SMART DESIGN: The Benefits of the Integrated OR

Advanced. Hybrid. Efficient. Tailored. Smart.

The same words you might hear a designer use to describe a modern loft apartment also apply to the integrated operating room. Marketers have used them all to describe these high-tech ORs, which combine surgical capabilities with the latest imaging modalities. Like a compact city dwelling, these ORs are high functioning in small spaces. They allow direct access to x-ray, CT, MR and other diagnostic equipment, which traditionally has been located in interventional radiology suites and cath labs. Having that equipment on-hand means the patient does not have to be moved during surgery where imaging is required. When that task is eliminated, so are a plethora of risks and inconveniences, and a world of advanced surgery possibilities opens.

Barbara Anderson, RN, MSN, an associate partner with Zimmerman Gunsul Frasca (ZGF) Architects in Seattle, Wash., brings a unique perspective to the topic of OR integration. In recent years, she has focused heavily on integrating lean thinking into the hybrid OR design process in order to maximize efficiency and improve patient outcomes.

“Once you bring imaging capabilities into the surgical environment, you have the capability to perform minimally invasive vascular and cardiac procedures in a hybrid OR,” she says. ‘The clinical outcomes are far superior to an open procedure.”

ENABLING MORE MINIMALLY INVASIVE PROCEDURES

A report published by the Millennium Research Group predicts growth in the OR integration market of approximately 15 percent annually between now and 2015. A primary driver of this growth, Anderson says, is the fact that new technologies are enabling less invasive approaches to many types of surgeries, especially cardiac and vascular.

“With surgical specialists, radiologists and cardiologists performing both diagnostic and therapeutic procedures in a sterile operating environment, the boundaries are blurring between departments, staff, procedures, equipment and recovery spaces that have traditionally been separate,” says Anderson. “As a result, operating room design continues to evolve to support these new procedures and technologies.”

Jeff Dunkley, the director of global training for Berchtold Corporation, which delivers integrated OR designs and equipment, says that integrated hybrid ORs have become more common over the past five to seven years. He defines a hybrid or integrated OR as one serving both diagnostic and surgical functions, in which all the different equipment is designed to work together in harmony with each another and with the staff. “The result is better patient care and more efficiency in the hybrid room.”

He believes the biggest challenge in successful OR integration involves integrating traditional cath lab imaging equipment with OR equipment. “When designed properly, the hybrid suite will eliminate costly patient transfers back and forth between the cath lab and the OR. The patient is diagnosed, treated and examined post-operatively in one location.”

POSITIVE CLINICAL OUTCOMES

Anderson stresses the potential for more positive clinical outcomes as one of the main benefits of hybrid ORs. These benefits are especially pronounced when hybrid ORs are used in the treatment of aortic aneurisms.

“There can be many complications when aortic aneurisms are performed as an open procedure,” says Anderson. “There is huge fluid loss and the possibility of post-op blood clots, as well as a high possibility of other clinical complications. Post-op, patients are usually transported directly to the ICU, and the overall patient recovery time is typically six to 12 months, depending on the status of the patient. But when this procedure is performed in a minimally invasive hybrid OR, complications are drastically reduced and clinical outcomes are improved.”

Anderson points to research that has shown clear benefits from designing adaptable environments that integrate surgery and imaging services. These benefits include reduced morbidity (1.2 vs. 4.8 percent), shorter hospital stays (3 to 4 days vs. 9 days) and shorter recovery time (30 days vs. several months).

Robert Popilock, the strategic manager for alliances and hybrid ORs at STERIS Corporation, a global leader in surgical and critical care technologies, agrees, noting that integrated OR devices can help shorten hospital stays by enhancing the quality of minimally invasive procedures due to greater visual acuity.

“We are seeing a movement toward multidisciplinary and minimally invasive procedures that synergize the benefits of imaging and surgical sciences,” says Popilock. “The hybrid OR makes it possible to combine two different procedures in the same room, at the same time. Bringing imaging, robotics and navigation into the hybrid OR is truly advancing patient care.”

Popilock points out the paradox that many hospitals today face as they strive to reduce procedure times without sacrificing quality. At the same time, they are dealing with pressure to decrease costs and improve quality indicators for the most challenging patients. “The ability to perform image-guided minimally invasive procedures under the safety net of a sterile environment is very beneficial,” he says.

THE EQUIPMENT AND THE PEOPLE SIDES

When it comes to the practical aspects and challenges of OR integration, Anderson breaks the discussion into two main components: the equipment/technical aspects and the people aspects. The major equipment impact on a hybrid OR is the decision regarding the imaging equipment. “Often, clinicians benefit from site tours before making this decision,” says Anderson.

Other equipment components include the location of the surgical table, lights and equipment booms. “Coordination of these functional requirements is driven by the types of procedures the client intends to perform in these rooms, both today and in the future,” says Anderson. “It involves resolving the spatial relationship between the equipment and staff flow needed for both open and closed procedures.”

Retrofitting existing (especially older) facilities to create hybrid ORs can be challenging, Anderson notes. “Technical coordination of the room can be complicated by the constraints of the existing size and dimensions of the space, mechanical systems and spacing of the column grid. Floor to ceiling heights must be adequate to house everything that is needed, including several booms, surgical lights and the mechanical systems needed for air exchanges to meet OR codes.”

But you can’t get caught up in the equipment and technical aspects of hybrid ORs and forget to the address the people side of the equation. “There is no dispute that our healthcare system is very fragmented today,” says Anderson. “The imaging department and the OR are traditionally separate entities that reside in different locations in the hospital, and rarely have they needed to collaborate on the clinical side. So facilitating a collaborative relationship can be a big cultural challenge.”

The new 680,000 square foot tower that ZGF designed for Providence Regional Medical Center in Everett, Wash., includes a 28-room integrated platform, where teams were cross-trained. “One of the first steps was to have imaging techs spend time in the OR and surgical nurses spend time in the imaging department so they could see and understand each others’ worlds,” says Anderson. “A hybrid OR brings large multi-disciplinary teams together to help minimize fragmentation and increase collaboration.”

Popilock recommends that facilities considering creating hybrid ORs have plenty of contingencies planned for how the rooms will be used in order to maximize utilization and get the most bang for their integration bucks. “You want to bring everything together in the hybrid OR environment that will help you manage the most challenging patients and improve patient outcomes.”