Ambulatory Surgery Centers Simplified

INNOVATION THROUGH PARTNERSHIP

Ambulatory Surgery Centers Simplified

PREFACE

In today’s rapidly evolving healthcare landscape, efficiency, innovation, and superior patient experience are paramount.

Our ambulatory surgical center (ASC), featuring four state-of-the-art operating rooms, demonstrates the unique advantages of the design-build approach. This methodology integrates planning, design, and construction into a single streamlined process, enabling faster project completion, enhanced collaboration, and cost certainty.

By utilizing multicomponent prefabrication and Design for Manufacture and Assembly (DfMA) principles, the LS3P | Thomas team can simplify and standardize components for efficient manufacturing and assembly, reduce on-site construction time, minimize disruptions such as noise and congestion, and accelerate the delivery of operational facilities. These efficiencies allow healthcare providers to meet urgent community needs more effectively while maintaining patient care standards.

The resulting patient-centered facility is designed to optimize workflows, enhance provider productivity, and prioritize the well-being of patients and families.

Natural daylight, efficient layouts, and state-of-the-art technology create a healing environment that supports comfort, safety, and operational excellence.

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Contents 04

Challenges

06

Solutions

10

Design

16

MEP Systems

20

Flexible Options

22

Insights

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Our Partnership

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01 CHALLENGES

Ambulatory surgery centers face recurring challenges: inefficient workflows, facilities that lack flexibility, and construction delays that inflate costs. As patient expectations and regulatory demands rise, the need for an innovative, adaptable solution has never been greater.

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MUSC R. KEITH SUMMEY MEDICAL PAVILION LS3P

In today’s rapidly evolving Healthcare Landscape, providers face mounting pressures to address growing patient demands, rising operational costs, and stringent regulatory requirements.

These challenges necessitate innovative, adaptable solutions that streamline facility design and construction while maintaining high standards of patient care and operational efficiency.

HEALTHCARE ACCESS

design is critical to meeting budgetary

CARE SPACE DESIGNS

There is a growing demand for

and performance goals. Effective design

Successful ASCs need to address

outpatient medical facilities across the

choices—such as modular layouts,

both patient and provider needs in

Southeast, fueled by rising populations,

efficient workflows, and sustainable

harmony. Their design should prioritize

evolving healthcare delivery models, and

materials—not only help control upfront

efficient patient flow and a comfortable,

increasing patient expectations. In North

costs but also reduce long-term

welcoming atmosphere while also

Carolina specifically, the anticipated

operational expenses, creating facilities

fostering a positive staff experience.

expiration of the Certificate of Need

that are both functional and financially

(CON) process by 2025 presents a

sustainable.

unique opportunity to address critical gaps in healthcare infrastructure.

By incorporating features that enhance staff productivity, reduce fatigue, and

ADAPTABLE PLANNING

support workplace satisfaction, these

Evolving healthcare regulations and

facilities create environments conducive

COST AND EFFICIENCY

advancements in medical technology

to seamless operations and the delivery

Healthcare organizations often face

require facilities to be designed with

of exceptional care.

financial constraints when planning

adaptability in mind. Planning for

new facilities. Striking the right balance

future needs and compliance without

between cost-effective construction,

inflating initial project costs presents a

operational efficiency, and thoughtful

significant challenge.

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02 SOLUTIONS

Ambulatory surgery centers are a valuable investment for the community – playing a crucial role in a broader network of care that supports human health and well-being. The development of an ASC involves collaboration among the healthcare system, caregivers, contractors, architects, and individuals seeking outpatient care.

COLLABORATIVE EXPERTISE

patient-centered environments tailored

This expedited approach minimizes

With over 60 successful projects

to diverse healthcare needs.

disruptions and creates a smoother,

across 11 states, the LS3P | Thomas

more seamless experience for patients,

team combines unmatched healthcare

EFFICIENCY & SPEED-TO-MARKET

expertise with a proven design-build

Efficiency is at the core of our

providers, and stakeholders.

approach. Our track record reflects our

prototype’s success. By leveraging

FUTURE-READY ADAPTABILITY

ability to deliver innovative, precision-

operationally optimized layouts,

Our modular prototype evolves with

driven solutions that exceed client

streamlined approval processes, and

healthcare needs, offering flexible,

expectations, ensuring every project

advanced prefabrication techniques, we

multi-specialty design, patient-

meets the highest standards of quality

significantly reduce project timelines

focused layouts, and balanced staff

and efficiency.

while maintaining cost certainty.

environments. It accommodates

This is achieved through meticulous

specialty-specific requirements, adapts

SIMPLIFICATION THROUGH D/B

planning, strategic vendor partnerships,

to regulations, and integrates new

Our design-build strategy streamlines

standardized components, and

technologies for a future-ready solution.

project delivery by integrating planning,

predictable material sourcing.

Scalable layouts and expansion planning

design, and construction into a single,

prioritize efficiency and compliance

cohesive workflow. By leveraging our

Additionally, proactive risk mitigation

without major modifications. Tailored

adaptable ASC prototype, which starts

strategies—such as early identification

for specialties like ENT, orthopedics,

with a baseline floorplate meeting FGI

of potential cost overruns and real-time

and ophthalmology, the prototype

minimum standards, LS3P | Thomas

budget tracking—helping projects stay

streamlines design-build with modular

eliminates complexity and accelerates

on target financially. Our prototype

configurations, optimized workflows,

timelines. This approach simplifies

accelerates development schedules by

and specialty-focused considerations.

decision-making, supports seamless

approximately three months, delivering

This forges a sustainable, adaptable

expansions, and reduces stakeholder

projects 33.5% faster compared to

solution for modern ambulatory care.

burden while creating cost-effective,

traditional design-bid-build models.

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Implement flexible design solutions that can support a multispecialty ASC.

Foster balanced work environments that support staff.

Provide functional, efficient, and patient-focused clinical areas.

Enhance operations through strategic design solutions.

Promote the overall wellness of patients, providers, and families.

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Our ASC prototype is best suited on a single-elevation site, spanning approximately three acres.

We understand that every site presents unique opportunities and challenges. The following recommendations provide a guideline for property assessment and acquisition to best support the function and layout of this prototype.

LS3P | Thomas’ approach is grounded in this understanding, allowing us to tailor adjustments during the design development phase to position proper implementation of the prototype on each site.

Considerations for Site Optimization:

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1

Secure, accessible routes for optimal mobility

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Covered drop-off zones

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Dedicated access for material loading and unloading

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Minimum overall length of route into the ASC

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Separate covered patient pick-up zone

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Generator and dumpster enclosures designed to complement the building’s exterior

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Connect accessible route to handicap parking where feasible

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Exterior signage that highlights the client’s brand

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Parking ratios tailored to ASC standards, staff needs, patient turnover, and zoning regulations

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03 DESIGN

While there isn’t a one-size-fits-all approach to ambulatory care, LS3P | Thomas has selected two footprints for our prototype, balancing operational efficiency, patient flow, and adaptability to future healthcare needs.

MODULAR DESIGN What does a healthcare facility need? It must seamlessly meet the diverse needs of patients, families, and providers while delivering high-quality care in a supportive, efficient environment. This requires a carefully designed ecosystem where every element works in harmony to enhance the overall experience and prioritize operational success.

To support these goals, our modular design incorporates standard modules for pre-operative and PACU care, enabling rooms to be used interchangeably based on patient volume and needs. Clinic areas are crafted with higher-end aesthetics to foster a welcoming atmosphere, while cost-effective materials, such as tilt-up walls and sustainable fixtures, create long-term value. At the core of this framework, a dedicated sterile area provides accessible supplies to each of the four operating rooms, and a semi-sterile corridor creates safe, defined pathways for patient transportation.

FOR MARKETING BOOKLET USE

FOR MARKETING BOOKLET USE

15,500 SF

19,500 SF OPERATING ROOM Operating Rooms

Opera

Pre-/Post Op

Pre-/P

PRE/POST OP SEMI-STERILE

CLINICAL SUPPORT Clinical Support

Decontamination/Sterilization

STERILIZATION

Staff

STAFF AREAS

Lobby

Administration

Admi

ADMINISTRATION TOILET ROOMS CIRCULATION

FOR MARKETING BOOKLET USE

Deco

Lobby (Public)

Circulation

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Clinic

Staff + Locker Rooms

LOBBY Toilet Rooms

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SEMI-STERILE

Toilet

Circu

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Our 15,500 SF option includes 4 pre-op rooms, 4 post-op rooms, 2 operating rooms,

Standard Floor Plan

and 2 procedure rooms that can be seamlessly converted into operating rooms as needed. The design also incorporates essential support spaces and staff areas to promote optimal functionality and efficiency.

ADMINISTRATION ANESTHESIA BUILDING CORE CLINICAL SUPPORT DECONTAMINATION DISCHARGE LOBBY LOUNGE / LOCKERS NURSE STATION OPERATING ROOMS PATIENT INTAKE PRE/POST OP RECEIVING / MATERIALS RECEPTION RESTROOMS SEMI-STERILE CORRIDOR STERILE CORE STERILIZERS/PACKAGING WAITING AREA

1

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OVERALL FLOOR PLAN - 15,000-SF 1/8" = 1'-0"

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Our 19,500 SF option features 8 pre-op rooms, 8 post-op rooms, and larger operating

Enhanced Floor Plan

rooms designed to accommodate a variety of procedure types. Enhanced guest and staff spaces create a spacious, boutique-style facility that prioritizes comfort and efficiency.

ADMINISTRATION ANESTHESIA BUILDING CORE CLINICAL SUPPORT DECONTAMINATION DISCHARGE LOBBY LOUNGE / LOCKERS NURSE STATION OPERATING ROOMS PATIENT INTAKE PRE/POST OP RECEIVING / MATERIALS RECEPTION RESTROOMS SEMI-STERILE CORRIDOR STERILE CORE STERILIZERS/PACKAGING WAITING AREA

A1

OVERALL FLOOR PLAN 1/8" = 1'-0"

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Pre/Post Op Rooms & Staff Support Areas

Pre-post-op rooms flank the staff core providing direct line of sight from each nurse station to patient rooms. Staff support spaces are centrally located. With a consistent layout, the pre-/post-op rooms can be used interchangeably depending on the patient volume. The wall of windows to the south allows natural daylight to flood the interior spaces.

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Operating & Procedure Rooms

By planning each procedure and operating room to be the same square footage, the conversion of a procedure to operating room is simplified. The sterile core to the north of each room offers efficient access. Additionally, this layout allows for expansion of one operating room into the sterile core without disrupting facility operations.

PHYS. ALCOVE 89 SF

SOILED 98 SF PACU 120 SF

Enlarged Operating Room & Reflected Ceiling Plan VACUUM + MED AIR 217 SF

B1

TYPICAL OR - ENLARGED PLAN 3/8" = 1'-0"

CONTROL DESK 141 SF PACU 120 SF

PRE-OP 120 SF

ANESTHESIA OFFICE 136 SF

WOMENS LOCKER 247 SF

PRE-OP 120 SF

B3

MENS LOCKER 247 SF

EQUIPMENT STORAGE 342 SF

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04 MEP SYSTEMS

Our ASC prototype has been meticulously designed to meet the unique needs of a modern healthcare environment, with a strong emphasis on efficiency, safety, and flexibility.

Each system - mechanical, plumbing, electrical, and low voltage - incorporates best practices tailored to enhance operational performance while prioritizing the well-being of patients, staff, and visitors. Informed by lessons from the COVID-19 pandemic, these designs feature heightened ventilation standards, advanced filtration options, and adaptable airflow controls, particularly for high-risk areas. This robust, code-compliant approach positions the ASC to provide safe and resilient spaces, setting a standard for future-proofed healthcare facilities. The following sections provide a detailed breakdown of each system’s specifications and intended functions within the ASC prototype.

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MECHANICAL DESIGN

Copper piping is used throughout, with

Pre-op, post-op, and PACU rooms are

The mechanical design fosters

a copper domestic riser located 5 feet

equipped with one each:

efficient, reliable, and code-compliant

outside the building for durability and

• oxygen outlet

performance. The system incorporates

reliability. Sanitary sewer systems utilize

• medical vacuum outlet

a semi-custom direct expansion air

PVC piping except in the Central Sterile

handling unit with VAV units to deliver

suite, where CPVC is specified for added

Systems for deionized and reverse

precise airflow control and optimized

resilience.

osmosis water and steam are assumed to be provided by the Owner Vendor

energy efficiency. Ventilation and exhaust systems are designed to provide

The Medical Gas System in each

and are not included in this design.

adequate airflow in critical areas such as

operating room is in accordance with

This comprehensive plumbing system

restrooms, sterilization rooms, and The

FGI minimum requirements and includes

supports the critical operational

plumbing design for the ASC prototype is

Type L cleaned and capped copper with

needs of the facility while prioritizing

tailored to meet the highest standards of

brazed wrought copper fittings, providing:

compliance and reliability.

functionality and compliance. Systems

• oxygen outlets (2)

are installed according to Code, with the

• vacuum outlets (3)

assumption of adequate water pressure

• medical air outlet (1)

on site, eliminating the need for a

• waste anesthetic gas disposal outlet

domestic booster pump.

(1)

UNC HEALTH PANTHER CREEK ASC LS3P

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WAKEMED NORTH RALEIGH SURGERY CENTER LS3P | THOMAS

ELECTRICAL DESIGN

and supports critical systems, including

power at key entrances. Electrical

The electrical system is robust and

operating rooms, HVAC equipment

rough-ins are included for future building

compliant with healthcare facility

serving the ORs, and sterilizers. Clinical

signage, while site lighting is excluded

standards. It features a 1000A single

spaces such as operating rooms

and assumed to be provided through

service fed by transformers, located

and PACU are illuminated with IES-

an owner lease-back arrangement with

within 15 feet of the building at the

recommended luminaires, promoting

the local utility. This comprehensive

power company’s discretion. Aluminum

optimal lighting for healthcare settings,

electrical design supports functionality,

feeders connect the transformers to the

while mechanical and electrical rooms

safety, and adaptability, meeting the

electrical room, with healthcare-rated

use industrial-grade LED fixtures.

unique needs of a modern ambulatory

MC cable utilized outside the Surgery Suite as permitted by code.

surgery center.

Means of egress are designed to meet NFPA 101-2018 standards, and exterior

Emergency power is supplied by a

lighting includes decorative canopy

300kW diesel generator, positioned

lighting and 10 exterior wall sconces,

adjacent to the main electrical room,

two of which are backed by emergency

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UNC HEALTH PANTHER CREEK ASC LS3P

LOW VOLTAGE DESIGN

This streamlined approach allows

The low voltage design forges a seamless

flexibility for customization while creating

integration of essential systems to

the infrastructure to meet the facility’s

support operational efficiency and

technological needs.

communication. The general contractor will provide pathways, including raceways, backboards, and outlet boxes, to accommodate structured cabling systems. These pathways are designed to support the installation of critical systems such as nurse call, security, and other low voltage requirements, which will be implemented by the Owner’s preferred vendor.

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05 FLEXIBLE OPTIONS

In evaluating the baseline design of the standard floor plan, which includes four operating rooms along with pre/postsurgical spaces, several potential upgrades—outlined on the adjacent page—have been identified to significantly enhance the facility’s overall functionality and long-term performance.

These options are thoughtfully designed to meet specific client needs—such as budget, site constraints, and operational requirements—while improving patient care through streamlined clinical layouts that enhance accessibility and reduce wait times. Optimized workflows are achieved with strategically placed support spaces, clear staff pathways, and modular configurations that minimize inefficiencies. Durability is infused through the use of highquality, resilient materials and construction methods that withstand the rigors of daily healthcare operations. Additionally, these designs offer flexibility for future expansions, allowing for evolution with changing demands.

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Operational Requirements

Plumbing

Openings

» Upgrade procedure rooms to operating rooms

» Nitrous Oxide, Carbon Dioxide or Nitrogen/instrument air

» Manual sliding ICU entrances instead of curtains

» Enlarge one operating room

» DI/RO water for sterilization

» Stainless steel wall protection in ORs

Finishes

Electrical/Low Voltage

HVAC

» Ceramic wall tile in locker rooms

» UV light sterilization ceilings in ORs

» Pre-fabricated operating room ceilings

» Pre-manufactured laminate headwalls in in PACU and pre/post-op

» Low voltage cabling for all systems

» UV light sterilization in ductwork

» 48-hour emergency generator run time

» Hydronic HVAC upgrade

» Wood cloud ceilings instead of ACT at nurse stations

» Lightning protection systems

» BAS remote access control » Active return control » Venturi valves for ORs and sterile areas

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06 INSIGHTS

Our ASC prototype is the culmination of insights and lessons learned from a range of successful healthcare projects.

By analyzing key elements—such as workflow optimization, patient-centered design, and innovative construction strategies—we’ve taken the best practices from these projects to create a highly adaptable, efficient, and forward-thinking solution. These foundational projects have informed our approach, allowing the ASC prototype to address the unique challenges of modern ambulatory care.

Sterile cores promote efficiency and safety

Ample daylighting elevates the patient experience and encourages healing

Spacious operating rooms transform the provider experience

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Research-based room orientation, size, optimal table positioning, anesthesiologist positioning, and finishes

LEAN-driven clinic layout design, including on-stage/offstage exam room layouts

Finishes and fixtures reflect the high quality of care while curating a welcoming environment for healing

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07 OUR PARTNERSHIP

LS3P and Thomas Construction Group have been a trusted team for over 20 years. Our diverse portfolios illustrate a comprehensive, human-scale approach to healthcare design. This enduring partnership has led us to create an innovative ASC prototype that is not only efficient, but thoughtfully designed to meet the evolving needs of both patients and providers.

Chris Thorn LEED AP, CHC THOMAS CONSTRUCTION GROUP HEALTHCARE SECTOR LEADER E CTHORN@THOMASCONSTRUCTIONGROUP.COM P 910.662.4092

With nearly two decades of experience in acute care construction, Chris joined Thomas from the Pacific Northwest, where he led significant projects such as a $260 million Trauma II healthcare facility.

As Thomas’ Healthcare Sector Leader, Chris plays a pivotal role in guiding projects from feasibility planning through construction. With extensive experience and a proven track record, Chris ensures that every phase is executed with precision, safety, and efficiency. His expertise strengthens the team’s ability to deliver innovative solutions, meet complex healthcare requirements, and exceed client expectations, solidifying our commitment to excellence in healthcare construction.

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Steve Freyaldenhoven AIA, NCARB LS3P HEALTHCARE PRACTICE LEADER E STEVEFREY@LS3P.COM P 336.579.5367

Steve serves as LS3P’s firmwide Healthcare Practice Leader, based in the Greensboro office. Steve brings over 25 years of experience to the firm in a broad range of healthcare designs including specialty clinics, long-term care facilities, renovations of entire hospital departments, and the design of new free-standing medical centers.

His extensive knowledge of regulatory guidelines, codes, best practices, and trends in the profession makes him an outstanding leader in this sector.

Trusted partners, nationwide.

THOMAS HEALTHCARE PROJECTS THOMAS & LS3P HEALTHCARE PROJECTS LS3P HEALTHCARE PROJECTS

At Thomas Construction Group, we are ‘Always Building’—structures, relationships, and legacies.

As a contractor with local roots and national reach, we excel in healthcare construction, delivering exceptional results through innovation and teamwork. Our mission is to exceed client expectations by fostering partnerships, leveraging expertise, and prioritizing quality and collaboration. This focus on people, process, and excellence positions us as a trusted industry leader.

LS3P is an architecture, interiors, and planning firm with 61 years of design excellence. Rooted in the Southeast with national reach, we combine large-firm resources with small-firm relationships. Guided by our vision, we create community-enriching architecture through design excellence, innovation, and collaboration. With extensive experience in healthcare design, LS3P delivers innovative solutions to enhance functional efficiency and long-term flexibility. Our holistic approach focuses on creating adaptable, inspiring spaces that promote healing.

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A Trusted Partnership Delivering Design-Build-Finance Solutions for Healthcare Facility Development Combining deep expertise to develop efficient, future-forward facilities that support advanced patient care.

Always Building