Surviving an OR Building Project

Action plan prepares staff for OR move-in

In preparing to move to its new operating rooms, managers and staff at 350-bed Memorial Medical Center in New Orleans were ready with a 4-day action plan.

But planning actually began 3 years before the actual move as the new OR suite was being designed.

Memorial opened its new 12-OR surgical suite in 2001 in a renovated property adjoining the existing hospital. The hospital had outgrown its old suite and needed new ORs to accommodate new technology. The new department houses not only surgery but also support departments including the surgical intensive care unit, the cardiac catheterization lab, and the ambulatory surgery unit. The new building is separated from the existing building by a breezeway and 6 flights of stairs. The hospital has a surgical volume of about 10,500 cases a year.

The OR management team presented its experience with planning and overseeing the relocation in a poster presentation at the 2004 Association of periOperative Registered Nurses Congress. Memorial’s managers shared their experience in an interview with OR Manager.

Pre-action plan
Planning for the move began with equipment planning in the early stages of OR design. During this phase, the team took several steps that would be important to the move later. They took digital pictures of equipment in the ORs, substerile rooms, and utility rooms. They also made equipment lists for each of the new ORs and how the team wanted them to be set up.
“ We included what equipment we would move and what we would need to buy,” says Mary Jo D’Amico, RN, nurse manager for the OR and central sterile department.

They also determined which ORs in the new facility would be completed first and which ORs in the old facility would be shut down and moved first.
For example, the cystoscopy room in the new facility would be entirely new. The team decided to set up that room first because it didn’t require shutting down a room in the old facility. Some surgical lights in the old facility were new and would be moved, which required those rooms to be shut down first.

Action plan
As the completion date got closer, and the architects announced a move-in date, OR managers began developing a plan for how the move would be accomplished. The goal was to open the new OR with a minimum disruption of services in the old OR.

According to the 4-day action plan, elective surgery in the old OR suite would end at 3 pm on the Friday of Labor Day weekend and resume in the new ORs at 7:30 am the following Wednesday.

The labor and delivery department would be used for emergency surgery during the move.

In this time frame, existing furniture, supplies, instruments, and equipment had to be moved and installed in the new facility. Staff education had to be completed on fire safety; new OR lights, sterilizers, and communication systems; and orientation to the new facility.

Getting ready to move
The OR began paring down services on the Monday before Labor Day. Three ORs were closed so surgical lights and ceiling-mounted ophthalmic microscopes could be moved to the new OR.

The ophthalmologists were the only surgeons who had a major disruption of service, but arrangements were made to take emergencies to a sister facility, notes the OR director, Ann Seal, RN, BSN, MHA, CNOR,
“ We knew these rooms would take longer and so we closed them down early.”

As these 3 rooms were dismantled, the staff began packing materials and equipment into large rolling bins.

Relocation of the sterilizers was planned in the same fashion. The sterilizer between the ophthalmology rooms was moved first.

Moving day
On moving-day Friday, elective surgery was scheduled through 3 pm. At 3 pm, 11 of the 13 operating rooms were shut down. (The remaining 2 rooms were left for any Friday evening emergencies.) The staff in each room were given an assignment and told to “get ready to roll,” notes Seal.
The staff were assigned to specific roles.

“ We had teams on one side who packed, and teams on the other side who unpacked. We didn’t want packers to have to change their focus to unpacking and vice versa,” says D’Amico. “It was a very efficient plan and moved very quickly.”

Personnel in each OR in the old facility were assigned to move the bins to an OR in the new facility. In the new suite, other staff members were assigned to each room to unpack the bins and set up the new room. Still others were assigned to wipe down the equipment with a disinfectant before it was placed in the new rooms. At the same time, staff from the postanesthesia care unit and surgical ICU staff were moving their units.
The staff assigned to the new ORs were assigned to their area of expertise. They had made diagrams in advance of where supplies and equipment would go so they knew where to put them.

By 9 pm Friday evening, everything was moved except for the contents of the 2 ORs reserved for emergencies and 2 SICU beds for emergency postanesthesia recovery.

In addition, the labor and delivery unit was set up for any emergent dilatation and curettage or small GYN procedures.
“ Those emergency rooms were stacked with everything but the kitchen sink,” says D’Amico.

One emergency case was performed in the old OR on Friday evening, and 2 emergency cases were performed in the new OR on the following Tuesday morning before the grand opening on Wednesday.

“ I think we settled on a very aggressive plan of action,” says D’Amico. “We had just finished the in-services on Tuesday when the first emergency came in at the new facility.”

The management staff initially planned to ramp up with 6 ORs on Wednesday and 9 by the end of the week. But 8 ORs were opened up the first day because of surgeon requests, and the staff was confident everything was ready.

Involve the staff
Staff buy-in is key to a successful move. The staff were involved from the beginning in planning to move surgical tables and other equipment to the new OR.

“ The staff were excited about the new facility, and that was the big thing,” says Seal. She kept the staff involved as much as possible, relying on them as resources because they were the ones who would work in the rooms and knew how they wanted the rooms set up.

To help staff feel a part of the new facility early, managers took them on tours throughout the process. A blueprint of the new OR was laminated and displayed in the existing OR so the staff could keep up with the renovations, plus have a map of the new OR.

Lessons learned
“ My advice would be to over-plan every foreseeable detail and have every assignment outlined in writing,” says Seal.

Every staff member was assigned to work an 8-hour shift on Saturday and 4 hours on Sunday, part in the morning and part in the afternoon. On Monday, staff were there even less time. On Tuesday, the whole staff came in on the day shift to attend the in-services and a post-move meeting to discuss any problems.

One problem that surfaced was a reminder of the need to check and double-check all measurements. The problem was that the floor-to-ceiling height in the new facility was lower than in the old facility. This made the surgical lights too low, and the surgeons kept hitting their heads on them.

“ We had a trusted architectural firm that had been in health care for a number of years. We had the vendors involved who cleared the room measurements before purchase of the lights. We went over all the plans. But all of us failed to recognize that the ceiling in the new facility was 18 inches lower than the ceiling in the old facility,” says D’Amico.

“ We thought we had been involved with every aspect, yet that one very obvious aspect didn’t jump out at us,” says Seal.

The only thing to do was to take the suspended monitor arms off the ceiling and put them on rolling stands. The monitor arms were suspended from the same ceiling anchor as the lights.

“ We had been looking forward to having the monitors suspended from the ceiling, but we had to take them down, which gave us another 10 inches of height for the lights,” Seal comments.

The only other major problem was with the existing elevators in the new facility. The architects asked the OR managers to measure the distance needed to accommodate a large orthopedic bed with traction and the staff pushing it so they could renovate the elevators accordingly. It became apparent after moving, however, that elevators still were not large enough. The OR managers convinced the architects and contractors to extend the back wall of the elevator.

“ Those kinds of basic aspects are easily overlooked when you trust the contractors and architects to know their jobs, and you don’t check and double check them,” says Seal.

Since moving into the building, the OR has become so busy that another room was added in January 2004.

— Judith M. Mathias, RN, MA