When planning an Ambulatory Surgery Center (ASC), especially within an existing building, there’s one thing that becomes clear very quickly: no two projects are the same. The needs of the users, the types of procedures performed, and the nuances of certification and code requirements mean it’s never a plug-and-play process. That’s why the most important step you can take before you start evaluating buildings is to engage with an experienced architectural and engineering team.
From IBC, IEBC, NFPA 101, and FGI to CMS, ASHRAE 170, IMC, IPC, AAAA, and AAAHC, the regulatory landscape can feel more like deciphering a code than following a straightforward checklist. Different jurisdictions often interpret and enforce these standards in unique ways, and what worked for a facility five years ago might not meet today’s requirements.
By engaging a design team early, you’ll gain the guidance needed to define a detailed preliminary program—one that identifies your functional needs, space requirements, and infrastructure demands. This critical step ensures that you evaluate buildings with a clear understanding of what is truly feasible, helping to avoid costly surprises down the road and setting the stage for a smoother, more successful project.
Key Questions to Answer as You Begin Evaluating Buildings:
Before you can assess whether a building is a good fit, you’ll need to outline your operational goals. Here are some essential questions to consider during preliminary programming:
The answers to these questions will guide everything from square footage targets to infrastructure requirements.
General Guidelines of What to Look for When Selecting a Site:
Once you’ve outlined your operational goals and program requirements, the next step is to evaluate whether a potential site can support them. Not all buildings are created equal, especially when it comes to healthcare infrastructure. Below are some key considerations that can make or break a site’s viability for your ASC.
Fire Protection: The building should be fully protected by a fire sprinkler system. This is a baseline requirement for most jurisdictions and essential for patient and staff safety.
Backup Power: Consult with your architect and engineer to determine whether a backup generator is required, even if one wasn’t needed in the past. Generally, any ASC that includes sterile operating rooms, procedures involving moderate to deep sedation, general anesthesia, or life-supporting equipment will require a backup generator. This ensures that critical systems—including dedicated HVAC units and essential equipment—can operate during a power outage, allowing surgeries to be safely completed and patients to be monitored through recovery.
HVAC and Generator Placement: The location of mechanical equipment and generators should be considered during the site selection process. Rooftop units must meet structural load limits and may require screening to ensure compliance. Ground-mounted equipment, on the other hand, needs adequate clearance, a suitable distance from walkways and windows, and consideration of zoning and ownership approvals. These elements can significantly impact both design feasibility and cost.
Ceiling and Plenum Heights: FGI requires a minimum ceiling height of 7'-10" in occupied areas, with 7'-6" allowed in unoccupied zones. However, surgical lighting systems often require higher clearances—8'-0" for single Cardanic lights and 9'-0" or more for dual Cardanic setups. Additionally, generous plenum heights are crucial for accommodating plumbing, HVAC, and other systems, particularly in multi-story buildings where drain lines must pass through the floor below. Some older buildings may also require a water service upgrade to meet plumbing demands.
Building Type: Business and industrial/flex spaces are generally more suitable for ASCs due to their flexibility and infrastructure. Mixed-use buildings—particularly those with residential units—can introduce added complexity, restrictions, and cost, making them less ideal.
Floor Level: Ground-floor locations are preferred and often required for facilities with multiple operating rooms or higher-acuity cases. A ground-floor suite with direct exterior egress is optimal for patient flow and emergency access.
Elevator Requirements: If the ASC is not on the ground floor, the building must have at least one elevator. For facilities where patients will be transported between floors on gurneys, the elevator must be a minimum of 5'-8" x 7'-9". In buildings four stories or taller, codes require elevators sized to accommodate a 2' x 7' ambulance stretcher.
Designing an ASC within an existing building involves far more than finding a space that “looks right.” It requires a deep understanding of clinical workflows, code compliance, and infrastructure needs, paired with early and thoughtful planning. Engaging an experienced design team from the start allows you to navigate the complexities with confidence, ensuring your facility supports high-quality care, meets all regulatory requirements, and is tailored to the unique needs of your patients and staff. With the right guidance, what starts as a challenging puzzle becomes a clear, achievable path toward a fully functional, future-ready surgery center.
