OR expansion—a journey into the unknown

AORN Journal, Feb, 2004 by Kate L. Oliver

The meeting had taken a turn for the worse. The new operating suite project, which originally had been considered a minor remodeling issue, was now being called a major renovation project because it had been determined that inadequate room size precluded converting one of our existing ORs into a new endovascular suite as originally planned. The new plan called for departments to move temporarily in a leapfrog kind of pattern, essentially affecting everything and everyone. The good thing was that I was not going to be in charge. The best thing, however, was that after the project was completed, we would be the first hospital in our area to have a designated room and the newest technology for endovascular abdominal aortic aneurysm repair.

When I was young, my family took many vacations that required driving endless hours, and I was one of those kids who constantly asked "are we there yet?" I was not necessarily looking forward to the journey ahead.

PLANNING THE JOURNEY

The scope of the revised project would involve approximately 15% of the existing floor plan but would affect nearly 100% of surgery department employees. The director of surgical services, who was my immediate supervisor and the project leader, had been through major renovations before. We knew that potential problems included

* air contaminants;

* budgetary constraints;

* fire;

* infection;

* inconvenience for employees, patients, and visitors;

* security; and

* workflow disruption. (1)

We needed to put together a plan that would allow architects, engineers, consultants and construction crew members to have 24-hour access to our department while minimally affecting quality of care, workload, and employee morale. (2) It seemed a monumental task.

The next several months were filled with meetings with engineers and architects, the facility planner, the director of plant operations, the building supervisor, the biomedical engineer, the infection control nurse, and many others. Surgeons, anesthesiologists, pathologists, and departmental directors were asked for their input. With time, this group--comprised of individuals from a variety of disciplines each speaking their own language evolved into a relatively cohesive team that worked toward understanding everyone's perspectives. Just when the number and frequency of meetings seemed intolerable, time decision was made to begin construction.

BEGINNING THE JOURNEY

The project plan called for exterior work to begin first. For several weeks, the surgery department was not affected adversely by the construction. There were some parking problems and other concerns, but these proved minimal and were contained and rectified easily. Even though everyone knew that the interior construction was coming, we did not fully appreciate the proverbial calm before the storm.

I had warned staff members that the interior work was going to begin on a Monday, but it still came as a surprise to most of them when they walked into the surgery department and found the front desk had been transformed into a hut complete with a roof and columns. This signified that asbestos abatement had begun.

BUMPS IN THE ROAD

Other facets of the project were progressing concurrently as planned when the first major design problem surfaced. The new automatic doors leading into the holding area were not performing correctly. They were designed to open in time for a moving stretcher to pass through without slowing. Staff members complained that the doors were not opening in time, were opening erratically, and often closed prematurely. After spending a number of hours observing the problem, the architect and subcontractor agreed on a fix, and the new design was implemented successfully. I joked with others that if this was the worst that happened, I could handle it. Unfortunately, this was not the case.

POTHOLES

After the first phase of asbestos abatement was complete, the plan dictated that fireproofing material be blown into the ceiling. This was scheduled to take place on a Saturday because of the potential for overspray. Sterile areas were secured with plastic sheets and tape, and negative air pressure was applied. Scheduling this occurrence on a Saturday turned out to be a good plan because, despite all efforts to keep the spray in the ceilings, overspray did occur. Some of the offices on the floor ended up looking like a Colorado winter scene.

Another problem occurred during one of the temporary moves. The physicians' lounge and dressing area was moved to the daytime surgery annex, an overflow unit for outpatients. All physicians were given one week's notice and were requested to empty their lockers to facilitate the move. Unfortunately, only two of more than 100 physicians found the time to clear out their belongings. The lockers had to be disassembled before they could be moved, so the task of emptying the existing lockers and bagging and labeling the contents was left to a small group of helpers and me. An entire 11-hour day was spent bagging and labeling.

A TRAIN WRECK