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THEATRE DESIGN


The best theatre size for different surgeries


In this article, Hiroshi Yasuhara MD, OR medical director at The Surgical Center at the University of Tokyo Hospital, presents what he dubs ‘a universal model for estimating the appropriate size for new operating theatres’.


The design and architecture of operating theatres (OTs) have, over the years, developed, alongside the emergence of new surgical procedures and technologies. The design of an operating theatre is influenced not only by the surgical disciplines that were prevalent at the time it was built, but also by the type of patients seen, and even the historical background of the hospital. Above all, an operating theatre’s size is one of the key factors to impact on its performance and the quality of surgery undertaken.2–4 More recently, a number of administrative regulations and standard guidelines for healthcare facilities have been established, and have become a key factor in determining OT size. HBN 26 in the UK5


recommended


that a standard inpatient OT should have an area of 55 m2


FGI Guidelines for Design and Construction for Hospitals state that a standard operating room (OR) requires an area of 37.2 m2


, and


However, the rationale behind these guidelines has not really been clarified. 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


Failure to reflect users’ standpoints


Another issue with these models is that the majority of the designs do not appear to


that an OR for image-guided surgery – which requires additional personnel and/or large equipment – should have an area of 55.7 m2.6


. On the other hand, the 2018 Abstract


The 2014 Facility Guidelines Institute (FGI) guidelines include a method to calculate the minimum size of operating theatres (OTs).1


However, the rationale


behind the guidelines has not been clarified. The purpose of this study was to create a universal model for the design and structure of operating theatres. Our major assumption was that OT size can be calculated by adding together the areas occupied by medical equipment, healthcare workers, and their traffic pathway. The area designated to healthcare workers was set as a circle with a 2 m diameter, compatible with a human’s height according to the ancient model of the ideal human body. The remnant corners of the 2 m2


outside of the


circle were designated to the traffic space. Routinely used medical equipment was included in the model beforehand, together with the operating table, part of which was included later as being within the patient’s area. The shape of the OT was set as square as possible. Ordinary surgery was considered to be performed by a surgeon, first/second assistants, an anaesthesiologist/assistant, and an assistant/circulating nurse.


, respectively. However, again, it is hard to understand how these OT sizes were arrived at from many complicated standards.


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


Questionnaire issued


Using our model, the proposed sizes of OTs measured 36, 48, 64, 80, 90 and 100 m2


for the minimum OT, standard OT,


ideal OT, OT for cardiac surgery, OT for specific surgery, and OT for multi- subspecialty surgery, respectively. In the next stage of our research, the proposed model was evaluated through contact with the operating theatre directors at national university hospitals nationwide. We sent them a questionnaire to determine their satisfaction with the size of theatres presently used for 13 representative types of surgery.


They were asked to provide the floor maps of the surgical suites, so that we could measure the sizes of the operating theatres for each type of surgery. The calculated sizes of the operating theatres arrived at using our model were almost identical to those of the theatres that the directors were satisfied with and accustomed to. The questionnaire’s results demonstrated that the proposed model could be used to estimate the appropriate size of an operating theatre with a high degree of success.


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.


This article, entitled ‘Appropriate sizing of operating theatres with high satisfaction’, was first published in the December 2018 issue of Healthcare Facilities, the magazine of the Institute of Healthcare Engineering Australia (IHEA). CSJ thanks HEJ and the author, the IHEA’s publisher, Adbourne Publishing, and the IHEA, for allowing its reproduction, in slightly edited form, here.


34 I WWW.CLINICALSERVICESJOURNAL.COM AUGUST 2019


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