1. Ensure that the ambulatory surgery center is separated from the recovery care center. According to Ms. Bushee, the state-by-state definitions for recovery care centers can be a gray area, but the Department of Health emphasizes that the ambulatory surgery center must be distinctly separated from recovery care. "Otherwise, they can fine the ASC for violating licensure requirements," she said.
2. Certain cases are better suited to 23-hour facilities. Cases that require long term care will be ideal for 23-hour facilities, Mr. Chester said. "There is definitely a growing market for orthopedics and orthopedic spine cases," he said. "These are about long term care and a long time returning to being ambulatory. The Society for Ambulatory Spine Surgery is currently working out a set of guidelines for recovering patients."
3. The facility must be equipped to respond to emergencies. Ms. Tiberi said that a 23-hour facility must have the appropriate rooms, medications, equipment and transportation capabilities to handle emergency situations. "Many of the organizations we deal with specialize in orthopedics or ophthalmology, and a common question we ask is, 'How are you going to respond to an emergency situation?'" she said. "There are often issues and complaints we have to investigate about this. Be careful about which patients you accept into your center, and make sure that they can be handled in your facility."
4. Surgery centers looking to add a recovery care facility must pay attention to building requirements. The complexity of adding a recovery care facility to an existing surgery center depends largely on how the original facility was built, said Mr. Chester. "If the center is on the ground floor of a noncombustible building with fire sprinklers, it's almost there to meet requirements for the institutional life safety level," he said. "If the building is on multiple floors or on the second or third floor and does not have fire sprinklers, you're looking at a major investment to upgrade the life safety of your building."
5. The recovery care facility should be equipped to run for longer than 24 hours. According to Mr. Chester, 23-hour recovery care facilities should be equipped with the proper generator, oxygen cylinders and air conditioning equipment. "The center has to have reliability and the capacity to exceed 24 hours," he said. "You can also have break rooms for the nurses with windows looking directly into the recovery area, so nurses can take a break but still have complete view of all the patients." Mr. Chester added it can be difficult to make these additions in an older facility due to a lack of square footage.
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