowles Medical Practice Management, goes through the essentials.

Question: What is a functional narrative?

Amy Mowles: A functional narrative is a written, detailed description of the proposed project (ASC) that is submitted with the design plans.

Q: What is it used for?

AM: Requesting approval to construct a new ambulatory surgery center

Q: Is it a requirement?

AM: In many states, yes, it must be provided with the design plans for Architectural Review. It is one of the processes necessary for ambulatory surgical centers' license approval. The owner/operator may not begin construction of a new building, new addition, renovation, alteration, modification, or conversion of an existing building

Q: What components are typically included?


1. Project identification. Describe the intended project: including legal name, and physical address, type of project such as single or multi-specialty and the focus of such, type of occupancy (renovation or new construction), ownership and management specifics as well as the costs.

2. Purpose of project. Explain the emphasis of treatment services (scope of services/procedures) that will be provided and who will provide them, such as board-certified surgeons. Specify the levels of anesthesia intended and who will provide anesthesia, such as CRNAs or anesthesiologists.

State the reasons for intended project, such as the need for services that will be provided in this venue, the need of the community and the projected demand for utilization.

3. Space planning and space relationships. This should describe the overall space requirements for the ASC. Space planning should include a departmental functional service description of types of procedures to be performed, including credentialing policies and patient selection criteria.

4. Work flow. Describe circulation patterns:

• Start with where staff will park and enter, such as: Staff enters the ASC through a separate door into a one-way flow of lounge/locker room with toilet and shower, through a dressing room (M&W) to the surgery suite.

• Define the location for deliveries and pick-up services.

• Describe the flow for patients, from where they park and enter to what happens pre-procedure and how they are taken to the operating room and PACU.

An example for a patient procedure sequence would be: All patients will have a recent history and physical examination prior to any procedure. All necessary pre-op test results will be obtained and available pre-procedure, along with patient's medical history. Patients will check in at the ASC waiting receptionist. The patient walks or is taken by wheelchair to a pre-procedure cubicle to change clothes and receive an IV if receiving procedural sedation. Patients receiving procedural sedation will be placed on a pulse oximeter, automatic non-invasive blood pressure monitor, and EKG monitor (if necessary).

The attending physician will obtain an informed consent. Oxygen is administered as needed, under direction of the physician. During procedure, vital signs are to be monitored and documented. Dosage and names of all drugs administered, techniques used and any unusual events and patient status will be documented. Post-procedure, patients will be transferred from the procedure room to the recovery suite by wheelchair or patient cart as deemed appropriate.

Depending on the level of anesthesia, the patient will go to Stage One or Stage Two recovery station. Patients requiring Stage One recovery will transfer to Stage Two to redress, meet with the physician and receive post-procedure written instructions and medications. All patients will be monitored for vital signs within normal range and be observed to be awake and alert and at controlled pain levels before discharge.

• Describe how instruments go from use to sterilization to storage.

5. Architectural — mechanical, electrical, plumbing, finishes, air, medical gases and code applicability, life safety code and compliance status. Detail all of the design and construction codes used in project design:

• State of ______ and their code (i.e. Guidelines for Design and Construction of Health Care Facilities and the year version used)
• Medicare: NFPA 101, Life Safety Code, 2000 Edition
• City of _______ (i.e. their building code)

Detail code compliance status of existing and/or new buildings. This is where the architect would describe the code compliance with each regulation, citing the number of the code and how the ASC will comply with applicable provisions.

For example:

Selection subchapters _______________
_______ minimum standards – covered entrance complies

• Plans to correct non-compliant issues
• Description of all fire/smoke detection and suppression systems

Q: How will surveyors use or review the narrative?

AM: Surveyors will review the narrative and determine if the center is actually doing what they said they were going to do. Staff will need to articulate how things will flow from instruments to patients for infection control, quality assessment and performance improvement.

Learn more about Mowles Medical Practice Management.

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