Chad Cleveland
Project executive, Catamount Constructors Inc., Denver
Advanced technologies in health care surgical suites are driving modernizations in design and subsequent changes in construction.
These include changes in operating room design, spatial requirements and demands on mechanical and electrical systems. For construction project success, it is critical to identify risks and minimize the impact of construction activities to return the operating room to use and revenue generation as soon as possible.
Reducing trauma to the patient by using minimally invasive techniques for surgery is a driver of these advancements. An example of this emerging technology is the hybrid operating room, which allow patients to undergo both surgical and interventional procedures at the same time. Referred to as “hybrid,” “integrated,” “universal” or “smart,” these advanced operating rooms give surgeons new flexibility by coupling traditional surgical capabilities with the latest imaging modalities.
An example of this is the new Advanced Multimodality Image Guidance Operating suite installed recently at Brigham and Women’s Hospital. In these rooms traditional operating equipment is combined with advanced imaging equipment including CT, C-Arm, ultrasound, Pet-CT and MRI that provide real time information. A provision of the interventional OR is a bigger footprint. Such rooms often combine two to three existing rooms to meet the spatial needs of the additional equipment. With AMIGO, the MRI is located in an adjacent room and can slide into the operating room via a ceiling-mounted track system.
According to an October 2015 study published by Acute Market Reports, the global hybrid OR market is expected to grow at a compound annual rate of 16.66 percent from 2015 to 2021, and 75 percent of cardiovascular surgeons are expecting to be working in a hybrid OR by 2018.
From our experience in building and renovating for these new technologies, we have identified strategies that can significantly improve project success. First, it’s essential to understand the project goals and intended use of the space to identify the risks and minimize the impacts of construction to the facility. Getting the facility back into use quickly, safely and without interruption to daily operations is the ultimate goal. Accomplishing this starts with pre-planning. Understanding patient and staff flow from pre-op to recovery, the red line protocol and the function of patient and sterile corridors will allow for the creation of the Infection Control Risk Assessment and Interim Life Safety Measures plans. The contractor should develop these plans with the facility managers of safety, infection prevention, construction and plant operations.
Meticulous scheduling is key to getting the facility operational quickly. In a recent renovation our company completed for a robotic operating room, there were modifications to the quantity and locations of monitors, power and medical gas outlets, and light fixtures. Increased boom sizes required a greater load, necessitating enhancement or full replacement of the existing structural support. Complete modifications to the existing MEP and med gas systems and the upsizing of the isolation panels also were required. Having completed many preconstruction program and design reviews, we were able to identify the work scope in advance and properly time the construction.
Often new equipment increases requirements for cooling or air exchanges, leading to potential for enhancement or replacement of the air-handling unit. In the surgical suite, there are strict infection prevention guidelines as to how the air-handling unit is tested and started, which increases the time for commissioning. Therefore, it is important to coordinate this with the infection prevention staff early as it eventually will tie into equipment installation, test and balance, and turnover.
In another example, a renovation to create a hybrid OR, the facility combined two individual operating rooms into a single, larger room. In this design, the center point of the new patient table shifted to the space that was previously between the two rooms. In operating room suite design, the space between the ORs is designed to house the main infrastructure feeding the operating rooms while the center of each room is reserved for the critical locations of lights, diffusers and equipment booms. In order to clear space for the center of the new hybrid OR, main duct, electrical and steam lines had to relocate.
In every project, several critical steps should be taken to ensure success. First is getting above the ceiling to review existing conditions and validate as-builts. It is worth the cost of off-hours investigation to identify conflicts before construction starts than to be delayed due to unforeseen existing conditions. The second step is to pay attention to owner equipment coordination. Constant communication with the vendor is critical from receipt of template for layout, to coordination with subcontractors, electrical box walks, room turn over, final connections and inspections. Tie the vendor activities, installation and training to the construction schedule. The third critical step is managing the state inspection process. Due to long review times, it is important for the design team to submit for permit early. The contractor, in concert with the owner and architect, should schedule site inspections throughout to avoid surprises at the end that can add unanticipated time to the schedule.
Construction projects for modern surgical suites requires an understanding of the precision required for these facilities, the preplanning for ICRA and ILSM, and the proper coordination of equipment vendors, inspecting agencies and mechanical and electrical system installation. Communication is key, along with recognition that every project team member must be involved from start to finish. Today’s modern ORs are complex, involve many technologies and many disciplines. A successful project requires collaboration between the designers, builders, vendors, hospital staff, physicians and IT as each plays an important role in timely project completion to provide medically advanced procedures for patients.
