Lga Asc Presentation Final Final

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Round Rock Surgery Center Case Study

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Lga Asc Presentation Final Final

  1. 1. A Newly Licensed ASC in an Existing Building- Processes, Challenges, Insights & Lessons Learned AIA AUSTIN COMMITTEE FOR HEALTH ASC PRESENTATION September 18, 2009
  2. 2. Agenda I. Introduction II. Preplanning, Accreditation, Licensure and Operation - Nan Finch, RN, MSN, CNS – Diverse Heath Consulting (President) III. PreDesign/Design Considerations - Craig Puccetti, AIA – Lawrence Group (Associate Principal) -Tamara Toon – Lawrence Group (Associate) IV. Construction Intricacies - Seth Bonnecarrere, LEED AP-Flynn Construction, Inc (Project Manager)
  3. 3. Preplanning, Accreditation, Licensure and Operation
  4. 4. Game Plan **Note: Importance that all players specifically have Licensed Surgery Center Experience Education -Physician -Realistic Timeline Financing - Proforma Mission Statement Specialties - Partners Number of Rooms Timing Expectations - 1 year PLAN RFP
  5. 5. Team Selection ** All major players on board early on Owners Rep/Construction/Program Manager Contracting - Insurance Consultant Clinical Consultant Equipment Planner/Consultant General Contractor (as early as Schematic-Never TOO early) Credentialing Consultant Marketing Representative HealthCare Architect and Consultants -MEP -Structural -Civil -Interior Design -Interior Finishes, Furnishings, Artwork & Signage
  6. 6. Concept Plan (Test Fit)
  7. 7. Application to DSHS, CMS & Accrediting Body • Timing • Info Requested • Flexibility to change info provided Fees • Info required from Other Parties
  8. 8. Policies, Procedures & Administration Establishing programs to meet licensing requirements • Pharmacy – DEA • Lab - CLIA • Contracts – Laundry / Pathology / Janitorial Services / Anesthesia / Pharmacy • Logs • Internal Policies -OSH -Clinical -Administration -Business Office -Environment of Care -Anesthesia • Staffing -Hiring -Job Descriptions -Employee Handbooks -Types of Staff and Plans -EHR use and training
  9. 9. Final Inspection and Operation State/Life Safety Inspection -Timing/Preparation /Fees -Process Accreditation / Medicare Inspection -Timing/Preparation /Fees -Process Open For Regular Business Type of Patients for reimbursement Staff Competencies / Training Reimbursement/Timing State Licensing/Accreditation / Medicare Certifications Insurance Contracts Open House / Marketing Continuous Follow-Up and Availability for Quality and Success
  10. 10. DSHS Documentation-Maint. Logs
  11. 11. PreDesign and Design Considerations
  12. 12. Site & Building Evaluation (Physical Attributes) Construction Type Covered Canopy – Patient Drop off/Pick up Compliant Elevator Accessible Parking and Site Ambulance and Fire Dept. Access Common Areas/Patient Friendly Access Separated Use (vertical and horizontal) Building Envelope MultiStory Configurations-Patient Services on more than 1 level Egressing Access Control Hazardous Locations Zoning and Use Designations Shared Services (Space and Systems)
  13. 13. 4 Story Existing POB
  14. 14. Site N IH-35 HIGHLAND PROFESSIONAL MAYS
  15. 15. Ground Floor
  16. 16. Roof Plan
  17. 17. Site & Building Evaluation CHECKLIST 1. Need to have a covered canopy or awning the will cover a car for patient drop off and pickup near the main entry point. Canopy or awning will be submitted for approval. Flatwork outside this entry could also be required to be accessible and provide accessible route from drop off/pickup to entry and discharge areas. Will a patient drop off and pick up area be possible? 2. Need location along back side of building adjacent to ASC where the diesel emergency generator can be placed. Will possibly need to access drives for refueling and add bollards or screen wall. A dumpster will also be required. A service area for deliveries of supplies and medical gas will also be preferred. 3. Will possibly want to add windows in facade at Operating Rooms and other Business areas. Additional doors for egressing may also be required on the ground level. 4. Will want to modify some storefronts for installation of new door systems including the main entry on the surgery center side. Main entry door will be upgraded with design approved by landlord. 5. At least 2 exterior doors from the ASC will need to be min 44" wide for wheelchairs. 6. Consider getting a certain number of dedicated patient parking spaces near entry (where applicable) 7. Ensure that all site elements and entry points are accessible as per TAS requirements. 8. Ensure that adequate water pressure is available to support the the ASC when part of larger development. Many times an ASC domestic water line is larger to handle the larger fixture demand.
  18. 18. Site & Building Evaluation CHECKLIST 9. Ensure that we are able to locate new hvac equipment on the roof, penetrate the roof, and upgrade structure to support units 10. When Multistory building with ASC on 2nd Level, Ensure that provisions are made to allow us to and accessible 5'x5' minimum cab size gurney elevator within lease space serving ASC if ASC is going to be located on 2nd floor. . 11 Ensure we have adequate electrical service and capacity to serve the ASC. A surgery center requires a larger service than a typical lease space 12. Verify construction Type. Is the building steel? If so, is it fireproofed or wrapped to be a rated assembly? Is there anything unique about the construction type like tilt wall exterior walls or post tensioned slab. 13. Verify if the building has a fireline/riser to the building if the building is fully sprinklered. 14. Verify if possibility of modifying and or reinforcing floor /roof structure for new rooftop equipment and clearances from existing exhaust fans and vents that are existing. 15. Make sure we are not in a flood zone. 16. Verify designed parking ratio. 17. Verify that stairwells are strategically located so more than 1 means of egress is possible from 2nd floor occupancy. 18. Verify Structural Clearances (floor to floor heights). 15 foot top of steel preferred. 19. Are there any nuisance areas surrounding the site, high power lines, underground fuel tanks....etc.
  19. 19. Site & Building Evaluation (Utility Infrastructure) Available Building Services Medical Gas Domestic Water including RO, DI or Softened Water Water Pressure to Building-Flow Test Fire Sprinkler System Telephone/Fire Alarm System Electrical Service/Generator-Type 1 Essential Electrical System Building Air/Fresh Air/Pressurization
  20. 20. Building Construction Type and Structure Vertical Clearances Structural Considerations Ceiling Heights/Plenum Clearances Modifications to allow for Vertical Connectivity (Elevator) Fire Rating
  21. 21. Building Section
  22. 22. Clearance Analysis
  23. 23. RCP
  24. 24. Plan Configuration & Code Issues DSHS Licensing Rules JUNE 2009 REVISION IBC vs. NFPA 101 Occupancy Type I-2 or B Occupancy??? Mech/Support Room Locations Staff, Patient and Support Flow Min. Facilities, SF Requirement, tied to # of OR’s Windowless Anesthetizing Location – Smoke Evacuation?
  25. 25. Fourth Floor
  26. 26. Rendering
  27. 27. Consultant Selection MEP – Most Important Prior Experience with Licensed ASC – Not just Hospital Equipment Overlay and MEP Coordination - CRITICAL Selection of Major Systems – Desired OR Temperature Air Change / Fresh Air Requirements/Pressurization/Pre and Final Filtration of Air Annunciators and Alarm Systems Piped or Portable Medical Gas Design Build of MEP Systems (Fire Protection)
  28. 28. Construction Intricacies
  29. 29. Pricing/Establishing Contract Price Early Involvement – Team Approach Pricing at Schematic, DD and CD (GMP Established) Reconciliation of Actual Cost to Budget Opportunities for Savings-Value Management Versus Value Elimination
  30. 30. Contracting – CM at RISK Preferred Types of Contracts Managing Changes Responding to Owner Initiated Modifications / Options Savings Split – Money Back to Owner!!
  31. 31. Establishing & Maintaining Schedule Critical Path Tracking Identifying Long Lead Time Items Submittal Timing
  32. 32. Managing Day to Day Construction Activities Subcontractors and other On Site General Contractors Inspections/City Requests Process and Communication Common Issues /Encountered Resolutions Project Specific Challenges/Resolutions
  33. 33. Project Challenges Electrical conduit, Plumbing, mechanical routing through occupied floors to surgery center and roof level Precast floor and wall construction, and precautions that arise from this design Installation of exterior elevator shaft in an occupied area, traffic and safety concerns Above ceiling conditions and clearances at Operating rooms Locating roof top unit with existing cell tower equipment and cabling
  34. 34. Project Close-Out/Post Occupancy/Successes DSHS Documentation Final Test and Reports As Built Documentation O & M Manuals Substantial Completion and Post Occupancy Merit Award-Flynn Construction EXCELLENCE IN CONSTRUCTION
  35. 35. DSHS Documentation
  36. 36. “Without reservation I would recommend Flynn Construction in the special and complicated area of Surgery Center planning and building” -Dr. Mark Malone, Advanced Pain “Lawrence Group worked closely with us from beginning to end resulting in a well coordinated project that exceeded Dr. Malone’s Goals and Expectations” -David Wardell, Advanced Pain “Nan was a great resource with getting us up an running quickly” -Caroline Domin, Advanced Pain Testimonials
  37. 37. Before and After

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