Ambulatory Surgery Center Functional Flow
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Functional Flow of the Surgery Center
The Surgery Center will be providing outpatient surgery services and will contain operating and treatment rooms; a waiting and reception area; patient consultation rooms; pre-operative space; post-operative recovery services spaces; decontamination and sterile processing work areas; clinical and nonclinical storage; mechanical, electrical and medical gas storage rooms; soiled holding and janitor areas; locker rooms, and shower. (cosmetic surgery flow)
Patient Flow: All patients admitted to the Surgery Center will check in at the reception area in the waiting room. If necessary, patients will use the toilet in the waiting room prior to entering.
From this point, patients will be directed to the pre-operative area in a queue. We expect to utilize the pre-operative area as a consultation area and a holding area for pre-surgical and pre-treatment patients. I.V.s and pre-procedure medications can be given in this area, which will be continuously staffed by registered nurses, the ratio of nurse to patient will be 1:2. Patients will also change in this room, and their belongings will be bagged and travel with them throughout the process. (we encourage the family members to take the belongings with them and we do not allow any expensive items to be left with the patient as it is a high risk management issue).
The recovery area will be utilized for post-surgical/treatment patients who have been sedated in the surgical/treatment rooms. As patients recover they will be discharged upon meeting discharge criteria. They may be transferred to the Step Down Unit if additional recovery time is required for pain or nausea issues and then discharged upon meeting discharge criteria. Patients will be sent home via the exit on the north side of the building opposite the gurney alcove. We will be building, equipping and utilizing two operating rooms and one procedure room. Sterile instruments and supplies will be brought into the operating room through the doors that open into the operating rooms off the Sterile Workroom. Nothing from the outside will be brought and used on patients unless it has gone through rigorous testing via the biomedical engineers contracted with our facility to perform routine testing on all the patient care equipment. Items that are brought from the outside into the facility will first and foremost be environmentally cultured to ensure that there is no growth of any infectious type organisms that can potentially cause harm and breakout to the entire facility.
To limit cross traffic between sterile and soiled materials, supplies for the entire day's cases will be assembled and stored in cabinets in each operating/procedure room. Soiled material will leave the operating rooms via the doors opening into the corridor and will be brought to the Soiled Workroom, where they will be processed through a washer/decontamination unit.
An Ambulatory Surgery Center Functional Flow: Clean material will then travel to the Sterile Workroom for assembly and re-sterilization. The use of bedpans is not anticipated. Patients arrive at the facility under NPO directive (confirmed by staff upon pre-op interview); therefore toiling is typically not necessary. Foley Caths are inserted for patients that will be having peritoneal surgeries, abdominal surgeries, urinary, etc. However, most all the time, these patients are stable and able to void with the F/C removed prior to discharge. If ever there is the possibility of urinary retention, abdominal scans would be performed and then either straight cath'd or foley will remain in tact for the patient to be sent home.
General Supplies: All supplies for the Surgery Center will be delivered to the Receiving Room in the adjacent clinic. Cases will be broken down here and supplies will be distributed to their appropriate storage area, within the Surgery Center. These activities are scheduled to take place outside of times when procedures are scheduled.
Administrative Offices: Medical records, billing, accounts payable and accounts receivable will all be located in business office space apart from the Patient Care Area. The administrator and business office manager will also be located in this area. This area will also contain records/storage, a telecom and copy rooms/areas. Patient medical records will be available to staff at all times.
The Director of Clinical Services will be a registered nurse who will oversee all clinical services of the Surgery Center and will be located next to the Post Anesthesia Care Unit. This location will allow for the direct monitoring of people entering and leaving the operating room area.
Anesthesia Services: The Surgery Center will furnish anesthesia services which will be directed by an anesthesiologist. Emergency Services: The Surgery Center will not provide emergency services. The facility will direct all emergency patients to an adjacent hospital for services. The Surgery Center will provide services for patients that have been admitted for scheduled, nonemergency surgeries, elective procedures and unscheduled urgent procedures. For unanticipated emergencies, emergency supplies and equipment will be readily available and will include a crash cart and defibrillator, emergency call, oxygen, airways, ambu bags, cardiac monitoring equipment, suction equipment, laryngoscopes, endotracheal tubes, tracheostomy set and any emergency drugs and supplies specified by the medical staff.
Governing Body: Surgery Center Functions and Services. The Governing Body of the Surgery Center will assume the legal responsibility for the organization, management, control, and operation of the Surgery Center, including appointment of the medical staff. This body will be formally organized and will have written bylaws that set forth the organizational structure and responsibilities. This body will appoint an administrator who will be responsible for managing the hospital. Infection Control: The Surgery Center will provide an active program for the prevention, control, and investigation of infections and communicable diseases. We will designate one person as infection control coordinator. This person will implement a system for identifying, reporting, investigating, and controlling infections and communicable diseases between patients and personnel. Services: The hospital will perform only CLIA waived laboratory tests that comply with the Clinical Laboratory Improvement Amendments of 1988 (CLIA 1988) and will provide laboratory services through a contract with a facility which complies with CLIA 1988. Linen and Laundry Services: The Surgery Center will utilize a laundry service for the linens that are not disposable. Medical Record Services: These services will be under the supervision of the administrator whom will ensure that all HIPPA requirements for patient charts are in place. Medical Staff: The facility's medical staff will be organized in a manner approved by the Governing Board. The medical staff will be accountable to the Governing Board for the quality of care provided to the patients. I t will be composed of physicians, surgeons and other practitioners.
All members of the medical staff will receive copies of the medical staff bylaws and the rules and regulations of the medical staff and will be submitted by the Medical Executive Committee to the Governing Board for approval. Nursing Services: The Surgery Center will have an organized nursing service that provides pre- and post-operative nursing services as needed. There will be a registered nurse serving as the Director of Nursing who shall be responsible for the organization of the service and ensuring proper nurse to patient ratios and other appropriate staffing to meet the needs of the Surgery Center. Registered nurse(s) will be present during the hours of operation. Hours of operation will be 6:00 am to 6:00 pm and first surgery/procedure(s) will begin no sooner than 7:00 am.
Pharmaceuticals: The use of pharmaceuticals and the maintenance of the medication room will be supervised by the anesthesiologist and the Medical Director and will ensure that all medication handling will comply with the Arizona State Board of Pharmacy. All pharmacy services will meet the requirements of the Arizona Department of Health and DEA.Quality Assurance:The Governing Board will implement a Surgery Center Quality Assurance Program which will be on-going and will have a written plan of implementation. Committees:The following committees will meet at regular intervals:
- Fire drills will be held each quarter.
- Performance and Quality Review Committee will meet biannually.
- Medical Records Committee will meet annually.
- Disaster Committee will meet annually.
- Laser Safety Committee will meet annually.
- Peer Review, Surgical Case Review and Credentials Committees will meet annually.
Sterilization and Sterile: The head nurse of the operating rooms will oversee the sterilization and maintenance of sterile supplies. The Surgery Center will provide a washer/decontamination unit for disinfecting surgical instruments, a large sterilizer for sterilization of wrapped items and a "flash" sterilizer for use between surgical cases. The Surgery Center will also contain an automatic endoscope washer/decontaminator for processing endoscopes, colonoscopes and gastroscopes. Surgical Services: The Surgery Center will provide surgical services and will be under the direction of a registered nurse. These services will be governed by written policies and procedures approved by the Governing Board. A registered nurse will supervise each operating room, including activities by surgical technologists, LVNs. and MAs.
- Patient Rights: The Governing Board will adopt and implement a policy to ensure patients' rights. This policy will be posted in the reception area and will be delivered to each patient as part of the admission process. Discrimination or Retaliation Standards: The Surgery Center will not discriminate against or retaliate against any employee, non-employee or staff member who reports a violation of the law. A statement regarding this policy will be posted in English and Spanish in a public area of the Surgery Center. Transfer Agreement: The Governing Board, in consultation with the Medical Executive Committee, shall adopt a policy with respect to patient transfers to another hospital and shall meet the requirements of the State Department of Health.
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