Resources for OR Design & Construction

If you’re planning to build or renovate new operating rooms, you’re likely considering a minimally invasive surgical (MIS) OR. Dedicated MIS ORs are a "hot button" in surgery suite design. Minimally invasive surgery continues to increase, and surgical teams are asking for rooms that function more efficiently and ergonomically.

In contrast to a traditional operating room, MIS suites are equipped with a variety of new technologies to assist in these types of procedures. Networked systems link equipment to a single control panel, flat screen displays, and ceiling-mounted articulating arms that carry an array of devices are a few of the typical features. These MIS suites can be as simple as designating a room only to handle MIS procedures or as complex as a completely integrated system with surgical robotics, data archiving, and telemedicine capabilities.

Rooms with surgical booms mean video carts no longer have to be wheeled from room to room, avoiding damage to equipment and simplifying workflow for the staff. OR floors are no longer cluttered with as many cords and cables.

MIS ORs have intriguing possibilities. The room can be fitted with centralized controls that enable a nurse or physician to control lights and other equipment with the touch of a finger. The booms can be configured not only for new liquid crystal displays but other functions such as electrosurgery and smoke evacuation. More advanced suites can be equipped to transmit data for digital imaging and communication for educational telemedicine.

But it’s easy to get carried away with the "Christmas morning" phenomenon. There are a lot of bright and shiny toys, and your team wants them all. This can get very expensive. Installing booms in new construction can cost tens of thousands of dollars per room, not including associated video equipment. Adding arms to a renovated room that doesn’t have adequate ceiling space and support might cost even more, or might not be realistic at all. Linking video and procedure-specific equipment to a central workstation can increase the cost significantly, depending on the complexity required. High-end equipment such as a surgical robot or intraoperative MRI boosts the cost even higher.

How do you determine if a dedicated MIS suite is right for you? And how do you spend your money wisely?

The driving force for a dedicated MIS room usually is a surgeon or group of surgeons. You need a team that can balance their enthusiasm with the needs of other physicians and the hospital as a whole. Among those who should be represented are surgeons, the OR director, the clinical staff, biomedical and facilities engineering, information technology, and hospital administration.

Be sure to include from the beginning the RNs and techs who will use the room daily. They can tell you what will work and what won’t. If you find out too late, making changes can be expensive and time-consuming.

For example, creating a cutting edge MIS suite—surgical robotics, video display arms, and so on—but leaving out a critical component such as perfusion booms is bound to have financial headaches. Changing or adding some items in a room once the project is started can lead to architectural changes and delayed construction.

Consider whether you have the surgical volume to support a dedicated MIS OR.

Among questions to ask:

• What is the current volume of minimally invasive procedures by specialty? Can you afford to dedicate a room only to minimally invasive surgery?
• Is the volume of MIS procedures growing?
• Are the surgeons who will use the MIS OR a stable group? Are these surgeons who are likely to stay and continue to use the OR?

More facilities, including community hospitals, are looking at including MIS systems in new construction. Though these systems are attractive, not every hospital needs all of the capabilities available. A community hospital, for example, may see benefits in a system with surgical booms and simple equipment controls. Major medical centers, on the other hand, may need a sophisticated control system, surgical robotics, and the ability to send information and images out of the OR for teaching and consultation.

MIS system manufacturers are building into their systems something called "open architecture," which means the system can be upgraded and expanded. A community hospital could plan to integrate more complex devices and capabilities as procedure complexity and volumes change.

Vendors may not necessarily help you distinguish between the "need to haves" and "nice to haves." Ask vendors a lot of questions about what you really need now, what you might be able to add later, and how easy it will be to upgrade.

In developing a cost analysis and a budget, we find it is better to start with a top-of-the-line system, then determine through meetings with clinicians and staff what the client really needs to do its procedures. This process continues until a realistic budget figure emerges.

For this process to work well, managers need to have everyone at the table when they discuss the options. For example, a nurse manager could say, "Dr Jones, we know you want this piece of equipment. Can you provide us with data from other facilities similar to ours to show how often this equipment is used?" It is not uncommon to have a clinician insist on a device, only to realize the potential use is not high enough to warrant the cost.

This can be painful process, but it is helpful to get as many points of view and gather as much objective data as possible.

You also want to make sure you don’t spend so much on the MIS OR that you slight the budget for other services, such as additional sterilizers and automatic disinfector systems, that aren’t as glamorous but can be crucial for a new MIS OR to function efficiently.

Vendors for MIS systems range from component manufacturers (eg, cameras and light sources) to companies that provide full room systems that network equipment and assist in surgical boom placement, room design, and equipment installation.

A full-service vendor can be a time saver for the project team because they don’t spend additional time and resources researching components. It also has the potential to streamline materials management and provide a central source for service and troubleshooting. MIS equipment vendors can provide a wealth of information on the integrated OR concept.

But consider the implications of choosing one vendor. What will happen 5 years from now if another company develops a better technology your surgeons want to use? What if new surgeons come on board who prefer another vendor?

One place this has become an issue is with surgical robotics. The two major players in robotics, Computer Motion and Intuitive Surgical, have agreements with different companies that provides integrated OR equipment. If you have a surgeon who prefers one integrated system to the other, it may take some effort to get it to network the devices efficiently.

We are just seeing the beginning of this trend. Ten years down the road these decisions will be even more complex as MIS equipment and procedures grow in complexity.

Before you make a final decision, talk to people who have installed and are using dedicated MIS suites.

Integrated-OR companies can provide a list of references to call. (If they won’t, it’s a red flag.) Some companies sponsor trips to visit their customers. Of course, keep in mind that you will see a "showcase" site, which may or may not be a realistic example of what you can expect for your facility. If you accept their invitation, insist on speaking to the OR manager and the staff who use the room to ask what they like and don’t like.

You may also be able to arrange visits on your own. If you don’t have travel money, there may be facilities in your local area that can give you an objective point of view.

ECRI, a nonprofit organization sometimes called the Consumer’s Reports of health care, is known for its objective approach to medical device evaluation. www.ecri.org