OPERATING THEATRES The planning concept
The hybrid OR is a composition of diverse components that need to work seamlessly as a singular functional unit, to ensure smooth workflows and clinical success. The need to accommodate a wide range of patient positioning across multiple surgical disciplines affects the placement of the surgical table, imaging system, lights, ceiling service units, and monitors. Equipment placement must also be sufficiently flexible to accommodate the increased number of people in the operating theatre. Cardiac procedures often require a dedicated workspace for a perfusionist, and a heart/ lung machine. Neurosurgery often requires the help of microscopes and navigation systems. The anaesthetist may need additional flexibility in positioning. The use of 3D software supported by VR is especially helpful during the evaluation stage to help visualise avoidable collisions and workflow optimisation in design of the theatre.
Adapting to different surgical needs Planners have the task of ensuring that the hybrid OR quickly adapts to the needs and preferences of each surgical discipline. Understanding the relationship between medical staff, equipment, and information flow, is vital to help planners create a safe and ergonomic environment, regardless of what type of surgery will be performed.
The design of a hybrid OR requires a systematic approach in a logical step-by- step manner. The key steps should include: n Selecting the wall system to be used – traditional construction versus flexible modular wall. This has a significant overall impact, since despite their initial higher costs, modular walls can reduce the time needed for, and cost of, future room modifications and technology upgrades, bringing long-term savings.
n Choosing the appropriate imaging system depending on surgical needs
effective surgical environment and interactivity between the various devices.
n Evaluating the available digital integration systems to ensure effective image handling inside the OR, centralise documentation, enable communication with people outside the room, and control equipment functions.
n Selecting an anaesthesia system. n Determining the need for additional equipment (ultrasound, heart-lung machine, injector, robotics, microscopes, and navigation system) based on room utilisation.
Equipment placement must be sufficiently flexible to accommodate the increased number of people in the theatre.
(C-arm, CT or MRI, or a combination), plus auxiliary equipment.
n Determining the optimal workflow between the hybrid theatre and adjacent rooms.
n Selecting a hybrid OR surgical table with interchangeable tabletops – including a carbon fibre floating tabletop and universal breakable tabletop with carbon fibre back rest – both to accommodate a wide range of patient positioning for different surgical procedures, and for the surgical team’s comfort.
n Designing and integrating the air- conditioning system to ensure effective laminar flow and sterile working conditions for a range of different patient positions.
n Selecting the ceiling-mounted equipment (surgical lighting, ceiling supply units), and determining the optimal positioning to ensure an
Project management risk The inherent complexity of hybrid ORs introduces a level of project management risk that can only be mitigated by the participation and interaction of knowledgeable stakeholders and consultants. Common issues include workflow interruptions, missing software and hardware interfaces, patient positioning challenges, and collisions due to misaligned equipment installation. Hospitals that have successfully implemented their first hybrid OR have taken the following steps to avoid these potential problems: n Involving experienced consultants to help ensure that there are no oversights in the planning process.
n Teaming with solution providers rather than equipment-focused vendors; this approach will help you better and more effectively manage the interface between the various systems and platforms – in terms of planning, installation, and service, which, if not adequately co-ordinated, can delay project implementation or limit the theatre’s usability.
n ‘Visualising’ the hybrid OR using 3D tools with VR technology, to facilitate discussions among stakeholders, while helping to identify potential problems that would otherwise not be readily apparent to the planning team.
Real-time availability of high quality imaging helps surgeons preserve as much healthy tissue as possible.
50 Health Estate Journal June 2018
Getinge recommends a hybrid OR surgical table with interchangeable tabletops for flexible patient positioning.
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