Every Hospital Can Be Modernized

How to Upgrade Aging Facilities to Accommodate State-of-the-Art Operating Rooms

June 12, 2018

Medical Planner, NBBJ

Editor’s Note: This post was originally published by Healthcare Design.

Operating rooms provide a critical component of a hospital’s continuum of care and constitute a substantial slice of annual revenue, not only in direct earnings from procedures, but also in their patients who fill hospital beds. It’s critical that hospital administrators maintain the productivity of their existing OR suites as well as provide procedural flexibility as market demands necessitate.

However, hospital administrators don’t always have the luxury of building new facilities when they need newer or larger ORs to support procedures that are increasingly more technologically complex and clinically demanding.

How can organizations find the space they need to meet these demands within their existing hospitals and avoid costly new construction? One strategy is to improve the productivity of existing surgery space by capturing and repurposing it, both horizontally and vertically.

 

Repurposing Space Horizontally

Most ORs in older hospitals are roughly 400 to 500 square feet. However, new technology demands, increases in the size of surgical teams, and the financial demands for ORs to be multipurpose—with the flexibility to support multiple specialties, such as cardiology, neurology, and oncology—have resulted in general ORs needing to be sized up to 600 to 650 square feet, with some specialty ORs requiring 750 square feet or more.

One way to increase OR square footage is to capture and renovate adjacent “soft” space, such as a clean core or storage space, which can add 100 to 300 square feet. The hospital project team then must develop new processes and operational models to replace the lost space and functional areas.

Another way to create space horizontally is by converting two substandard operating rooms into one highly functional one, which usually gains additional support space, as well. While reducing the number of ORs might seem counterintuitive, it can increase utilization, as one functional OR is preferable to two obsolescent ones. It can also expand a facilities services by making it possible to accommodate multiple specialties and procedures, which can maximize revenue as well as enhance recruitment and retention of the surgical staff.

 

Creating Space Vertically

New equipment competes for space not only in the room but also in the service space above the ceiling. The typical floor-to-floor height in a new facility is 16 to 18 feet, which allows room for changes in the necessary structural and mechanical systems. However, many existing buildings may have as little as 12 feet between each floor.

One strategy to address this issue is to replace large mechanical air ducts with more, smaller-sized ducts. This solution reduces the height of space required above the ceiling, however one tradeoff is that the increased number of ducts can congest overhead space, making it more difficult to arrange other equipment like electrical connections, lighting, boom mounts, and access panels.

A hybrid OR with integrated ceiling, at the University of Washington Medical Center in Seattle. © Sean Airhart/NBBJ

Hybrid OR with integrated ceiling, University of Washington Medical Center. © Sean Airhart/NBBJ

Another option is to use an integrated ceiling in which some or all components are prefabricated and coordinated systematically before being built into the room. Because prefabricated systems can be engineered more precisely than individual systems installed in the field, they yield a more compact, efficient design that can be accommodated in tighter floor-to-floor heights.

Different levels of integrated ceiling systems are available, from units that have all major and minor components integrated and prefabricated as an entire piece of equipment to others that include only the major structural and mechanical systems with space for the smaller components to be added in later.

An integrated ceiling can also be installed on-site quickly and easily, which can shorten construction and installation timelines.

 

Planning Steps

Operating rooms are complex spaces that require meticulous planning and design to successfully add space that will allow for more efficiency. Older hospitals considering updating their ORs need to evaluate their current state and determine which strategy to pursue.

For some facilities, their rooms may have enough square footage, but their ceilings and equipment may be outdated and inflexible. In these cases, innovations like an integrated ceiling can make it possible to update equipment and create flexibility for future technology within the existing walls.

Other facilities seeking to expand their ORs will need to determine which rooms are in a position to be merged to create the right square footage. Some steps to consider in this process include:

  • Understand the needs of surgical staff and the hospital’s surgery business plan.
  • Evaluate the physical plant, from the square footage of standard ORs to floor-to-floor heights and ceiling system infrastructure.
  • Assess room utilization and productivity.
  • Understand departmental support procedures.
  • Get input and involve surgeons in the planning and design process.

Once a facility determines that an upgrade is needed, the design team can develop a strategy to shift an aging group of ORs into high gear with the right amount of space to support the care needs of its patients and staff.

Banner image courtesy Russ Ward/Unsplash.

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