Planning, Designing & Implementing a Modern OR
How can you bring your vision to reality? Here’s some ideas to help ensure that your OR construction project meets the current and future needs of your surgeons, OR nurses and other departments while coming in on time and on budget?On September 19, 2006 Surgical Products, in association with STERIS Corporation, presented a live, educational and interactive webcast entitled From Vision to Reality: Planning, Designing and Implementing a Modern OR. Based on positive viewer feedback and requests for further information, we are revisiting that theme to bring you some of the main points that were covered in the presentations and subsequent discussion.
The recent advances in surgical technology and techniques have greatly improved patient care by reducing procedure and recovery time, as well as increasing patient and staff safety. In addition to these benefits, though, the same advances in surgery have also put a strain on many operating rooms, which may have been designed and built decades earlier. The accommodation of the myriad of new surgical systems and devices, the every growing number of patients and the need for more rapid turnaround times can pose a significant challenge to any healthcare facility.
The planning and building of new, state-of-the-art modern operating rooms is one way to address these issues. Once again, many operating rooms in existing facilities were initially setup to meet the needs and technology that were prevalent in the 1960s and 1970s. Much has changed since then. Most modern medical equipment currently used in one procedure after another today is designed to be integrated into a connected and centrally controlled OR. In addition to newer surgical instrumentation and systems, the modern OR has to incorporate computers, overhead monitors, imaging equipment and information sharing systems on top of the traditional table and lighting systems. For older ORs this can lead to a very cluttered and inefficient work environment for surgeons and the rest of the medical staff.
Whether redesigning an existing OR or preparing to build a new one, among the most important steps is setting up an extensive design team. In the end, an effective and efficient OR is one that will consistently meet the needs of all those that use the space. A good design team working together from the start can go a long way to ensuring that everyone’s concerns are taken into consideration and can cut down on the likelihood of unnecessary or superfluous design features that can take up valuable space and require reworking later.
A prime example of an effective design team can be seen in the OR of the Future (ORF) Project that is being carried out as Massachusetts General Hospital in Boston, MA. Facilitated by the Center for Integration of Medicine and Innovative Technology (CIMIT), the ORF Project is, in essence, a living laboratory designed to explore the new medical technologies and techniques that are being developed for minimally invasive surgery. The Project involved the building of a modern operating room as well as the continued study of the impacts of new technology and perioperative workflow on patient outcome, OR processes and staff satisfaction.
The design team that was that was set up for the ORF Project brought together representatives from the whole spectrum of those that would be involved in building, equipping and using the OR. The team included consultants from outside the facility such as surgeons and staff from MIT and Harvard who had studied the new technologies and best practices in the healthcare environment, as well as construction managers and contractors with experience in healthcare architecture. They were joined by equipment manufacturers, hospital administrators, the actual medical staff (surgery, anesthesia, nursing and technicians), data and communication engineers and even patient advocates. The interaction between all of these different specialties ensured that all areas of concern would have a voice and input into the planning and design process.
One of more beneficial aspects of a design team such as the ORF Project had was having the equipment manufacturers on hand early on in the planning stages. By working with the surgeons and equipment providers from the start, the architects and contractors knew in advance what type of equipment the room would need to accommodate and even the size of the tables, surgical systems, lights and booms that would be in place once the OR was complete. Once the decisions were made on the makes and models of the capital equipment, a mock-up could be made allowing any spatial constraints and communication/electrical infrastructure issues to be worked out in advance. That helped to avoid any unpleasant surprises when it came time for the actual equipment to be moved in.
Of course, an efficient layout and the most advanced equipment does not automatically make for an effective and efficient modern OR, though they are undoubtedly important in maximizing positive patient outcomes and decreased turnaround times. In the course of planning and implementing the new OR, though, it is also important to look at the whole patient care process in order get most out of the surgical suite and the staff.
One important planning step is to take a serious look at the traditional processes that are currently employed in the entire spectrum of patient care, because any problems and inefficiencies in patient handling, room turnaround and staff or OR downtime can easily be transferred over to a new OR.
In looking at their own patient care process, the ORF Project design team at Massachusetts General Hospital saw some problems and bottlenecks that would often contribute to non-operative time. In planning the ORF, they addressed these concerns not simply with a more efficient architectural design, but also by implementing additional personnel and process changes, and by organizing a system based on parallel processing.
On the architectural end, the ORF was designed to accommodate induction, the actual surgical procedure and early recovery in an almost assembly line type of fashion. What helped to increase case flow and eliminate downtime was that all of these steps in the process could be going on simultaneously, with one patient being prepped while the OR was being set up and the prior patient was transferred to an early recovery room.
To help facilitate this new efficient system, the MGH staff added personnel to streamline the process. Rather than losing time with handoff after handoff throughout a case, MGH arranged for a single perioperative nurse to provide door-to-door continuity of care. In this system, the same nurse who checks and preps the patient also stays with them throughout the procedure and early recovery and transports him/her to the PACU.
In the end, with the introduction of the new architecture and technology, institution of parallel processing and the streamlined continuity of care, MGH saw not only a 50 percent decrease in OR downtime, but also a five percent reduction in overall procedure time.
Another consideration that can help speed turnaround, and also make things easier for the staff and less traumatic for the patient, is implementing newer technology and capital equipment that reduces or eliminates the need for patient transfers. There are currently a few systems in place in American hospitals, and even more in European hospitals, in which the patient remains on the same table surface from pre-op straight through to PACU.
Certain systems of this kind utilize a single lightweight surgical table that can be used to transport the patient throughout the facility, then functions as the operative platform as well. One of the major benefits of these systems is that they can often incorporate portable booms or equipment transport accessories that allow critical care and monitoring equipment to be moved along with the patient wherever he/she may go without disconnecting.
Other systems consist of a detachable table surface that can be easily and effortlessly shifted from a mobile base to a fixed docking station in the OR. Once again, the patient remains on the same surface and can transported throughout the facility. The only transfer required is to the fixed stand, but that can be accomplished without any lifting of the patient by the staff.
Naturally, the planning, design and eventual building of a modern operating room is an enormous undertaking. The suggestions and ideas discussed here only begin to scratch the surface of all that needs to be considered when engaging in a project of this nature. Nonetheless, these ideas can at least help to build a framework and provide and starting point for discussions. In the end the most important thing to remember is to listen to those who are going to be affected by the new, modern OR directly; specifically, the medical staff and the patients.
The Surgical Products Webcast, From Vision to Reality: Planning, Designing and Implementing a Modern OR, which was broadcast September 19, 2006 is currently available for free on-demand viewing on our website at www.surgicalproductsmag.com/modernor. The webcast is sponsored by and presented in association with STERIS Corporation, a worldwide leader in quality products for the healthcare market. STERIS’s extensive product line includes surgical and critical care systems, patient handling and transport products, sterilization equipment and supplies, instrument care and cleaning products and skin care supplies.