How can you design an OR today that can be upgraded over the next 5 to 10 years? Here’s advice from companies that provide integrated OR design services.

"You need a solid understanding of how your OR will be connected with the outside world," says Marcus Filipovich, director of the integrated OR business for Karl Storz Endoscopy-America, Culver City, Calif.

Ask what types of information will flow into and out of the OR.

• Will the room be used for education?
• What types of data will you want to receive and send? Examples are electronic medical records, radiology images (PACS), laboratory data, and supply management information.
• What capability do you want for video transmission and conferencing? Will you want to teleconference internally, externally, or both? For example, do you want a video link between the OR and the pathology department so the surgeon can consult with the pathologist while seeing an image of the specimen?

Regardless of technology, the OR’s core purpose is patient care. For patient- and user-friendly operating rooms, Darko Spoljaric, whose Portland, Ore-based firm, Val Med, consults on and equips integrated ORs, suggests:

• Think first about the physical characteristics of the room, considering:
  • orientation of the patient
  • location of the main and substerile doors
  • back table setup area
  • patient privacy.
• Think about workflow for each team member—surgeon, scrub tech, anesthesia provider, and circulating nurse.

"Forget the details at the beginning. Think about the economy of flow," he says. For example, make sure the nurse has good access to the patient from the nurses’ station and has good access to the sterile core to get supplies. Have the main equipment positioned on a service arm.

Help ensure sure your ORs will have the infrastructure to support new technology. Though not even the experts can tell you all of the technology that is coming, try to build in enough "pipe" (conduit), electrical power, and ceiling structure to support technology for the foreseeable future, advises Dan Couchman, product manager for Stryker’s integrated endoscopy suite business based in Kalamazoo, Mich.

"This isn’t trivial," he says. You might build an OR today that can support current equipment. But if your surgeons want to install a new surgical navigation system next year, and you have to rip into the ceiling to add wiring and supports, a $100,000 project can become a $750,000 project.

Though most systems today are analog, the transition to the digital OR is underway. Companies are introducing cameras with digital video output for image capture, review, editing, storage, and transmission. Surgeons are asking for access to digital radiology images and remote conferencing.

Make sure systems you are planning are capable of being upgraded to digital technology.

Lightweight flat-screen monitors can be placed anywhere in the room for viewing and access to integrated OR features. Flat screens are evolving rapidly. Several vendors rolled out upgraded versions at the American College of Surgeons meeting in October in New Orleans (related article).

Plan how the surgical team will control the array of equipment. Consider having a nurses’ workstation in a corner of the room, ideally toward the patient’s foot and left side, suggests Spoljaric. The station can be equipped like a production studio, with a computer and controls for lights, camera systems, and other equipment. Companies provide touch screens, voice activation, and pendants for equipment control.

Wireless systems will be a part of the OR of the future.

"We are moving toward being able to beam video images of surgery onto another surgeon’s wireless device," like a handheld PDA, Couchman notes. The surgeon could provide consultation from his car or the sidewalk.

Last spring, researchers at the University of Kentucky tested transmitting live video of surgery to handheld computers via a wireless Internet hookup. Wireless technology is developing rapidly for consumer applications and will be used in medicine, though it has to overcome privacy concerns.

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