Renovating the surgical suite reaps sweet rewards

Healthcare Purchasing News, April, 2008 by Susan Cantrell

Renovating the surgical suite these days often means integration. Integrated operating rooms (ORs) are all the rage now, but they were practically unheard of only a couple of years ago. What's the hubbub about? What makes an OR integrated, and why is it such a good idea? How can you accomplish it in your facility without breaking the bank? How do you know when it's been done well?

What does integration mean?

To find out what integration means, Healthcare Purchasing News went to some of the industry, experts. Rich Schafer, director of project design, STERIS Corporation, Mentor, OH, told HPN: "Many people don't understand what integration is, but they know they have to do it." Why do they need to do it? Max Paisley, associate production manager, Stryker, Flower Mound, TX, observed: "Technologically advanced facilities will attract a more talented surgical staff and a higher volume of patients." Randy Tomaszewski, RN/BSN, MBA, vice president of marketing, Skytron, Grand Rapids, MI, agreed, stating flatly: "You can't as effectively recruit doctors if you don't have the latest, greatest technology. The technology is not fluff; it's a requirement to deliver today's highest quality healthcare."

Where do you begin? "Start by gaining an understanding of all the sources that can be incorporated into a good design," said Schafer. David Johnson, product manager for integration systems, STERIS Corporation, continued: "There are two types of OR integration: (1) integration of all the devices that make the OR a more efficient and productive operation, and (2) video integration of high-definition (HD) audio and video." (For more info on equipment in an integrated surgical suite, go to http:// www.steris.com/hd360.)

In the article "Planning a Better Operating Room Suite: Design and Implementation Strategies for Success" (Perioperative Nursing Clinics 2008;3:43-54), Tomaszewski explained that the integrated OR is not a product in and of itself. "What you are purchasing from the vendor is the brain (hub, user interfaces, etc) that tie together all of the other companies' products. Integrating multiple devices results in changes of workflow and requires creation of a nursing command center within each OR." The nurse managing the command center controls video and data used in the OR, routing signals to users. The signals may come from sources such as endoscopic video cameras; radiographic images, via picture archiving communication (PACS); patient monitors; or the internet. Images and data could also be routed from the OR to remote locations to facilitate teaching or to make consulting in real time possible.

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Assess needs, build a budget

Once you understand the possibilities, you can assess your facility's needs and prioritize according to your budget. And there lies the rub: if you hadn't heard of an integrated OR until a couple of years ago, the money may not be there for it; so, how do you manage to make the shift now? "One of biggest challenges we face," noted Schafer, "is that many hospitals have not budgeted appropriately for integration. It's a new area of cost."

An experienced vendor can help you to assess and prioritize your needs and develop a budget, Schafer noted: "It's a good idea to approach vendors in the planning stage, so as to budget appropriately. Our most successful projects are where we have received a lot of input from clinicians," said Schafer.

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The planning stage is critical and, according to Tomaszewski, ideally starts 2 to 3 years prior to execution. Tomaszewski encourages facilities to assemble a multidisciplinary hospital team who can "clearly identify where they want to go with the surgical suite. You need input from architects, equipment planners, surgeons, and scrub nurses. You need to consider what role (vision) the facility intends to play in the next 5 or even 10 years. Is the goal to move from being a local to a regional healthcare support system? Does the facility plan to offer more types of services? Will teaching take place in the OR? Know your goals and what you want to achieve. Once a plan is identified, you can begin to look at possible solutions."

Fortunately, integration doesn't have to be accomplished all at once, and there are options that won't blow the budget sky high. Tomaszewski noted that all equipment doesn't have to be bought up front; it can be rented on a monthly or yearly basis, using the operating budget instead of the capital budget to acquire what is needed. A fee-peruse program is another option. "Look for vendors who are willing to work flexibly with you on financial matters," said Tomaszewski.

Visit the virtual OR

Virtual reality is a really useful planning tool used by a number of vendors to create a mock-up so that users can visualize the finished layout. The last thing you want is to find out too late that a door bangs the boom each time it's opened, right? Jim Wetzel, director of marketing and corporate accounts, Berchtold Corporation, Charleston, SC, explained: "We do a lot of custom design work, because we only focus on the OR. We ask the customer what they want and then give them a virtual bird's-eye view of the equipped room. Costly mistakes can be avoided. It's much less expensive to move furniture and equipment in a virtual world."