(B-0270) Day Surgery Procedure Unit
(B-0270) Day Surgery Procedure Unit
(B-0270) Day Surgery Procedure Unit
Preamble
Policy Framework
Description of Unit
PLANNING
Operational Models
Operational Policies
Planning Models
Functional Areas
Functional Relationships
DESIGN
Access
Parking Requirements
Disaster Planning
Infection Control
Environmental Considerations
Space Standards and Components
Safety and Security
Finishes
Fixtures and Fittings
Building Services Requirements
General
Non-Standard Components
APPENDICES
Schedule of Accommodation
Functional Relationships Diagram
Checklists
References and Further Reading
INTRODUCTION
Preamble
601801 270 .1.00 This Guideline aims to promote the development of optimal environments for
the conduct of a range of surgical and endoscopic procedures performed on
a day only and extended care basis, and the pre and post procedural
management of patients whilst enabling the adoption of emerging
technologies, changing models of care and accommodating day-to-day
fluctuations in caseload and the corresponding fluctuations in staff.
Description
601802 270 .1.05 ENDOSCOPY
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Endoscopy literally means “looking into” and endoscopic equipment can be
used to visualize the following areas some but not all of which are suitable
for a Day Procedure Unit.
- Nose (rhinoscopy);
- Lower respiratory tract (bronchoscopy).
There are two types of bronchoscopes: flexible (fibreoptic) and rigid. Flexible
bronchoscopy is often performed under local anesthesia with the patient
awake. Rigid bronchoscopes may be employed to remove foreign bodies or
to place stents. Such procedures are done under general anesthesia.
- Cervix (colposcopy);
- Uterus (hysteroscopy);
- Fallopian tubes (Falloscopy).
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Policy Framework
601808 270 .2.00 NSW Health policies that impact on the management of procedural and
surgical services and the operation of Day Procedure Units include:
What a difference a day can make - Same Day Surgical and Endoscopic
Procedures Policy, May 1999.
This guideline for a Day Surgery / Procedures Unit describes the facilities
necessary for the treatment and care of patients undergoing a range of
endoscopic and/or surgical procedures with provision to deliver Inhalational
and other anaesthetic agents and provide accommodation for the reception,
pre-procedural preparation and post-procedural recovery of patients.
Provision of an Extended Care Unit will affect the facility requirements and is
discussed below.
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- age;
- obesity;
- social circumstances;
- post-discharge carer support;
- transport and distance from the clinic”;
- expected level of patient compliance / willingness.
PLANNING
Operational Models
601812 270 .4.00 HOURS OF OPERATION
The unit may also include angiography rooms and facilities for day medical
procedures.
The inclusion of day surgery will need to be addressed and may depend on
case mix, possibility of full-time sessions and the surgeons’ preference for
incorporating day cases into an inpatient list.
Major centres may be able to justify dedicated units for individual specialties
such as Gastroenterology, Respiratory Medicine and Urology and will
depend on the level of service of each specialty and a viable throughput. In
these instances the Unit will probably also include all the offices for medical,
nursing and support staff.
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the main Operating Suite unless a separate Day Surgery Unit is envisaged
and viable.
Depending on hospital policy and location, the Unit may also incorporate the
angiography suite to facilitate provision of anaesthetic services, recovery
and access to the main Operating Unit in case of emergency.
Operational Policies
601819 270 .5.00 GENERAL
The following are examples of policies that may be specific to a Day Surgery
/ Procedures Unit. Users must be guided by their own policies in their own
health facility.
Project staff may refer to the following Australian and New Zealand College
of Anaesthetists Guidelines:
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PS9: Guidelines on Conscious Sedation for Diagnostic, Interventional
Medical and Surgical Procedures, 2005.
There will be a central processing room in the unit for all scope cleaning and
processing. Staff from individual clinical disciplines may wish to undertake
their own cleaning and assembly. In hospitals without a dedicated
Endoscopy Unit, the processing function may be performed in the Sterile
Services Unit.
The process is critical for effective infection prevention and control and is
addressed in detail in “Infection Control in Endoscopy, 2nd Edition,
Gastroenterological Nurses College of Australia Inc (GENCA).
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cared for in an adult unit, there must be a specific area for them and their
parents/carers, and separate sessions and/or facilities should be provided
including a separate small waiting area for smaller children and parents and
a few beds in Recovery designed so that they can be screened during
paediatric sessions with facilities and privacy for breast feeding.
Transfer to the procedure / operating room will depend on the age but may
be carried, walking, trolley, tricycle / small car. Storage will need to be
provided for special child-friendly transfer items.
The design should separate patients awaiting their procedure from those
awaiting discharge. Waiting patients, particularly children, should not be
exposed to frightening and distasteful sights and noises and distractions
should be provided in the form of music, television, magazines and toys for
children.
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appropriate i.e. hangers for gowns to prevent cracking of lead.
An office will be required for the Unit Manager and CNC and any other staff
permanently based in the Unit. In addition there will need to be write-up
workstations for visiting medical and nursing staff.
Provision of offices for the medical staff will depend on whether or not the
Unit itself is dedicated to a single specialty to form e.g. an integrated
Gastroenterology Unit located elsewhere in the hospital.
Operational Models
601832 270 .6.00 OPTIONS
601833 270 .6.05 If free-standing, the Day Surgery / Procedure Unit must be located in a
community which has a large enough population to support it and is not
already serviced by similar health care facilities. An acute bed hospital
should be within a reasonable distance (less than one hour drive) of the
centre for transfer of patients in cases of emergency.
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Paramount in its design is a patient flow pattern that ensures maximum
efficiency from admission to pre-op area to operating rooms to recovery and
finally discharge, and the flow path should be unidirectional.
Functional Areas
601835 270 .7.00 FUNCTIONAL ZONES
The Day Surgery / Procedure Unit comprises the following Functional Zones:
- Reception / Administration;
- Perioperative Area (unless separate Extended Care Unit established);
- Procedural Area;
- Recovery Area;
- Extended Recovery;
- Staff Areas;
- Day Medical Unit (if collocated).
Provides for reception and admission of patients to the Unit, with general
oversight of day-to-day operations, control of entry and exit from the Unit
and completion of general administrative tasks (eg files management,
clerical admissions/discharges, statistics compilation, typing). Areas may
include:
- Reception Desk;
- Administrative Office/s and support including the office for the Unit
Manager;
- Consult / Exam / Interview rooms (for consents etc);
- Public Waiting;
- Public Amenities including accessible toilet for people with disabilities.
Facilities comprise:
- Patient Amenities - toilets, showers, lockers and change rooms;
- Examination room with en suite and discreet small sub-waiting area (for
completion of bowel preparations for colonoscopies);
- Changed Waiting - chairs and trolleys - 3 places per room;
- Staff base and medications cupboard/safe;
- Access to Dirty Utility (depending on size and layout, may be able to share
with Recovery).
Ideally all rooms will be of the same size for flexibility and Endoscopy
Room/s should be fitted out as for an Operating Room (refer Standard
Components) with regard to GA capability.
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A scrub basin should be provided outside the entrance to the Procedure
Rooms.
Facilities include:
- Induction Rooms / Bays (may be optional);
- Endoscope Reprocessing Room;
- Clean-up Room (for Operating Rooms);
- Scrub Bay/s;
- Equipment Store / Bays;
- Linen Trolley Bays.
If paediatric services are provided, the Recovery Room should cater to the
needs of parents/attendants.
The Australian Day Surgery Council recommends four trolley spaces (each
space 9 square metres) for every operating / procedure room with a
minimum of 2.5 metre central corridor between facing bays to facilitate the
movement and manipulation of trolleys.
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“bypass” 1st stage recovery.
The discharge lounge must have large comfortable chairs with adequate
space between them for small tables. There should be a minimum of three
chairs for each procedure room with low level partitions to separate male
and female patients.
Centres which have a high volume of more rapid turn over patients with
shorter first stage recovery e.g. endoscopy, cystoscopy, ophthalmology,
plastic surgery, will require larger discharge lounges with more chairs to
avoid overcrowding.
The exit from the discharge area should be separate from the admission
entrance.
It must be noted that NSW Health is moving away from the terminology “23
hour care” to “extended care”.
“23 Hour Care Units are based on the premise that the majority of surgical
care can be administered within a 24-hour period in a non-ward
environment. Patients can be admitted, prepared for the surgical procedure,
then monitored and provided with appropriate pain relief post-surgery before
protocol based discharge occurs within 24 hours.”
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acute bed hospital accommodation.
Functional Relationships
601846 270 .8.00 EXTERNAL
DESIGN
Accessibility
601848 270 .9.00 INTERNAL
The general staff of the hospital and visitors should only be able to access
the Unit as far as the Reception / Entry area. Only authorised staff and
visitors should be able to enter the Unit beyond this point.
The majority of patients will be day stay but the unit will need to be designed
for access and management of inpatients both elective and emergency. If a
free-standing unit, there must be policies and procedures in place for
transfer of patients to a nearby acute hospital in an emergency.
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facility;
- clearly signposted directions to the area;
- provision of car parking for visitors to the area within easy access of the
main entrance to the facility.
Parking
601850 270 .10.00 Consideration should be given to accessible drop-off and parking for people
with disabilities and ambulance parking.
For staff parking, refer to Part C Clause 790 of these Guidelines for further
information.
Disaster Planning
601851 270 .11.00 The role of the Day Surgery / Procedure Unit within the context of the health
care facility’s disaster plan should be defined early in the planning process.
Infection Control
601852 270 .12.00 The infectious status of many patients admitted to the Unit may be
unknown. All body fluids should be treated as potentially infectious and
adequate precautions should be taken.
Environmental Considerations
601853 270 .13.00 ACOUSTICS
The ambient noise level should not exceed the recommendations of AS/NZS
2107 - Acoustics - Recommended design sound levels and reverberation
times for building interiors.
As far as practicable the design of the unit should incorporate external views
and natural light. This is especially so in the case of rooms such as the
Waiting Area, Pre-Operative Holding Area, Recovery and the Staff Lounge.
When external views and natural light are introduced into patient areas, care
must be taken to minimise glare and ensure privacy is not compromised.
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Sun penetration should be controlled to exclude glare and heat gain or loss
If daylight does enter the Procedure Rooms then consideration may have to
be given to the provision of black out facilities when procedures require a
controlled level of lighting.
Refer to:
The design of the Unit should seek to prevent injury and reduce the number
of potential hazards that may include:
- exposure to infectious substances;
- exposure to radioactive materials;
- exposure to anaesthetic gases;
- exposure to decontamination agents, particularly glutaraldehyde;
- injury from machines;
- injuries related to manual handling;
- fire safety including fire doors and adequate egress should be addressed.
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601860 270 .15.05 SECURITY
Finishes
601861 270 .16.00 GENERAL
As with most Units, the selection of finishes for the Day Surgery / Procedure
Unit is influenced by both durability and infection control issues.
Ceramic tiles are not recommended as a wall finish due to their potential to
compromise infection control. These tiles are also susceptible to damage
from trolleys and if cracked or broken individual tiles may be difficult to
replace.
Due to the high number of trolley movements in the Unit, wall protection is
an important issue, and wall and corner protection is required wherever
there is the potential for damage from trolleys.
In the Procedure Room, the colour should be such that there is sufficient
contrast to find small dropped items.
Non-slip sheet vinyl with welded joints and coved skirtings is considered
appropriate throughout the Unit.
Some substances heavily stain sheet vinyl. This should be considered when
choosing a colour and pattern for the floor material.
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601864 270 .16.15 CEILING FINISHES
Within the context of the Health Facility Guidelines and the Room Data and
Room Layout Sheets in the associated Health Facility Briefing System
(HFBS), Fixtures and Fittings can be described as follows:
Fixtures: Refers to fixed items that require service connection (eg electrical,
hydraulic, mechanical) and includes basins, light fittings, clocks, medical
service panels etc (but excluding services equipment such as theatre
pendants).
Fittings: Refers to fixed items attached to walls, floors or ceilings that do not
require service connections such as curtain and IV tracks, hooks, mirrors,
blinds, joinery, pin boards etc.
Also refer to Part C of these Guidelines and to the Room Data Sheets (RDS)
and Room Layout Sheets (RLS) for further detailed information.
The provision of appropriate building services to the Unit, and easy access
to these from the unit, is essential for efficient and safe operation.
These are described in more detail in both Room Data and Room Layout
Sheets.
Emergency call in all holding area, all procedure rooms and in Recovery.
Patient / nurse call at all recovery beds and in the pre-procedure holding
area.
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Oxygen, suction, scavenging, medical air and nitrous oxide will be provided
in all Procedure Rooms.
Oxygen and suction will be required to all bays in 1st stage Recovery and
shared between trolley bays in 2nd stage recovery.
In rural and remote units, gas cylinders may be required if gases cannot be
piped.
Refer to Part B, Section 90 of the Guidelines for the text and to separately
itemised Room Data and Room Layout Sheets
www.healthfacilityguidelines.com.au
Non-Standard Components
601872 270 .20.00 ENDOSCOPE REPROCESSING ROOM
CLEANING ZONE
“Dirty” bench with sink of a material impervious to solution. Large enough to
adequately hold a coiled full length colonoscope. Hot & cold water and
compressed air outlet. Adequate bench space for holding equipment
awaiting chemical disinfection.
DISINFECTION ZONE
Rinsing may be automatic or manual. Digital timers. Automated Flexible
Endoscope Reprocessors (AFERs) or manual disinfectant sink or container
for soaking plus rinsing sink contained within a fume extraction cabinet &
timers. Purge with compressed air. Specially designed container plus
rinsing sink placed in a fume cabinet. An ultrasound tank will be required for
accessories and small items. Cleaned scopes must be rinsed with sterile
water. An area contiguous with the disinfection zone should be provided for
drying the rinsed scopes.
CLEAN ZONE
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Clean assembly bench and endoscope storage cupboard.
CONSIDERATIONS
- handbasin;
- storage for personal protective clothing;
- waste disposal.
APPENDICES
Schedule of Accommodation
601873 270 .21.00
601874 270 .21.05 DAY SURGERY / PROCEDURES UNIT - Entry / Waiting / Reception /
Administration
TOILET - ACCESS yes 1x5 1x5 Add baby change table as necessary. Refer to
AS 1428.
RECEPTION yes 1 x 10 1 x 10 1 - 2 staff
OFFICE - SHARED (MEDICAL AND yes 1 x 12 1 x 20 2 and 4 workstations for visiting staff attending
NURSING WRITE-UP ROOM) unit for sessions
MEETING/EDUCATION/GROUP yes 1 x 12 1 x 15 Patients & Staff
ROOM
601875 270 .21.10 DAY SURGERY / PROCEDURES UNIT - Patient Exam / Prep / Waiting
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Component Area sqm Area sqm
2 rooms 4 rooms
GENERAL CLEAN-UP ROOM yes 0 1x7 Optional for surgical instruments processing
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RESUSCITATION TROLLEY BAY yes 1x2 1x2
LINEN TROLLEY BAY yes 1x2 1x2 Add 1 sqm if blanket warmer included
EQUIPMENT STORE yes 1 x 12 1 x 16 With power points for recharging pumps etc
DISCOUNTED CIRCULATION % 35 35
Functional Relationships
601879 270 .22.00 A diagram showing key functional relationships is attached.
Checklists
601880 270 .23.00 For planning checklists, refer to Parts A, B, C and D of these Guidelines.
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http://www.gesa.org.au/members_guidelines/endoscopy_ps/endoscopy_stan
dards.pdf
601882 270 .24.05 Fibre-optic bronchoscopy in adults: a position paper of The Thoracic Society
of Australia and New Zealand, R Wood-Baker, J Burdon, A McGregor, P
Robinson and P Seal, Internal Medicine Journal, 2001; 31: 479-487.
601883 270 .24.10 Day Surgery in Australia, Report and Recommendations of the Australian
Day Surgery Council of Royal Australian College of Surgeons, Australian
and New Zealand College of Anaesthetists and The Australian Society of
Anaesthetists, Revised Edition, 2004.
http://www.medeserv.com.au/anzca/publications/adsc_handbook.pdf
601884 270 .24.15 NHS Estates Schedules of Accommodation v2.0: HBN52V1A - Accom. for
Day Care, Vol. 1: Day Surgery Unit, 2 Theatres.
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FUNCTIONAL RELATIONSHIP DIAGRAM – DAY SURGERY / PROCEDURE UNIT
The following diagram sets out the relationships between zones in a Day Surgery / Procedure Unit.
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