DIGITAL IMAGING DRIVES HEALTH CARE DESIGN

Building Operating Management, Jul 2005 by Bang, Cathryn

Flexible designs will ACCOMMODATE CHANGES in technology and patient care strategies at minimal cost and disruption to operations

Recent advances in fully digital imaging technology have dramatically affected the planning and design of diagnostic and interventional radiology facilities. Requirements for image display and multidisciplinary consultation have created new criteria for lighting, acoustics, workstation ergonomics and telecommunications. Moreover, as imaging has developed as a critical element of patient diagnosis and treatment, state-of-the-art imaging departments have become a competitive advantage in attracting patients, as well as recruiting and retaining qualified staff. Indeed, in many ways, imaging has become the heart of today's hospital.

A look at the evolution of imaging from the traditional imaging department to today's fully digital department reveals major changes in key characteristics of these facilities. The traditional film-based department (circa 1990) contained a dark room, large file room, large central technical work area, and a minimal preparation and recovery area. The hybrid digital and film-based department (circa 1993) eliminated the dark room, stored files in a remote archive, had a large central work core for daylight or digital image reading, and enlarged the preparation and recovery area.

The fully digital department (circa 2000) uses a virtual digital archive. It requires a smaller central work core, which is organized around imaging and treatment clusters and a central preparation and recovery area. Diagnostic and interventional imaging and surgery suites are often colocated. Images can be transmitted and remotely read anywhere.

In fact, today's picture archiving communication systems, or PACS, require a telecommunications infrastructure capable of rapid transmission of large data files to workstations throughout the hospital, physicians' offices in the community and even consulting radiologists halfway around the world.

In addition to technology, planning and design of imaging facilities must take into account staffing and patient care. Shortages of qualified physicians, nurses and technologists have heightened the need for health care facilities that aid in recruitment and retention, as well as enhancing productivity.

Both outpatient and inpatient acuity levels are expected to be higher today than in the past, and there is a growing need for sophisticated diagnostic and treatment services. At the same time, patients are becoming savvy health care consumers who demand state-of-the-art care, good communication and a comfortable environment. Facilities are being designed to enhance patient care and comfort at the same time they reduce facility operational costs and improve staff productivity.

Facilities must also be planned and designed for maximum flexibility. That is, they must be able to accommodate future changes in patient care models and imaging equipment, both economically and without significant disruption of operations.

DIAGNOSTIC IMAGING CENTER

These issues have a significant impact on the planning and design of diagnostic imaging facilities. The design should take into account opportunities to geographically consolidate equipment and personnel into one area, while separating inpatient and outpatient traffic. This approach creates space and staffing efficiency, while preserving the optimal environment for infection control and the overall comfort, privacy and well-being of patients.

The public side of the diagnostic radiology service is a dedicated registration area, central viewing room and consulting rooms. The outpatient waiting area can be shared with other adjacent services for space or staffing efficiency. A separate dedicated inpatient holding area should be provided to avoid holding patients on gurneys in the hallways, which compromises their privacy, or in recovery areas, where they may become anxious viewing other recovering patients.

Diagnostic imaging procedure rooms should be organized around a central work core that contains digital processors, technical work areas, offices, supply rooms and the like. This area will provide staff access to procedure rooms and back-of-house support areas. The design is derived from a clustered "operating room clean core" concept, in which a central clean and work core is surrounded by radiology procedure rooms, other invasive procedure rooms and operating rooms. Visibility between work areas is essential to support efficiencies and patient safety.

A multifunctional pre- and post-procedure unit, or observation unit, should be easily accessible for acutely ill outpatients and those who are being prepped for or recovering from more invasive diagnostic procedures.

Procedure rooms should provide maximum flexibility for various procedures. Standardizing the size and colocating similar rooms offers flexibility with minimal construction costs and downtime. Similarly, soft space should be strategically located so it can easily be converted to procedure rooms if needed.