Designing an Ambulatory Surgery Center: A Friendly Architect’s Guide
Building an Ambulatory Surgery Center (ASC) is exciting, and perhaps a little intimidating. If you’re an owner, developer, or surgeon planning a new ASC, this guide breaks down what to expect, what to avoid, and how the right project team can save you from future headaches (and possibly a CMS surveyor’s raised eyebrow).
We’ll cover trends, common pitfalls, and even walk through two hypothetical ASCs — one designed by an inexperienced team, and one led by someone who actually knows what an SPD is and why it shouldn’t be the size of a broom closet.
Why ASCs Are a Big Deal Right Now
ASCs are booming. Patients like them because they’re fast, efficient, and not a hospital. Surgeons like them because they control their schedule. Owners like them because the return-on-investment is real — if the building is designed well.
In the southeastern U.S., especially states like Florida, Tennessee, Georgia, and North Carolina, ASC development is climbing fast. It’s a competitive landscape, and good design gives you a major operational advantage.
1. Things Owners Absolutely Need to Know Before Starting
A. Regulations: Your First Plot Twist
Before you start picking paint colors, you need to figure out:
Do you need a Certificate of Need?
Is Medicare certification part of your plan?
Does your state have a licensure process that requires 14 binders of documentation and a blood sacrifice?
CON can make or break the schedule. Medicare’s Conditions for Coverage can make or break your sanity.
B. Case Mix: What Are You Actually Doing in This Building?
Don’t let surgeons design an entire addition because they might buy a robot in the next five years. But also don’t design so tightly that you can’t bring in new service lines later.
Plan your ORs and procedure rooms for flexibility. ENT today, ortho tomorrow, GI on Tuesdays, ophthalmology when the moon is full.
C. Sterile Processing: The Most Important Room Nobody Talks About
The SPD is the unsung hero of every successful ASC. If the SPD is too small, too hot, too underpowered, or too poorly located, your cases will back up faster than the interstate during holiday travel.
This is also the room most often:
under-valued
under-designed
under-sized
and under-budgeted
Don’t worry — your architect is basically an SPD evangelist.
D. HVAC & Pressure Relationships: It’s Not Just Hot or Cold
Outpatient surgery has strict air-change and pressure requirements. Get this wrong and CMS surveyors will politely write down notes that ruin your week.
Architects and engineers should coordinate this early, so you don’t end up ripping ceilings out later.
E. Flow, Flow, Flow
ASCs live or die by how quickly (and safely) patients move through:
Check-in → Pre-op → OR/Procedure → PACU → Discharge
The southeast is full of ASCs that run beautifully — and others where patients wander like confused mall shoppers looking for the food court.
Your architect should be designing for:
Short staff travel distances
Clean/dirty separation
Easy observation
Happy patients (and happy families waiting with their coffee)
2. Common Pitfalls
A. Forgetting Storage Exists
Storage grows. Always.
If you think you have enough, you don’t. If you have too much, congratulations — you don’t.
B. Not Planning for Power
Robotics, imaging, tower equipment — it all needs juice.
If your ASC’s power can barely handle the coffee maker, there’s a problem.
C. Treating IT Like an Afterthought
Modern ASCs rely on:
EMRs
Video routing in ORs
Telehealth
Secure Wi-Fi everywhere
If you lack conduit routes, you’ll be fishing cables through walls like it’s a reality show challenge.
D. Skipping Mock Surveys
Please don’t wait until a week before opening to act out a pretend CMS walkthrough.
3. How a Good ASC Architect Makes Your Life Easier
A. Regulatory Assistance
We provide assistance through:
CON Application
Facility Guidelines Institute requirements
We’re basically the tour guide saying, “Don’t step there, it’s a regulatory quagmire.”
B. Efficiency Fanatic
We’re obsessed with:
adjacencies
turnover time
staff circulation
clean/dirty paths
instrument flow
Why? Because five minutes saved per turnover is money in your pocket.
C. Cost & Future-Proofing
Your architect helps you:
Size systems for today and tomorrow
Select finishes that are durable but still attractive
Avoid expensive change orders
Experienced ASC architects know exactly where to invest and where not to waste money.
4. Trends in ASC Design (Especially in the Southeast)
A. Bigger Case Mix, More Complex Procedures
Orthopedic and even cardiac procedures are moving outpatient. ASCs are becoming more robust, not less.
B. Repurposed Retail Buildings
In the Southeast, developers love turning old retail boxes into modern medical spaces. It works — but only with surgical-grade planning.
C. Infection Control Upgrades
Post-COVID, airflow and finishes matter more than ever. There’s a reason every ASC architect owns at least three books on HVAC they never intended to read.
D. Staff Experience Matters
Locker rooms, break areas, daylighting — these affect recruiting and retention. A well-designed staff suite is cheaper than chronic turnover.
Case Studies: The Tale of Two ASCs
“Sunshine Surgical Center” — Designed by a General Architect
Everything looked great in 3D renderings. But reality?
SPD was too small — instruments were stacked like Jenga.
PACU sightlines required staff to lean awkwardly around corners.
Incorrect pressure relationships caused a failed survey.
They needed an electrical service upgrade halfway through construction.
The CON application lacked essential documentation and added four months.
The owner saved a little on design fees and lost a lot in delays and change orders.
“Palmetto Coast ASC” — Designed by an Experienced ASC Architect
This team started with workflow mapping, detailed programming, and a regulatory checklist.
The result?
Smooth patient flow
Right-sized SPD with room for future growth
Extra electrical capacity for future robotics
A clean survey
Turnover times faster than the owner’s existing facility
Staff actually liked working there
The project finished on time, under budget, and the surgeons bragged about it on LinkedIn.
Final Thoughts
Building an ASC is a team sport.
When owners, surgeons, architects, engineers, and contractors collaborate early, the process is smoother, and the building performs better.
Bring an architect who understands regulatory requirements, clinical flow, and the realities of ASC operations. It’s cheaper, faster, and infinitely less stressful than fixing problems after construction starts.