Determine the range of procedures to be performed.

No design project will be successful without the input, expertise, and considerations of the staff that will use the space. Caregiver input should be focused on technology needs as well as ergonomics. Special instrumentation, monitors, and comfort needs must be discussed with surgeons, anesthesiologists, nurses, and core staff who would use the new suites.

This step is crucial, because it drives the design of the space not just for the next year or so but for the next decade. While laser and laparoscopic surgery may be leaders in surgical technology today, robotics may drive the field tomorrow, and the design needs to accommodate their instrumentation, utility, and space needs.

Communication systems need to be evaluated because of rapid developments in this area. The communications infrastructure should allow surgeons to speak with one another in different ORs during surgery. It is helpful if video and audio wiring, panels, and equipment for the communications and video recording systems are in a central closet near the ORs for easy accessibility for repairs or updating. In addition, a continuous cable tray in the ceiling and an empty conduit and junction box system allow for the adding of technologies as needed. Video systems allow surgeons and surgical residents to view surgeries from remote locations, expanding the idea of the classroom at this teaching hospital.

The first step to articulate why the project is being undertaken and whether space is available to accommodate the need.

Major beneficiaries must be included at every stage of design to ensure the final product meets the needs of all users.

This step happens naturally as stakeholders share their thoughts on the design of the OR. Write down all objectives at this point. They can be whittled down later in the process as overall needs come into focus.

Visually walk through the space to pinpoint efficiency needs and traffic flow. This step is crucial. Failure to visualize how patients, surgeons, anesthesia staff, nurses, core staff, and supplies will travel through the space can lead to inefficiencies in design. For instance, it is important to know where the patient and staff will enter the OR. The location of this entry point will establish the sterile field, which in turn will dictate the flow of sterile materials. Following the path of supplies from the clean core through the OR to a contaminated area helps to ensure clean areas will remain clean.

Help determine which items on the wish list are nonnegotiable and which can be eliminated in case of a space crunch. For the Mayo team, one nonnegotiable item was to build an elevator cart lift from central supply on the ground level of the building to the new surgical clean core.

Functional issues become visible once the suite is in operation. For instance, the team might find it is short one sterilizer once surgery begins. Additional storage may be needed for supplies.

Don’t think that because all stakeholders were involved in the design nothing can be overlooked or miscalculated. Be ready to make quick changes once the rooms are in use.

In renovating space, the primary goals are keeping electricity and other utilities on and minimizing inconvenience. These tips will help make the process run smoothly:

All hospital personnel, including the chief of surgery and the housekeeping staff, should be aware of all stages of the project. Making sure the staff knows what to expect is key to gaining their support. Also, if areas will be closed during renovation, the staff need to know alternative routes to take for patients and supplies and egress in case of fire.

All utility shutdowns must be scheduled in advance with stakeholders from the caregiver, facility, operations, and construction teams.

All team members need to understand that the schedule may change because of emergencies at the hospital. Crews must remain flexible and be ready to rework the schedule as soon as the emergency is over.

Never shut down a utility until hospital personnel are notified and agree to the shutoff. Some equipment may need to be plugged into uninterruptible power sources. The same procedure applies to communications, fiber, paging, anesthesia call, water, and sewer. A shutdown should never occur unless it is approved and scheduled in advance.

The renovation site must be sealed off from the rest of the hospital. All air from the site must be evacuated to the outside without routing through the building. Potentially contaminated debris and demolition materials must be isolated.

Some patients may demand to receive care in the new unit believing care is better there. The staff needs to be ready to explain that care is consistent throughout the building.

Reprinted from OR Manager newsletter. Copyright © 2001. OR Manager, Inc. All rights reserved. 800/442-9918. www.ormanager.com