OPTIMAL OPERATING ROOM DESIGN - cbparch.com

1 OPTIMAL OPERATING room DESIGN (3). OPTIMAL OPERATING room DESIGN . Cathryn Bang / . OPERATING rooms planned and built today must Surgery Department become old and must be considered to have a working lifetime modernize in order to improve the quality of measured in decades. Predictions about the details patient care. Regardless of the age of a facility, of future ORs are neither accurate nor useful. healthcare facilities must continually change in However, principles can be followed to give any order to meet patient demands, support new DESIGN a more successful working lifetime: procedures and technologies, and remain Think about how practices have changed competitive. over the last ten years and then consider how DESIGN can accommodate a like amount of change.

2 Flexibility is fundamental to robust DESIGN . Like other healthcare DESIGN , OPERATING room Participation in future technologies should DESIGN is a multi-constituency environment. be phased. Under-standing the roles of key players is an important part of success, involving: in the organization. Fundamental characteristics Steeling Committee of the desired culture must be identified at the Clinical Staff inception of the project. Organizational structure Surgical Services Managers must be congruent with the proposed function of Surgeons and Anesthesiologists the new environment. This raises questions for Administration each individual about their place in the new Contractors structure. These questions must be answered. Architects The management challenge is to: Engineers Build consensus among competing interests Equipment Planners Allocate resources Bio-medical Personnel Identify and harness existing expertise Infection Control Communicate with multiple constituencies Hospital Facilities Maintenance Change is encouraged by examining how Early clinical input is important to the success everything is done and by researching best of the project.

3 All staffs involved directly in the practice models. Enthusiasm for change can be DESIGN process must be made to realize that they developed by involving staff in data collection must also act as ambassadors to all of the staff not regarding existing conditions, data collection and able to participate directly. Who designed this analysis regarding utilization, and definition of place? are the last words planners, programmers, operational assumptions. Guiding questions architects, engineers and contractors want to hear. might include: Senior level staff should be engaged early in the What new services should the hospital process with line staff becoming involved as offer? greater levels of detail are reached. How can patient satisfaction be maximized through good departmental layout?

4 What inconveniences and inefficiencies in the current department layout might be Major projects represent an opportune time to eliminated? implement culture change - although not without drawbacks. Changing both culture and New Processes must be created before moving environment is disruptive and unsettling to many into new space. The expectation must be that OPTIMAL OPERATING room DESIGN (3). changes will be implemented from opening day. Telecom/Data Air Quality and Infection Control Each of these topics possesses its own trends During the DESIGN of Surgery Department and conventions. Each poses particular risks and project, following six topics should be significant challenges for the institution but in these DESIGN decisions: challenges lies the opportunity to develop superior Patient Needs DESIGN solutions.

5 The key characteristics are: Equipment Let s look at each of these individually Utilities before examining how they interact as DESIGN Space and room Sizes opportunities. TOPIC TREND or CONVENTION RISK/CHALLENGE OPPORTUNITY. Patient Sicker but expecting Patients are in more Gains in health of Every-larger health gains critical condition, community served, Procedures more distinction and reputation aggressive of the hospital Equipment More of it, most Increased congestion, Rethink the Mounted on carts for entrapment conventional ergonomic solutions Data More objects generate Fragments, proprietary View data as part of OR. data that needs to be systems infrastructure, as transmitted, displayed infrastructure need and recorded Utilities Expanding number of room walls as utility Find alternatives to types, increasing infrastructure no longer delivering utilities to point quantities serves well of use Space/ room Ever-larger rooms Costly, does not serve to Use "Human Factors".

6 Put needed items in approach to reorganize optimum locations the OR workplace Heating, Greater air volumes, Costly energy usage, Apply objective analysis Ventilation, empirical DESIGN rules little assurance of to improve performance Air Conditioning effectiveness and reduce cost Patients sides. In DESIGN projects, it is a good general practice Division of the PACU (Post Anesthesia to periodically and intentionally bring together Care Unit) into 10-12 bed modules. all points of view for a decision validation Planning for the use of beds instead of review - balance is the goal. In these reviews stretchers. and in the day-to-day decision making, Individually controlled lighting in each particularly where there is intense competition patient bay.

7 For resources, it becomes easy to overlook the Provisions for companions before and after patient s point of view. surgery. If patients don t have the designated Patients are sicker, and surgical aspirations are advocates, then appoint one. Never forget that all more ambitious, which combine to keep average of this effort is ultimately about the patient and inpatient case times from declining much if at all. doing the best that can be done for them. Companions are going to be guests in your waiting rooms for longer durations. In addition From the standpoint of judgments patients will to a pre-registration system which will hopefully make, the spaces most relevant to them are the speed patients through registration and on to prep intake waiting and registration spaces, the prep and holding, thought has been given to support or pre-operative space and to a less extent the for families and companions who will later help recovery space.

8 Undersized or poorly designed form the overall opinion of the quality of the pre-operative spaces can significantly impact the stay. Amenities include: throughput of OPERATING rooms. With the possible Higher Level of Finish. exception of the Perioperative Manager, it is A Business Center with desk space for patients who suffer the most stress when individuals to make calls, work on laptops, OPERATING rooms are delayed. Therefore the size, etc. capacity and efficiency of the pre and post- Sequestered Television Areas. operative spaces impact the patient experience as A Coffee and Refreshment Bar much as do finishes, lighting and color. Other Lockers large enough to hold the suitcases important characteristics of the pre and post- many patients still bring with them.

9 Operative spaces are: Video-Consult Booths to reduce travel, Patient Bays that are hard wall on three particularly for intra-operative updates. OPTIMAL OPERATING room DESIGN (3). Equipment Contemporary OPERATING rooms demand Regardless of the size of the room , the enormous amounts of power, special circuitry, limitations of doctors and nurses convenient easily a half-dozen different medical gases, data, reach and vision have not increased over the last communications, video, just to name the basics. hundred years. To be used efficiently by the As OPERATING rooms become larger, continuing to surgical team, instruments, supplies and use the walls of the room as the infrastructure to equipment must enter a zone immediately carry all of these utilities simply means that what adjacent to the OPERATING room table.

10 Anything you need is further and further away from the outside this reach zone must be remotely OPERATING room table. Draping dozens of cords operated or must be moved before being put into and hoses across the floor is neither a safe nor use. The space within reach is the most efficient workplace. Changing the physical valuable real estate in the OPERATING room . location of those utility connections requires the involvement of the contractor, creation of dust To enhance flexibility, the conventional and closure of an OPERATING room . Even the practice of instrument and equipment conventional medical gas column is limited in its manufacturers has been to place equipment on a ability to meet current demands. Materials and cart.