14.

0 Day Surgery/ Procedure Unit

14.1 Introduction

14.1.1 Description
A Day Surgery/ Procedure Unit is where operative or endoscopic procedures are performed
and admission, procedure and discharge occurs on the same date. It comprises one or more
Operating Rooms, with provision to deliver anaesthesia and accommodation for the immediate
post operative recovery of day patients.

The range of procedures that may be undertaken in a Day Surgery/Procedures Unit may
include:
 Surgical procedures, particularly ENT, Dental, Plastic Surgery, Ophthalmology
 Endoscopy - gastrointestinal, respiratory, urology;
 Electroconvulsive Therapy (ECT) for psychiatric inpatients
 Day Medical Procedures including intravenous infusions and minor treatments

14.2 Planning

14.2.1 Operational Models

The range of options for a Day Surgery/ Procedure Unit may include:
 a stand alone centre, fully self contained
 a dedicated fully self-contained unit within a hospital
 a Unit collocated with a specialist clinical service such as Gastroenterology or Respiratory
Medicine , within an acute hospital
 a Unit collocated with the Operating Unit with shared facilities.

If the facility is part of an Acute Care Hospital or other Medical Facility, services can be
shared, as appropriate to minimise duplication.

14.2.2 Functional Areas

The Day Surgery/ Procedure Unit may consist of a number of Functional Zones:
 Entry/ Reception/ Administration and Waiting areas
 Perioperative Area (provides for admission on the day of surgery), including patient
change areas, toilet and lockers
 Procedural Area
 Recovery Area ( this may also include extended recovery areas where patients are
discharged within 24 hours)
 Discharge Lounge
 Staff Amenities
 Day Medical Unit (if collocated).

ENTRY / RECEPTION/ WAITING AREAS

A covered entrance for picking up patients after surgery shall be provided. The Entry may be
a shared Outpatient Facility and shall include:
 Reception and information counter or desk
 Waiting areas that allows for the separation of paediatric and adult patients, if organised
Paediatric Services are provided
 convenient access to wheelchair storage
 convenient access to public toilet facilities
 convenient access to public telephones

ADMINISTRATIVE AREAS
General and individual offices shall be provided as required for business transactions, records

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and administrative and professional staff. These shall be separate from public and patient
areas with provision for confidentiality of records.

Enclosed office spaces shall be provided for:

 Administration and consultation
 Manager / Nurse Unit Manager as required
Offices are to comply with Standard Components.

CLINICAL RECORDS
A secure room shall be provided with provision for storage, recording and retrieval of clinical
records. If geographically appropriate, and if the Day Procedures Unit is part of, or attached to,
an acute hospital, the general clinical records facility might be used in lieu of a dedicated and
separate room.

HOLDING AREA
A Holding Area may be provided where gowned patients enter after changing and wait for
their procedure. Additional holding areas may be provided for seated patients before an
operation or procedure. Such an area must have access to nurse call services.

The Pre-operative Holding area shall be provided with the following minimum requirements as
appropriate to the proposed service:
 A patient trolley or patient seating
 Privacy screening
 Handbasins with liquid soap and paper towel fittings
 Patient nurse call/ emergency call buttons with pendant handsets and indicators
 Medical gases including oxygen and suction and power outlets to each bed

OPERATING/ PROCEDURES ROOMS

The design of the Operating / Procedure Rooms must allow for adequate space, ready
access, free movement and demarcation of sterile and non sterile zones. Operating Rooms
are to comply with Standard Components.
OPERATING ROOM/S FOR ENDOSCOPY
The number and operation of Operating Rooms for Endoscopy shall be as determined by the
Service Plan.

Room size may vary, dependent upon:

 The use of video equipment
 Electrosurgical laser treatment
 Fluoroscopy
 Multiple endoscope activity
 Multiple observers
 The use of X-ray (image intensifying)

Where basic endoscopy is to be performed, the room size shall be no smaller than 36 m2.
Where video equipment is used the room size should be 42 m2. Larger sizes, where possible,
are recommended for flexibility and future developments. The ceiling height shall be 3000 mm.

Operating Rooms for Endoscopy shall be fitted out as for a Minor Operating Room, for
example, it will be suitable for general anaesthetic with appropriate medical gases, power,
lighting, air-conditioning and ventilation. Staff assistance call shall be provided. Consideration
shall also be given to the special requirements of laser equipment

A clinical scrub up basin shall be provided outside the entrance to the Operating Room/s for
Endoscopy.
Direct access to the Clean-up Room is recommended.

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Impervious wall, floor and ceiling treatments are essential for ease of cleaning.

PATIENT CHANGE AREAS

Separate areas shall be provided where outpatients can change from street clothing into
hospital gowns and be prepared for surgery, convenient to the Waiting Area. The patient
change areas shall include Waiting Rooms and lockers. Design of Change Areas is to
facilitate management of patient lockers, patient property and keys.

PERI-OPERATIVE UNIT
Where Day Procedures (day only surgical service) are provided within the same area as
Inpatient Acute Surgery (shared facility), the design shall consider the need to separate the
two distinct functions at the incoming side. The design shall also preclude unrelated traffic
from the Day Procedures Unit and the Operating Unit.

PREPARATION ROOM
A Preparation Room may be required for patients undergoing certain procedures such as
Endoscopy or Ophthalmology.

If included, the Preparation Room should include:

 Handbasin - Clinical
 Bench, and cupboards for setting up of procedures
 Adequate space for procedures equipment trolleys
 Examination couch
 Patient privacy screening
RECOVERY AREAS
In larger facilities it is often considered desirable to have a three stage recovery area. The first
stage involves intensive supervision, the second stage has changing facilities in more casual
surroundings and in the third stage, the patient is fully mobile and is awaiting discharge.
Supervision of the patient is vital at each stage.

If Paediatric Surgery is part of the function, the Recovery Room shall provide for the needs of
parents/attendants.

Recovery areas will require:

 Staff station with a centrally located resuscitation trolley
 Linen Bay
 Clean Utility
 Dirty Utility
 Store room

Stage 1 Recovery
The number of bed/trolley spaces in the Stage 1 Recovery Area will be dependent upon the
nature of surgery or procedures performed as outlined in the Operational Policy and the
proposed throughput. As a minimum, 1.5 bed/trolley spaces per Operating Room shall be
provided.

Stage 2 Recovery
Stage 2 Recovery Room may be provided as required to accommodate:
 Patients who have regained consciousness after anaesthesia but require further
observation
 Patients who have undergone procedures with local anaesthetic.

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The patient is required to remain under observation until ready for discharge.

Stage 2 Recovery areas can be further described as follows:

 Stage 2A: Provision of patient trolley bays Patients in this area may recover in
recliners/chairs. A ratio of two chairs (minimum) to each Operating/ Procedure room, in
addition to the above bed requirement, is considered appropriate.
 Stage 2B: Provision of patient recliners. This area is also referred to as a Discharge
Lounge or Stage 3 Recovery. Patients are ambulant, dressed and may await discharge in
comfortable chairs. The lounge will require access to patient refreshment facilities and
patient toilets.

External windows are to be provided in Stage 2 Recovery

Minimum space requirement is three bed/ trolley/ chair spaces per Room and some
comfortable seating for ambulant patients.

14.2.3 Functional Relationships

EXTERNAL
The Day Surgery/ Procedure Unit will have functional relationships with the following units
 Operating Suite;
 Pre-Admission Clinic;
 Transit Lounge.
AMBULANCE ACCESS
A discreet pick-up point, preferably under cover, shall be provided for the transfer of patients
to and from the Day Surgery/ Procedure Unit.
CAR PARKING
Adequate car parking facilities with convenient access needs to be provided.
INTERNAL
Within the Unit, key functional relationships will include:
 Unidirectional patient flow from arrival at Reception, through holding, Procedure Rooms,
Recovery rooms, then to the Peri-operative Unit, Inpatient Unit, Lounge areas and
discharge to home;
 Separation of clean and dirty traffic flows
 Staff visibility of patient areas for patient supervision and safety

14.3 Design

14.3.1 General
Pre-operative and post-operative patient facilities can be located together as required.

14.3.2 Environmental Considerations

ACOUSTICS
Design should consider reduction of the ambient noise level within the unit, particularly waiting
areas.

Acoustic privacy treatment will be required to:

 Consulting / interview rooms
 Operating/ Procedure Rooms

Please refer to Part C, 9.2 “Acoustic Solutions for Healthcare Facilities”

NATURAL LIGHT
The design of the unit should incorporate external views and natural light as far as possible,

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particularly to Waiting Areas, Pre-operative and Recovery areas.
It is recommended that external views and natural light are provided in staff areas such as
Staff Rooms and Offices and areas where staff are confined to one location e.g. Reception,
Clean-up Rooms.

When external views and natural light are provided in patient areas, care must be taken to
minimise glare and ensure privacy is not compromised. Sun penetration should be controlled
to exclude glare and heat gain or loss.

If Procedure Rooms include external windows, provision of controlled level of lighting during
procedures may be required.

14.3.3 Safety and Security

Security measures will include the following:
 Controlled access to Procedural and staff areas
 Security and safe storage of drugs

14.3.4 Building Services Requirements

RADIATION SHIELDING
Radiation shielding to be recommended by AERB safety standards will be required in all
procedure rooms where imaging will occur.

14.4 Components of the Unit

The Day Surgery/ Procedure Unit will contain a combination of Standard Components and
Non-Standard Components. Provide Standard Components to comply with details in the
Standard Components described in these Guidelines. Refer also to Standard Components
Room Data Sheets and Room Layout Sheets.

14.4.1 Non Standard Components

ENDOSCOPE STORE

Description and Function

The Endoscope Store may be provided to store a variety of cleaned and decontaminated and
sterile endoscopes, ready to use.

Location and Relationships

The endoscope store will be located immediately adjacent to the endoscope processing room.

Considerations
Endoscopes will be stored in appropriately ventilated cabinets. Air supply to this room should
be HEPA filtered to prevent contamination of clean endoscopes.

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 14.5 Schedule of Accommodation

14.5.1 Day Surgery / Procedure Unit Generic Schedule of Accommodation

Schedule of Accommodation follows and assumes a 2 room and a 4 room suite that
may incorporate day surgery. The schedule will need to be amended in accordance
with the requirements of the Service Plan.
Provision of Offices, Workstations and support areas will be dependent on the
Operational Policy and service demand and may vary from the Schedule of
Accommodation.

DAY SURGERY / PROCEDURES UNIT - Entry / Waiting / Reception / Administration

ROOM / SPACE Standard 2 rooms 4 rooms Remarks

Component Qty x m2 Qty x m2
PATIENT WAITING yes 1 x 20 1 x 30

PATIENT WAITING - FAMILY yes 1 x 25 1 x 50

TOILET - PUBLIC yes 2 x 3 2 x 3

TOILET - ACCESSIBLE yes 2 x 5 2 x 5 Add baby change table as

necessary
RECEPTION yes 1 x 10 1 x 10

CLERICAL WORKROOM 1 x 9 1 x 12 1 – 2 staff

STORE - PHOTOCOPY / STATIONERY yes 1 x 8 1 x 10 1 and 2 staff respectively

STORE - FILES yes 1 x 4 1 x 6 Include stationery recycle bin

OFFICE – SINGLE PERSON yes 1 x 9 1 x 9 Unit Manager

OFFICE - SINGLE PERSON yes 1 x 9 Day Procedure Unit Clinical

Nurse Specialist
OFFICE - SHARED (MEDICAL AND yes 1 x 12 1 x 20 2 and 4 workstations for
NURSING WRITE-UP ROOM) visiting staff attending unit for
sessions
MEETING / EDUCATION / GROUP yes 1 x 12 1 x 15
ROOM

DAY SURGERY / PROCEDURES UNIT - PATIENT EXAM / PREP / WAITING

ROOM / SPACE Standard 2 rooms 4 rooms Remarks

Component Qty x m2 Qty x m2
CONSULT / EXAM / INTERVIEW ROOM yes 1 x 12 2 x 12 May also be used for medical
student training
SUB – WAITING (ENDOSCOPY) yes 1 x 2 1 x 4 For bowel preps

PREP ROOM (GASTRO) 2 x 9 2 x 9 Bowel preps

ENSUITE (TO PREP ROOM) yes 2 x 5 2 x 5

PATIENT CHANGE / LOCKERS - yes 2 x 10 2 x 15

MALE / FEMALE
PATIENT TOILET yes 2 x 4 2 x 4

ACCESSIBLE TOILET / SHOWER / yes 2 x 7 2 x 7 Similar to Toilet - Accessible

CHANGE similar
BAY - LINEN TROLLEY yes 1 x 2 1 x 2 Gowns etc.

"CHANGED" WAITING - CHAIRS yes 1 x 12 1 x 20 refer to Waiting-Sub

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ROOM / SPACE Standard 2 rooms 4 rooms Remarks
Component Qty x m2 Qty x m2
“CHANGED” WAITING - TROLLEY BAY yes 2 x 10 2 x 10 Similar to Patient Bay -
similar Holding;
STAFF STATION yes 1 x 10 1 x 14 To oversight changed waiting;

DAY SURGERY / PROCEDURES UNIT – PROCEDURES AREA

ROOM / SPACE Standard 2 rooms 4 rooms Remarks

Component Qty x m2 Qty x m2
OPERATING ROOM - GENERAL yes 2 x 42 4 x 42 Able to rotate bed through 360
degrees; provide Operating
Room-Minor if Operating
Room-General not required
OPERATING ROOM - MINOR yes 2 x 36 4 x 36 Able to rotate bed through 360
optional optional degrees
CLEAN-UP ROOM - SHARED SCOPE yes 1 x 12 1 x 16 If possible, direct access from
REPROCESSING Endoscopy Rooms
ENDOSCOPE STORE 1 x 4 1 x 6 Special cupboards

SCRUB BAY yes 1 x 6 2 x 6 Shared between rooms

CLEAN-UP ROOM yes 1 x 7 for surgical instruments

processing
BAY - MOBILE EQUIPMENT yes 2 x 2 4 x 2 X-ray units etc

BAY - LINEN yes 1 x 2 1 x 2

DAY SURGERY / PROCEDURES UNIT – RECOVERY

ROOM / SPACE Standard 10 bays 20 bays

Component Qty x m2 Qty x m2
STAFF STATION yes 1 x 10 1 x 14

CLEAN UTILITY yes 1 x 9 1 x 12

DIRTY UTILITY / DISPOSAL ROOM yes 1 x 12 1 x 14

RESUSCITATION TROLLEY BAY yes 1 x 2 1 x 2

BAY - LINEN TROLLEY yes 1 x 2 1 x 2

PATIENT BAY - RECOVERY STAGE 1 yes 1 x 12 1 x 12 Children; Neg/neutral air-

ENCLOSED conditioning for patients post-
similar bronchoscopy.
PATIENT BAY - RECOVERY STAGE 1 yes 7 x 12 14 x 12

PATIENT BAY – RECOVERY yes 6 x 10 12 x 10

STAGE 2
BEVERAGE BAY yes 1 x 4 1 x 4

DISCHARGE LOUNGE (3RD STAGE yes 1 x 18 1 x 36 Patient Lounge; screened

RECOVERY) similar chairs; 3sqm per chair
INTERVIEW ROOM yes 1 x 9 1 x 9

STORE - EQUIPMENT yes 1 x 15 1 x 20 With power points for

recharging pumps etc
DISCOUNTED CIRCULATION 35% 35%

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DAY SURGERY / PROCEDURES UNIT - STAFF AMENITIES

ROOM / SPACE Standard 2 rooms 4 rooms Remarks

Component Qty x m2 Qty x m2
STAFF LOUNGE / BEVERAGE yes 1 x 24 1 x 30

STAFF TOILET / LOCKERS - MALE yes 1 x 10 1 x 14 Full lockers - adjust mix as

required
STAFF TOILET / LOCKERS - FEMALE yes 1 x 10 1 x 14 Full lockers - adjust mix as
required

Please note the following:

 Areas noted in Schedules of Accommodation take precedence over all other areas noted in the FPU.
 Rooms indicated in the schedule reflect the typical arrangement according to the Role Delineation.
 Exact requirements for room quantities and sizes will reflect Key Planning Units identified in the service plan and the
policies of the Unit.
 Room sizes indicated should be viewed as a minimum requirement; variations are acceptable to reflect the needs of
individual Unit.
 Office areas are to be provided according to the Unit role delineation and staffing establishment.
 Staff and support rooms may be shared between Functional Planning Units dependant on location and accessibility to
each unit and may provide scope to reduce duplication of facilities.

14.6 Functional Relationship Diagram

14.6.1 Day Surgery / Procedure Unit Functional Relationship Diagram

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14.7 References and Further Reading

 Australasian Health Facility Guidelines. (AusHFG Version 3.0), 2009; refer to website
www.healthfacilitydesign.com.au
 Guidelines for Design and Construction of Health Care Facilities; The Facility Guidelines
Institute, 2010 Edition.
 Design Guidelines for Hospitals and Day Procedure Centres, Department of Human
Services Victoria, 2005
 Health Department Western Australia, Private Hospital Guidelines, 1998.

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