HCS 529 Week 3 Renovating a Building Into an Ambulatory Surgery Center Example

Turning 24,000 Square Feet of Warehouse Into Four Operating Rooms: The Renovation Plan, Code Requirements, Budget and Schedule for a Surgery Center Conversion

[Student Name]

University of Phoenix

HCS/529: Contemporary Health Care Facility Design

Week 3 Assignment

[Instructor Name]

[Date]

The health system, building, budget and schedule are composites written for a model paper; federal requirements and research come from the sources listed.

The previous paper recommended converting the empty 34,000-square-foot distribution building into a same-day surgery center holding four operating rooms, a pair of procedure rooms and 16 flexible bays, together filling roughly 24,000 of its square feet. The structural engineer's report arrived last week: the roof can carry new rooftop mechanical units if steel is added, and the concrete slab can be cut for plumbing trenches. This paper sets out the renovation plan, the codes it must meet, the systems surgery depends on and the budget and schedule.

The Building as Found

The warehouse is a single-story steel frame with 24 feet of clear height, columns spaced 40 feet apart, a concrete slab on grade, a metal roof replaced in 2018 and loading docks on the north side. It has no sprinkler system suitable for health care, limited electrical service and no plumbing beyond two restrooms. In a renovation, the building's shell is an asset; everything inside it is new.

The Layout by Zones

The plan divides the 24,000 square feet into four zones arranged front to back. The public zone at the south entrance includes a covered drop-off, waiting area, registration and a family consultation room. The semi-restricted zone in the middle holds 16 flexible preoperative and recovery bays around a central nurse station, with a separate phase two recovery lounge for patients preparing to go home. The restricted zone at the back holds the four operating rooms and two procedure rooms along a sterile corridor, with the anesthesia workroom and equipment storage. Sterile processing and clean supply sit between the operating rooms and the north loading dock.

Flows

Patients enter at the front, move to a bay, travel by stretcher through a single door to the restricted corridor and return to a recovery bay without passing through public areas. Staff enter through a separate door with locker rooms leading to the restricted zone. Soiled instruments leave each operating room through a soiled corridor to the decontamination room, move through washers into the clean assembly room, are sterilized and return to clean storage beside the operating rooms. This one-way flow from dirty to clean is the core of the sterile processing design.

Operating Rooms Sized for Joint Replacement

Because the center will perform joint replacements, each operating room is planned at about 600 square feet, larger than many rooms for shorter cases, to fit orthopedic tables, instrument sets, imaging equipment and staff. All four rooms share a standard layout so that the same equipment sits in the same place in every room, a feature supported by design research on standardization and errors (Ulrich et al., 2008).

Federal and State Requirements

Medicare's conditions for coverage require operating rooms suited in design and equipment to the cases done in them, recovery and waiting kept apart from each other and a building that meets the fire code chapters written for ambulatory health care (Centers for Medicare & Medicaid Services, 2026). A 2016 federal rule adopted the 2012 editions of the Life Safety Code and the Health Care Facilities Code for surgery centers and other providers (Centers for Medicare & Medicaid Services, 2016). The state licensing agency applies the Facility Guidelines Institute guidelines to plan review.

What the Codes Require of This Building

Because the center exceeds 10,000 square feet, it must be divided into at least two smoke compartments by a smoke barrier, so patients can be moved horizontally away from a fire without leaving the building. The whole building needs an automatic sprinkler system, a fire alarm system and exits sized for patients on stretchers. The remaining 10,000 square feet of warehouse will be separated from the center by a fire-rated wall until it is developed.

Ventilation

Operating rooms need high air change rates, filtered supply air delivered from above the surgical field and positive pressure relative to the corridor, so air flows out of the room rather than in. Sterile processing requires negative pressure in decontamination and positive pressure in clean areas. Two new rooftop air handling units with high-efficiency filters, one dedicated to the restricted zone, will serve the center, with humidity and temperature controls in each operating room.

Emergency Power and Medical Gases

Because patients will receive general anesthesia, the center needs an essential electrical system with a generator that restores power to operating rooms, life support equipment and critical lighting within seconds. Medical gas systems for oxygen, medical air and vacuum, with alarms and shutoff valves at each zone, will be installed and certified.

The Budget

The project budget totals $14.9 million, about $620 per square foot: $9.8 million for construction, $2.6 million for medical equipment, $0.9 million for information technology, $0.6 million for design and permits and a contingency of $1.0 million, about 10% of construction and equipment. In a renovation, the contingency is not a cushion; it is the budget for what the walls are hiding.

The Schedule

The schedule runs 22 months: five months of design, three months of permitting and state plan review, 11 months of construction and three months for commissioning, equipment testing, state licensing inspection and accreditation survey leading to Medicare certification. Rezoning must be approved before the permit application.

Equipment and Technology

The equipment plan includes ceiling-mounted booms in each operating room to keep cables and gas lines off the floor, integrated video for arthroscopy and endoscopy, portable imaging for orthopedic cases, two steam sterilizers and a low-temperature sterilizer for heat-sensitive instruments and flexible endoscope reprocessors for the procedure rooms. The electronic health record will be the system's existing platform, so surgeons and anesthesiologists see the same record in the hospital and the center. Wireless nurse call and real-time tracking of patients through each stage let the family waiting area display progress without names.

Infection Prevention Built In

Several design details serve infection prevention: handwashing sinks and alcohol-based rub dispensers in view of every bay, cleanable floors without joints and wall surfaces in the restricted zone, doors to operating rooms that stay closed during cases with supply passes to reduce traffic and separate clean and soiled elevators or routes, even on one floor. The infection preventionist from the main hospital will review drawings at each design stage.

Renovation Risks

Conversions carry risks new construction avoids. Hidden conditions under the slab, such as poor soil, could delay trenching. Utility capacity may require a new electrical service from the utility company, which can take months. The building's industrial neighbors may generate vibration or dust, which the design will address with filtration and vibration isolation for imaging equipment.

Conclusion

The warehouse's height, open floor and sound roof make it a strong shell for a surgery center, but nearly everything inside must be built new. A zoned layout with one-way flows, operating rooms sized for joint replacement, code-compliant fire protection and the systems surgery depends on turn the shell into a licensed facility. A $14.9 million budget and a 22-month schedule, with time for inspections, give the board a realistic plan.

References

Centers for Medicare & Medicaid Services. (2016). Medicare and Medicaid programs; Fire safety requirements for certain health care facilities. Federal Register, 81, 26872. https://www.federalregister.gov/d/2016-10043

Centers for Medicare & Medicaid Services. (2026). Ambulatory surgical services, 42 C.F.R. pt. 416. Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-416

Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H.-B., Choi, Y.-S., Quan, X., & Joseph, A. (2008). A review of the research literature on evidence-based healthcare design. HERD: Health Environments Research & Design Journal, 1(3), 61-125. https://doi.org/10.1177/193758670800100306