When the surgeons at Princeton (N.J.) Orthopaedic Associates designed their new ASC, they mapped it the way a patient experiences it: from walking in the door to the operating room to recovery.
They built the center around that path, positioning staff to deliver care, linking the pre-op and post-op areas so nurses could work across both, and leaving room to move fluoroscopy equipment — and, if needed, a surgical robot.
The result is a three-OR musculoskeletal surgery center in Skillman, N.J., which the practice, part of New Jersey orthopedic group OrthoNJ, opened in October. The surgeons designed and built the center, which they will also run.
Brian Culp, MD, headed the committee that led the center’s development. Frederick Song, MD, discussed with Becker’s what changes when the people performing the surgeries also draw the floor plan.
Designed from the front door to the OR
The practice didn’t hand the project to a developer. Every surgeon in the group helped plan the center, from financing and layout to equipment and staffing.
That involvement started with the map. The surgeons chose a site central to Princeton and the surrounding communities the practice serves, so patients could reach it easily.
Inside, they designed the flow of patients from the moment they walk in to the moment they’re wheeled into the OR, with two goals in mind, Dr. Song said: the best possible patient experience, and staff positioned to deliver care efficiently.
Surgeons know what a complex case demands in a room, and they built for it.
The center will perform the full spectrum of outpatient orthopedic cases: upper extremity, foot and ankle, arthroscopic sports procedures, and hip, knee and shoulder arthroplasty. Spine is on the list too, including lumbar decompressions, anterior cervical discectomy and fusions, and spine endoscopy.
To support that case mix, the center has three spacious ORs and an overnight post-anesthesia care unit room. The surgeons sized the ORs not only for complex cases, but for moving fluoroscopy, specialized OR tables and “future technologies such as robotics if needed,” Dr. Song said.
The surgeons also designed for the people who work alongside them.
The pre-op and post-op areas are linked, so nurses can communicate easily and staffing can flex to cover both. The layout also supports post-op care and physical therapy evaluations.
Owning the center, partnering with the hospital
The timing tracked a shift already underway. As more surgical services move to the outpatient setting, Dr. Song said, the practice saw the moment to build a surgeon-driven center focused solely on its patients’ needs.
Ownership, he said, is what keeps it adaptable.
“Since the surgeons own the center, we feel we can be nimble with regards to any changes in the ever changing healthcare environment,” Dr. Song said.
Designing their own ASC didn’t mean pulling away from the local hospital. Dr. Song framed the center as a site-of-service decision.
Procedures have migrated from inpatient to outpatient settings for years, he said, cost among the drivers, and choosing the right setting helps keep costs down across the healthcare system.
“Our goal is to deliver high-value care to our patients in a fiscally responsible way,” Dr. Song said.
That means the ASC for patients who fit it, and the hospital’s resources for patients whose surgeries and procedures can’t safely be done in a surgery center.
What design can’t solve
For all the control the surgeons had over the building, the toughest obstacles came from outside it: local municipal zoning, licensure and weather-related delays.
“As with any project, brace yourself for some unexpected challenges,” Dr. Song said. “Make sure you have ample time to plan and develop the center. Unexpected costs and delays can occur and should be built into the planning.”
For groups considering their own ASC, Dr. Song’s advice comes back to design. Involving every surgeon in the group is essential, he said, so the center fits each type of surgery the practice plans to perform and each patient it intends to treat.
And the input can’t stop at physicians. “Ensure that administration, nursing, and other staff members speak up so their vantage point and valuable insights also get built into the vision,” Dr. Song said.
The payoff, he said, is worth it: getting a new center off the ground “can be immensely rewarding.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
