THEATRE DESIGN 2.0 m
2.0 m 0.6 m
Area of patient’s body and positioning
Area of healthcare workers’ traffic
Vitruvian man
Area of patient’s body and positioning
Area of patient’s positioning of extremities and healthcare workers’ practice
Figure 2. A two-dimensional square designated to the operating table/patient and the work of the surgical/theatre team.
The US Department of Veterans Affairs (2016) Surgical and Endovascular Services Design Guide presents several room templates to provide a specific operating design plan adhering to standards related to ORs. In the room templates, the size of a general OR, orthopaedic OR, urology/cystoscopy OR, cardiothoracic OR, monoplane hybrid OR, and neurosurgical OR, is 62.4, 71.5, 62.4, 71.5, 85.7 and 71.5 m2
, respectively. However,
again, it is hard to understand how these OT sizes were arrived at from many complicated standards.
Failure to reflect users’ standpoints Another issue with these models is that the majority of the designs do not appear to reflect the viewpoints and real-world experience of the surgical and other healthcare staff working in the OT. As a result, we do not actually know how the recommended theatre sizes would affect the performance or safety of the theatre facilities. Thus – in our view – a universal model to determine appropriate OT size has not yet been established. The purpose of this study was to create such a model for use in the design and construction of operating theatres.
Methodology
In the first stage of our research, we set out to create a rationale for estimating the appropriate OT size. We then tested the validity and practicality of the proposed model.
Development of universal model for appropriate OT size Our major assumption was that the appropriate OT size should be arrived at by adding together the area occupied by surgical equipment and healthcare workers such as surgeons, nurses, and clinical technicians, and their ‘traffic’, and the movement area – depending on the type of operation being performed. The area designated to a healthcare
24 Health Estate Journal February 2019
Calculation of OT size using our model
6.0 m 48 m2 Figure 4. The ‘standard’ OT.
We classified operating theatre type into six categories based on size, i.e. minimum OT, standard OT, ideal OT, OT for cardiac surgery, OT for specific surgery, and OT for multi-subspecialty surgery. In our model, we apportioned an additional area to the movement of equipment and people, in addition to the area devoted specifically to equipment. For the sake of research, we selected 13 representative surgical procedures – including lens surgery, brain tumour surgery, head and neck surgery, coronary bypass (CABG) surgery, thoracic/abdominal aortic aneurysm surgery, lung cancer surgery,
worker was set as a circle with a 2 m diameter, compatible with a human’s height according to a model of the ideal human body in ancient literature. (Fig. 1) The two-dimensional square may include the area physically occupied by the human body and that of the individual’s minimal movement. The remnant corners
Trolley for anaesthetic drug
Anaesthesia machine
of the 2 m square outside the circle were designated as ‘for traffic space’. The area designated ‘for the patient’ was also set as a similar circle, with a 2 m diameter. The circle area was considered to comprise the area devoted to the patient and the operating table, the area within which the patient is positioned, and the area within the surgical and other theatre staff work during the procedure (Fig. 2). We set the size of the operating table as 0.6 x 2.0 m, again using the model of the ideal human body.
6.0 m 36 m2 Trolley for surgical instrument Figure 3. The ‘minimum’ OT.
The shape of the ‘OT’ The equipment routinely used for operations, including the operating table, was incorporated into the model. Such equipment is considered to be ‘carried through’ the traffic space. Routine/ general surgery is generally performed by a surgeon, first/second assistants, an anaesthesiologist/assistant, and an assistant/circulating nurse. (Fig. 3). The shape of the OT was assumed to be as square as possible, with shelves embedded in the wall. In the study, we excluded specific types of operating theatre equipped with large equipment, such as X-ray units used for angiography, CT or MRI units, or surgical robots..
2.0 m
1.8 m
8.0 m
6.0 m
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