Office Based Surgery  (OBS) Part 2

Office Based Surgery (OBS)  Part 2


Bob King continues the discussion on what agencies can certify the procedure suite for OBS and what architectural features are required for certification.


 QUES – Who certifies office based surgery (OBS) verses a hospital or clinic?

ANS – Independent certification agencies authorized by the State of New York, here where we practice and similarly in most other States and jurisdictions. Each practice or facility must contract one of these entities to conduct the requisite reviews of plans and procedures as well as conduct a post-construction survey and certification. They also do follow up surveys over the specified time period to make sure the practice or facility is operating as certified.


QUES – Who are the authorized independent certification agencies for office based surgery (OBS) in New York State?

ANS – There are three as of this writing (2015) – they are American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (JC). We have used all three in our projects & the difference is more to the tailored needs of the particular doctor & what procedures they wish perform. We find that JC is the most stringent, mostly in the delineation of work documentation, but some slight variations in the mechanical considerations of the procedure room itself regarding gas evacuation & positive air pressure standards. JC is the current “gold standard” for hospital and clinic certifications to date. Since most of our doctors are within existing buildings, some of the JC considerations can be more problematic, but usually solvable at least on the architectural/mechanical end of things.


QUES - Do all office based surgery (OBS) practices have to be certified?

ANS – Yes, as of 2009. We obtained certification (plastic surgery practice on Long Island) of our first OBS (AAAASF) in 2008, ahead of the legislation. This affects all 50 States by now.


QUES – What are the main architectural/mechanical design elements that comprise a typical OBS project?

ANS – The most important design element of any medical office, but specifically office based surgery is “flow” of both patients and staff (particularly the doctor). Here in New York City, there are all the usual privacy and access requirements common to all doctor offices, but with surgery being performed, we find the best placement on a floor plate is “in the back” farthest from the front door and ideally a back exit out of the space when persons are OK’d to go home. Since most offices are already defined & the needs must fit the space, compromises must be made, but usually if you follow the basics and do the best with what you have – the design will be optimized. On the mechanical side of the design, the biggest issue is supplementary air conditioning! Often overlooked, even with LED task lighting (cooler temperature bulbs), the procedure room will overheat unless mechanically cooled. Most buildings do not have air conditioning available “on demand”, so planning ahead for this is paramount. Also, the patients in the recovery area want to be warmer, so zoning of the HVAC environment is very important. We usually specify (3) independent HVAC zones with separate controls – one for procedure room(s), one for recovery and then one for the main office space at a minimum.