INTEGRATED THEATRES


Refurbishing operating theatres Whichever direction the future of operating theatres takes, it is clear from the frequency and nature of these changes that the life cycle of an operating theatre is finite. On average, operating theatres need to be significantly refurbished every 10 to 12 years.


As technological developments accelerate, this requirement seems set to continue for the foreseeable future. In a highly pressurised climate, however, finding the time and resources to close operating theatres in order to make these essential upgrades is challenging. The 2017 Naylor review10 estimated that backlog maintenance costs alone were in the vicinity of £5bn, and Trust financial teams are in the difficult position of having to stretch available funding to cover urgent repairs, leaving little capital for planned refurbishments. Closing theatres for renovation also impacts on the Trust’s revenue; the loss of elective patient flow also means the loss of the tariff income associated with performing these surgeries, so that many Trusts cannot afford to close theatres for refurbishment if they are to meet their financial targets. Traditionally, Trusts wishing to maintain patient flow during these periods of downtime have outsourced patients to the private sector, which not only equates to a loss of tariff income but can also mean they are operating at a loss for each procedure they are paying for outside of the core NHS pathway. The advent of mobile operating


theatres in the 2000s offers an alternative to hospitals looking to refurbish their theatres. Designed to promote ergonomic staff workflow and enable smooth, continuous patient flow, these self-contained facilities can be brought onto site to serve as decant capacity for theatres closed for refurbishment. Each mobile operating theatre has the necessary ancillary spaces included within the footprint, including an anaesthesia room and a first-stage recovery bay. The electrical


and water systems are integral, requiring only a connection to mains supplies ahead of the commissioning process to ensure that clinical activity can safely begin. Through the deployment of this flexible infrastructure model, Trusts are able to meet targets through maintaining access to services during what would otherwise be periods of downtime, or times when care is diverted to the private sector. It also enables Trusts to meet key performance indicators in activity volumes and revenue flow that could only otherwise be maintained at the expense of delaying or cancelling refurbishment programmes.


In summary Technology and patient demographics have changed significantly in the 70 years of the NHS’ existence, necessitating extensive changes to operating theatre design. This trend of rapid change looks set to continue, with technological advances in fields like communications, robotics and even artificial intelligence making their way into the operating theatre and changing the fundamental structure required to support innovative surgical practice. Already there is growing debate as to the efficacy of laminar air flow systems, and what the next generation of theatre ventilation


Technologyandpatientdemographicshave changedsignificantly inthe70yearsof the NHS’ existence,necessitatingextensive changes to operatingtheatredesign.


60 l JULY 2018 l OPERATING THEATRE


technology will look like and what infrastructure changes would be required to support it. With the maintenance backlog


growing and current funding settlements widely reported as being unable to bridge the gap between the state of existing NHS infrastructure and the required standards for optimal patient care, NHS hospitals are running the risk of falling behind developments in operating theatre design and technology unless they can find a way to balance the need for upgrades to their theatres with the necessities for continuous patient flow.


References


1 Shooter, R.A. et al. Postoperative wound infection, Surgery, Gynaecology & Obstetrics, 1956, vol. 103 p. 257


2 Essex-Lopresti, M. and Hubert, D. Planning operating theatre suites, British Medical Journal, 1962, p. 1471


3 Nuffield Provincial Hospitals Trust, Studies in the functions and design of hospitals, 1957, p. 60


4 Department of Health, Health Building Note 26: Operating department, 1991


5 Health Building Note 26: Operating department, 1991


6 Health Building Note 26: Operating department, 1991


7 Department of Health, Health Building Note 26: Facilities for surgical procedures, volume 1, 2004


8 Neyens D.M. et al, Using a systems approach to evaluate a circulating nurse’s work patterns and workflow disruptions, Applied Ergonomics, Mar. 2018


9 Bitterman, N. OR design: characteristics and future directions, European Healthcare Design 2018


10 Naylor, Sir R. NHS Property and Estates: why the estate matters for patients


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