As demand for outpatient surgical care continues to grow, the need for Ambulatory Surgery Centers (ASCs) has surged. Across the country, healthcare providers are turning to an innovative solution: repurposing existing retail buildings into high-performance surgical facilities. While this approach maximizes real estate opportunities and accelerates project delivery, it comes with a unique set of engineering and design considerations.
At EMA, we’ve partnered with clients on multiple ASC projects, including the Vascular Medicine & Surgery Center in North Richland Hills, the Lifeline Vascular Care Dialysis Access Center in Tyler, and the Methodist Surgery Center in Keller (currently nearing completion). Through these projects, we’ve learned that converting retail spaces into ASCs requires creativity, coordination, and a deep understanding of healthcare facility requirements.
Making the Most of Real Estate
Location is a key driver of ASC success. In competitive healthcare markets, visibility, accessibility, and branding play a significant role in attracting patients. Repurposing retail spaces allows providers to secure prime real estate, but it often pushes the limits of existing buildings.
For example, exterior equipment such as HVAC units and generators requires substantial space, yet many retail sites are constrained in space. This can force engineers and architects to get creative with equipment placement while balancing site lines, city requirements, and parking needs. In fact, every parking space matters; zoning requirements may already be tight, and losing spaces to accommodate mechanical systems can be a significant challenge.
Understanding Each ASC’s Unique Requirements
No two surgery centers are alike. The types of procedures performed greatly impact the design of HVAC, medical gases, and electrical systems. Early conversations with medical professionals are essential to align on requirements.
At the North Richland Hills Vascular Medicine & Surgery Center, we coordinated closely with doctors whose specific preferences exceeded minimum code requirements. Temperature, humidity, and even staff comfort during lengthy procedures influenced how we approached system design. This early alignment helped ensure that the facility would not only meet regulatory standards but also enhance staff performance and patient care.
Upgrading Existing Utilities
Most retail spaces lack the robust infrastructure required for surgical environments. Early coordination with utility providers is critical. In the Tyler Lifeline Vascular Care project, upgrades to electrical, water, and gas services were essential. We also coordinated with civil engineers for the installation of a new fire sprinkler system, which was not initially present in the building.
To reduce site footprint and long-term maintenance costs, we often explore options like natural gas emergency generators. With AHJ approval, these can be a cost-effective solution while still meeting strict reliability standards.
Overcoming Limited Interior Space
Retail spaces typically weren’t designed to house the complex MEP systems required for an ASC. This often means:
+ Tight ceiling spaces with limited room for ductwork and piping
+ No existing medical gas systems
+ No dedicated emergency electrical rooms
+ The need for additional rated barriers to ensure room pressure relationships
At the Keller Methodist Surgery Center, we faced the challenge of integrating sterilization equipment, water treatment systems, and new medical gas infrastructure within the limited building footprint. Careful placement of systems ensured OR functionality wasn’t compromised, minimizing risks from leaks, vibrations, or noise while preserving patient safety and infection control.
Navigating Strict Codes and Regulations
Healthcare facilities must meet stringent standards, and ASCs are no exception. Texas Health and Human Services (THHS) imposes ASC-specific requirements (Chapter 508) little room for exceptions based on existing conditions. For instance:
+ HVAC intakes must be at least six feet above ground, often requiring special curbs.
+ Exhaust and plumbing vents must be kept at least 25 feet from HVAC intakes.
Balancing compliance with cost-effectiveness is an ongoing challenge. Not every system can be upgraded, yet non-compliance during inspections is a serious risk. Our team helps clients navigate these requirements while aligning design choices with both budget and operational needs.
Moving Healthcare Forward
Repurposing retail spaces into ASCs presents exciting opportunities for healthcare providers to expand access, enhance visibility, and reduce construction timelines; however, it also requires thoughtful engineering and careful coordination across various disciplines.
At EMA, we’re proud to help clients transform challenging spaces into state-of-the-art surgery centers. By leveraging our healthcare expertise, we deliver solutions that not only meet codes and standards but also support better outcomes for patients, providers, and communities.
