Case Study: Planning a Medical Procedure Unit

Historically, same-day medical procedures at Midwest Medical Center have been provided by a variety of different departments and scattered throughout the hospital with redundant patient reception/waiting, preparation, treatment, and recovery spaces. As demand for same-day medical procedures continued to grow, the hospital leadership was concerned that outpatient satisfaction was being compromised while operational costs were increasing dramatically. Department staff were inpatient-focused and reluctant to alter pre-established protocols and processes. They were also reluctant to consider any changes to their existing “turf.”

BACKGROUND

After several failed attempts at operational redesign, the serendipitous retirement of several key managers allowed the hospital’s leadership to recruit a new manager who shared their vision. A variety of same-day medical procedures would be consolidated in an area that would function as the equivalent of the same-day surgery center and include flexible space for:

  • Prep and post-procedure recovery for endoscopy, invasive radiology, and other departments/procedures using conscious sedation.
  • Intravenous (IV) therapies such as transfusions, antibiotics, and hydrations.
  • Diagnostic procedures such as bone marrow aspirations/biopsies, liver biopsies, and paracentesis/thoracentesis.
  • Injections, allergy skin testing, and other similar procedures.

The hospital leadership decided to refer to the new same-day medical service as the “medical procedure unit” or MPU to facilitate outpatient wayfinding. A business plan was prepared and operational processes were established and new job descriptions were developed in conjunction with facility planning.

PLANNING APPROACH

A detailed analysis was initially undertaken to identify the current and projected workload volumes and corresponding treatment spaces required:

  • Prep and post-procedure recovery for endoscopy, invasive radiology, and other departments/procedures using conscious sedation.
  • Intravenous (IV) therapies such as transfusions, antibiotics, and hydrations.
  • Diagnostic procedures such as bone marrow aspirations/biopsies, liver biopsies, and paracentesis/thoracentesis.
  • Injections, allergy skin testing, and other similar procedures.

It was decided to refer to the new same-day medical service as the “medical procedure unit” or MPU to facilitate outpatient wayfinding. A business plan was prepared and operational processes were established and new job descriptions were developed in conjunction with facility planning.

PLANNING APPROACH

A detailed analysis was initially undertaken to identify the current and projected workload volumes and corresponding treatment spaces required:

    • Current workload volumes. Data on the current number of patients to be prepped, treated, and recovered in the new unit was collected along with the corresponding number of minutes. A total of 10,100 outpatients would qualify for the new unit (based on current workload data) resulting in an average of 42 patients per day and an average length of stay of 106 minutes. However, 37 percent of the visits/procedures would be less than an hour.
    • Projected workload volumes. Future (five-year) workload volumes were projected for each treatment category. For example, endoscopy recoveries were projected to increase five percent per year consistent with the outpatient endoscopy growth assumptions while IV therapies were projected to increase 20 percent per year and pain clinic procedures were projected to remain constant. An average of 55 patients per day were projected to receive treatment in the MPU.
    • Estimating the number of treatment spaces. Once the future workloads were projected for each procedure category, the current average minutes per procedure were used to estimate the number of treatment bays to be programmed. The projected annual minutes were divided by 250 days per year to determine the average number of treatment minutes required per day. This figure was then divided by 360 minutes per day (assuming an eight-hour shift with 75 percent occupancy) to estimate the number of treatment bays required. The analysis indicated that an average of 16.7 patients would be treated in the MPU at any given time, in addition to those undergoing an endoscopy procedure.
    • Configuration of prep/treatment/recovery spaces. The following patient prep, treatment, and recovery spaces were programmed to optimize flexibility:
      • 3 major procedure rooms (scoping procedures)
      • 1 minor treatment/exam room (flexible, multipurpose room)
      • 4 prep/holding bays (adjacent to the procedure rooms)
      • 8 prep/treatment/recovery bays (three walls with curtain closure)
      • 2 private prep/treatment/recovery rooms
      • 6 prep/treatment/observation recliner chair bays
    • Space requirement. A total of 4,550 net square feet (NSF) was programmed including: a patient reception/intake area; prep, treatment, and recovery spaces (mix of enclosed rooms, partially enclosed, and open bays); and related support space. Applying a factor to accommodate internal corridors and the width of walls, columns, and utility shafts resulted in a total of 6,800 department gross square feet (DGSF).
    • Facility layout and location. Alternate facility layouts were evaluated to promote efficient staffing patterns and patient flow. An ideal location was selected on the first floor of the hospital adjacent to the emergency department’s Nonurgent care (or fast track) area to facilitate use of the MPU space after-hours if needed for emergency care during peak workload periods. The new MPU would also be adjacent to the central imaging department and immediately accessible from the new customer service center that is planned near the main hospital entrance. An adjacent office suite (that could be relocated off the first floor) would provide future expansion space for the MPU as required.

CONCLUSION

Creation of the new MPU would not have been possible without the vision and strong leadership of the executive team and their facility planning consultant. Previous attempts by the organization to get input from individual department staff resulted in recommendations to simply maintain the status quo. Once the unit is operational for a year, hospital leadership will determine if there are other outpatient services that could potentially be incorporated into the MPU. For example, outpatient cardiac catheterization patients are currently transferred from the first floor to a third floor nursing unit for their recovery and outpatient chemotherapy patients receive treatment in the adjacent physician office building.

To view the actual workload analysis and room-by-room space program click here.

This article is an update of a previous post.