Building the Hybrid OR of the Future

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Martina Gallagher
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1 Building the Hybrid OR of the Future The Hybrid Operating Room: Architectural Issues The American Association For Thoracic Surgery - May 1-5, 2010 Toronto, Ontario, Canada 90 th Annual Meeting Charles Martin, AIA - Principal

2 PLANNING FOR ADAPTABILITY & FUTURE FLEXIBILITY * * Apple iphone 3G Handheld. but isn t there an app for that?

3 IMPACT OF PLANNING DECISIONS Programs Buildings Land Time (Years)

PLANNING FOR CHANGE - SPACE NEEDS Then 1980 s 1990 s OR 400-500 Sq. Ft. PACU Support Departmental Space 2,000 Sq. Ft. / OR Now OR/Hybrid OR 600-800-1,000 Sq.

4 PLANNING FOR CHANGE - SPACE NEEDS Then 1980 s 1990 s OR Sq. Ft. PACU Support Departmental Space 2,000 Sq. Ft. / OR Now OR/Hybrid OR ,000 Sq. Ft. 60 Pre op Area (Am Admits/ Outpatients) PACU Stage II Recovery Much More Support! Departmental Space 3,200-4,500 Sq. Ft. / OR

+/- 34 PLANNING FOR CHANGE SURGICAL / INTERVENTIONAL PLANNING MODULES Universal OR Module: Accommodate future conversion to image guided procedure rooms 17 ft 34 ft 34 ft 34 ft 34 10 ftm 34 ft 34 ft

5 +/- 34 PLANNING FOR CHANGE SURGICAL / INTERVENTIONAL PLANNING MODULES Universal OR Module: Accommodate future conversion to image guided procedure rooms 17 ft 34 ft 34 ft 34 ft ftm 34 ft 34 ft Clean Core Storage (650 sf) Equipment Storage & Material Support Electronics ( sf) Material Support Control Room & Electronic Equipment Storage (900+ sf) Scrub & Gurney Scrub & Gurney Scrub & Gurney Corridor +/- 34 +/- 34 +/- 34 Universal OR Cardiac Cath/Endovascular/ Hybrid OR Specialty OR

6 Planning For Change The Universal OR Zone Flex Zone OR Use Equipment Stor First Use Zone Zone Flex Zone IR/Cath/ Hybrid Use Control Room Subsequent Use Equipment Storage Control Room Floor Plan Electronic Utility Equipment Flex Zone

7 Equip Storage Zone Equip Storage Zone Control Zone Control Zone PLANNING FOR CHANGE SURGICAL / INTERVENTIONAL PLANNING MODULES Universal OR Modules Located on a Traditional Central/Clean Core: - Lower-Half of 10 Room Department (Traditional Central/Clean Core Design) - Future Migration To Image Guided Rooms or Larger Hybrid OR s - Avoid Disruption of Ongoing Operations or Cannibalization of an Existing Room Central or Clean Material Core Storage Storage Electronics Electronics Storage Surgical (650 sf) Surgical (650 sf) Cardiac Cath / Endovascular (650 sf) Hybrid OR (1,000 sf) Specialty (650 sf) Scrub/Gurney Scrub/Gurney Scrub/Gurney Scrub/Gurney Scrub/Gurney Corridor +/- 34 +/- 34 +/- 34 +/- 34 +/- 34 Universal OR s Cardiac Cath/Endovascular/ Hybrid OR Use Specialty OR

same size/configuration Rooms same-handed Reduce errors/rework CHALLENGES Changes in organization, procedures,

8 PLANNING FOR CHANGE UNIVERSAL PROCEDURE ROOM Clean Core OPPORTUNITIES Ultimate flexibility Scheduling, patient & physician satisfaction, higher room utilization Accommodating future technology Standard work (reduce errors) Rooms same size/configuration Rooms same-handed Reduce errors/rework CHALLENGES Changes in organization, procedures, behaviors, culture Management and storage of specialized equipment Multiple specialists share more common resources Staff cross-training

PLANNING FOR CHANGE: OTHER CONSIDERATIONS Future Flexibility & Minimizing Disruption: Modular Ceiling Structural Systems ISSUES Each OR a unique design Fixed elements make coordination mistakes

9 PLANNING FOR CHANGE: OTHER CONSIDERATIONS Future Flexibility & Minimizing Disruption: Modular Ceiling Structural Systems ISSUES Each OR a unique design Fixed elements make coordination mistakes costly Time and costs of disruption CHALLENGES Accommodate new technologies Increasing OR capability & efficiency Satisfy surgeon & staff needs Improved return on initial capital investment Standardize HVAC, Electrical & IT infrastructure reduce renovation costs Speed to market

PLANNING FOR CHANGE: OTHER CONSIDERATIONS Future Flexibility & Minimizing Disruption: Modular Ceiling Structural Systems BENEFITS Standardization of MEP & structural systems among OR s More efficient

10 PLANNING FOR CHANGE: OTHER CONSIDERATIONS Future Flexibility & Minimizing Disruption: Modular Ceiling Structural Systems BENEFITS Standardization of MEP & structural systems among OR s More efficient use of ceiling space increases future flexibility Reduced construction time & expense during remodel IMPLICATIONS More intensive planning This system may drive additional standardization of room operations options (room zoning, circulation and user ergonomics) Active management of systems

11 PLANNING FOR CHANGE: OTHER CONSIDERATIONS Future Flexibility & Minimizing Disruption: Modular Ceiling Structural Systems

interventional, surgery, imaging Demand for more space and more flexible building infrastructure systems Advances in imaging, MIS and

12 BLURRING OF THE BOUNDARIES CHALLENGES IN PROCEDURE DELIVERY Changes in operations & reimbursement Increase productivity and improve the patient experience Better utilize investments in equipment, technology and human resources Interventional Services interventional, surgery, imaging Demand for more space and more flexible building infrastructure systems Advances in imaging, MIS and catheter based technologies Enhance recruitment, retention & business development opportunities Emphasis on LEAN strategies, safety and collaboration

13 DEPARTMENTAL PLANNING CONSIDERATIONS Planning the Organization and Culture: What Does This Mean? Interventional Radiology Surgery Traditional Model General Surgery (MIS/Robotics) Cardiac Cath Labs Interventional Cardiology Traditional Organization (Separate Autonomous Models) CV/Specialty Surgery (MIS/Robotics) Interventional Radiology (Endovascular, Image Guided)

14 DEPARTMENTAL PLANNING CONSIDERATIONS Planning the Organization and Culture: What Does This Mean? Interventional Services Model Interventional Radiology Surgery Cardiac Cath Labs Interventional Radiology Interventional Cardiology Shared Support Interventional Services Organization (Single Integrated Model) CV/Specialty Surgery General Surgery

15 DEPARTMENTAL PLANNING CONSIDERATIONS Planning the Organization and Culture: What Does This Mean? General Surgery Prep Hskp Cardiac Cath Recv Lckrs MM Recp Admin IT Interventional Radiology Shared Support CV/Specialty Surgery Interventional Services Model MIS/Robotics

16 WHAT S THE PAYBACK? BANNER ESTRELLA CASE STUDY Space Utilization Area Comparison Interventional Radiology Surgery Interventional Radiology Surgery FU's DGSF FU's DGSF OR's/Endoscopy Proc Rms , ,360 8% Departmental Cath Labs , IR Rms , Interventional 0 General Interventional Rad / US , Cardiology 6,616 MR Cardiology Rms , ,770 CT Rms , ,260 NM Rms , ,090 Area Savings NI Cardio Rms , ,003 Shared MM & Staff Support 0 18,589 Shared Level 1/2 Prep/Recv ,632 Shared Central Recp 0 3,467 Traditional Model Total , ,787 Interventional Services Model

OPERATIONAL CHALLENGES: HYBRID OR Lessons Learned Physician involvement across disciplines is key Integration of anesthesia, perfusion, robotics.

17 OPERATIONAL CHALLENGES: HYBRID OR Lessons Learned Physician involvement across disciplines is key Integration of anesthesia, perfusion, robotics. Surgical policies and procedures table flexibility Managing hemodynamics Appropriate lighting location, types, levels and controls Flat panel displays (pendants and/or gantries) Equipment and utilities support (boom types and locations) Data integration including images Charting nurse is manager of information and image systems

18 SUMMARY: INVEST IN MOCK-UPS

19 SUMMARY: INVEST IN TRAVEL AND INDUSTRY-WIDE PERSPECTIVES

20 SUMMARY: INVEST IN FUTURE FLEXIBILITY

21 The Best In Healthcare Is Yet To Come Seattle New York London Boston Los Angeles Columbus San Francisco Shanghai Beijing Dubai Moscow

Hybrid Operating Room or Hybrid Procedure? Staff Safety

Hybrid Operating Room or Hybrid Procedure? Staff Safety Gabriel Bartal MD, FCIRSE, FSIR Dept of Diagnostic and Interventional Radiology, Meir MC, Kfar-Saba, Affiliated to Tel-Aviv University, Tel-Aviv,