As part of Healthcare Design magazine’s 25th anniversary, we invited industry leaders to reflect on some of the key milestones that have shaped modern healthcare facilities. Here, Catherine Gow, principal, health facilities planning, at FCA (Philadelphia) discusses the impacts of the outpatient shift.
(Headshot credit: Alyssa Maloof Photography)
For more than 20 years, procedures and services historically performed in an inpatient setting—such as total joint replacements and minimally invasive general surgeries like gallbladder removals, hernia repairs, and cardiovascular and spinal surgeries—have shifted to outpatient facilities.
Driving this shift to outpatient care has been a combination of the need to drive costs down, new clinical and technological advances in minimally invasive surgical procedures, and evolving anesthesia techniques that have reduced complications and allowed patients to go home the same day.
Also playing a significant role are the financial incentives from health plans and government payment policies that have supported providing services in lower-cost settings such as outpatient facilities. Another impact has been health systems linking payments to quality and effectiveness measures through quality and value contracts.
What benefits and challenges have hospitals and outpatient centers faced in past years because of this shift? And how has the design of both outpatient and inpatient facilities been impacted?
Design impacts on the outpatient side
Today, freestanding outpatient surgical and procedural facilities are larger and more complex than in the past. They’re being designed to consider future flexibility of space and use to allow for more aggressive procedural spaces such as interventional cardiac catheterization suites and hybrid operating rooms. The size requirements have increased as well.
Where a typical ambulatory operating room would be 400 to 500 square feet, now we’re seeing an increase to 600 square feet and as high as 1,000 square feet for spaces with the highly technical imaging such as cardiac catheterization or robotic equipment.
Technology advancements in outpatient treatment are propelling the detailing and design of aggressive procedural spaces such as a Class 3 imaging or hybrid operating room, which also must comply with higher-level code requirements.
Design considerations include monolithic and scrubbable ceilings, washable wall finishes, monolithic flooring with integral coved wall bases, isolation panels inside the room, and ventilation systems that meet ASHRAE 170’s minimum 20 air changes per hour (ACH).
Some of the demand for outpatient spaces is being met through adaptive reuse projects, which maximize available retail or commercial space and can increase speed to market due to renovation verses new construction duration. Additionally, the design of clinical spaces in former retail or commercial properties has the added benefits of larger column bay spacing, increased ceiling height potential, and typically abundant parking.
Outpatient care’s impact on inpatient facilities
While growth in outpatient procedures continues to climb, aging baby boomers with chronic diseases have been pushing some surgeries and procedures back into inpatient settings due to comorbidity issues.
Healthcare systems believed that the need for hospital beds would diminish as more cases moved to outpatient settings, with patients recovering and going home rather than requiring a bed for several days. While this has occurred in some cases, the opposite has proven true for complex patients and, as a result, the healthcare sector is building more beds than ever to accommodate this need.
Facility age and accommodating the single-patient room model has driven this up as well. This shift to building more beds to accommodate private rooms reflects a desire to improve the patient experience and enhance outcomes.
To accommodate this growing need, hospitals are building additions and vertical expansions, re-opening dormant bed units, and designing to allow for crossover flexibility of acuity-adaptable bed units so the unit can flex up or down to meet changing care needs. The design of these bed units should also take into consideration pandemic future-proofing for infrastructure needs.
Demand is also growing for inpatient surgical and procedural areas to accommodate increasingly complex cases. For example, inpatient surgical suites must now be designed to accommodate larger operating rooms and hybrid environments for neuro, vascular, and cardiovascular cases, increasing the surgical footprints in most hospitals.
There’s also demand for imaging and procedural spaces to accommodate complex care with larger-scale equipment needs and fixed imaging – single or double C-arms, increasing the sizing of operating rooms from the more standard 500 to 600 square feet to as large as 700 to1,000 square feet in some acute care settings.
Healthcare’s evolving landscape
The shift to outpatient care continues on as complex surgeries and treatments such as joint replacements and more complex cardiovascular and spinal cases continue to move to outpatient settings. At the same time, inpatient acute care settings continue to be impacted by these complex patients as many with co-morbidity issues simply are better treated in an inpatient setting.
Design for these typologies will most certainly benefit from modular layouts with larger bay column spacing of 30 to 32 feet that provide more open, flexible procedural, surgical and interventional plans that allow the spaces to change over time.
Some facilities also are adding lead shielding into the slabs of new construction to facilitate ease of future reconfigurations, allowing for flexibility and future cost reduction by taking advantage of current pricing as costs are expected to continue increasing.
With future growth modeling, facilities can maximize their campus infrastructure using a modular, flexible design that ensures that healthcare systems can accommodate both evolving outpatient and inpatient demand.
Catherine Gow is principal, health facilities planning, at FCA (Philadelphia) and can be reached at [email protected].
For more design trend insights from Healthcare Design’s 25th anniversary issue, go here.
