Lga Asc Presentation Final Final
-
date post
19-Oct-2014 -
Category
Documents
-
view
774 -
download
3
description
Transcript of Lga Asc Presentation Final Final
A Newly Licensed ASC in an Existing Building-Processes, Challenges, Insights & Lessons Learned
AIA AUSTINCOMMITTEE FOR
HEALTHASC PRESENTATION
September 18, 2009
AgendaI. 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)
Preplanning, Accreditation, Licensure and Operation
Game Plan
**Note: Importance that all players specifically have Licensed Surgery Center Experience
Education-Physician-Realistic Timeline
Financing - ProformaMission StatementSpecialties - PartnersNumber of RoomsTiming Expectations - 1 year PLANRFP
Team Selection** All major players on board early on
Owners Rep/Construction/Program Manager
Contracting - Insurance ConsultantClinical ConsultantEquipment Planner/ConsultantGeneral Contractor (as early as
Schematic-Never TOO early)Credentialing ConsultantMarketing RepresentativeHealthCare Architect and Consultants
-MEP -Structural-Civil-Interior Design
-Interior Finishes,Furnishings, Artwork & Signage
Concept Plan (Test Fit)
Application to DSHS, CMS & Accrediting Body
• Timing
• Info Requested
• Flexibility to change info providedFees
• Info required from Other Parties
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
Final Inspection and Operation
State/Life Safety Inspection-Timing/Preparation /Fees-Process
Accreditation / Medicare Inspection-Timing/Preparation /Fees-Process
Open For Regular BusinessType of Patients for reimbursement Staff Competencies / TrainingReimbursement/TimingState Licensing/Accreditation / Medicare Certifications
Insurance ContractsOpen House / MarketingContinuous Follow-Up and Availability for Quality and
Success
DSHS Documentation-Maint. Logs
PreDesign and Design Considerations
Site & Building Evaluation (Physical Attributes)
Construction TypeCovered Canopy – Patient Drop off/Pick upCompliant ElevatorAccessible Parking and SiteAmbulance and Fire Dept. AccessCommon Areas/Patient Friendly AccessSeparated Use (vertical and horizontal)Building EnvelopeMultiStory Configurations-Patient Services on
more than 1 levelEgressingAccess ControlHazardous LocationsZoning and Use DesignationsShared Services (Space and Systems)
4 Story Existing POB
Site
IH-35
MAYS
HIGHLANDPROFESSIONAL
NN
Ground Floor
Roof Plan
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.
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.
Site & Building Evaluation (Utility Infrastructure)
Available Building ServicesMedical GasDomestic Water including RO, DI or
Softened WaterWater Pressure to Building-Flow TestFire Sprinkler SystemTelephone/Fire Alarm SystemElectrical Service/Generator-Type 1
Essential Electrical SystemBuilding Air/Fresh Air/Pressurization
Building Construction Type and Structure
Vertical Clearances
Structural Considerations
Ceiling Heights/Plenum Clearances
Modifications to allow for Vertical Connectivity (Elevator)
Fire Rating
Building Section
Clearance Analysis
RCP
Plan Configuration & Code Issues
DSHS Licensing RulesJUNE 2009 REVISION
IBC vs. NFPA 101Occupancy Type
I-2 or B Occupancy???Mech/Support Room LocationsStaff, Patient and Support FlowMin. Facilities, SF Requirement,
tied to # of OR’sWindowless Anesthetizing
Location – Smoke Evacuation?
Fourth Floor
Rendering
Consultant SelectionMEP – Most ImportantPrior Experience with Licensed ASC –
Not just HospitalEquipment Overlay and MEP
Coordination - CRITICALSelection of Major Systems – Desired
OR TemperatureAir Change / Fresh Air
Requirements/Pressurization/Pre and Final Filtration of Air
Annunciators and Alarm SystemsPiped or Portable Medical GasDesign Build of MEP Systems (Fire
Protection)
Construction Intricacies
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
Contracting – CM at RISK
Preferred Types of Contracts
Managing Changes
Responding to Owner Initiated Modifications / Options
Savings Split – Money Back to Owner!!
Establishing & Maintaining Schedule
Critical Path
Tracking
Identifying Long Lead Time Items
Submittal Timing
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
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
Project Close-Out/Post Occupancy/Successes
EXCELLENCE IN
CONSTRUCTION
DSHS Documentation
Final Test and Reports
As Built DocumentationO & M Manuals
Substantial Completion and Post Occupancy
Merit Award-Flynn Construction
DSHS Documentation
“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
Before and After