SURGERY DESIGN
OR X 4
OR X 4 OR X 4 Sterilisation, supply rocker room
Ward, out patient clinic
LR
Figure 2: Stratification of QCOR. The number of operating rooms can be increased by multiples of four.
Reliability of elevators: To achieve
stratified operating rooms, many elevators are essentially needed, and the breakdown of them is unacceptable. Elevators are considered to be the most reliable transportation system, even during the failure of electric power supply because every modern hospital has an independent electric
power plant. Building costs: We did not calculate the
difference of building costs between our new stratified model and the past flatly arranged model.
Discussion Surgeons want to have a larger operating room according to the increase of high performance medical electric devices. Although it has not been clarified how much area is suitable for an operating room, 50 m2 may be at least necessary empirically. A preparation room is also necessary if possible. When the operating rooms are arranged under this concept, the walking line of nurses and the moving line of instruments becomes very long. As a matter of course, a long distant working line is a disadvantage for the efficacy of operating rooms. However, the line is minimally shortened in a QCOR.1
It never
elongates, even after an increase in the numbers of the operating rooms because the QCOR is only duplicated by stratification. Separation of the lines of instruments and
people is still a big problem. The lines of supply and contaminated instruments should also be differentiated. To achieve these concepts, operating rooms need to have at least three doors in each room. If possible, the lines of patients and surgeons should be isolated. If patients can pass through the unit an independent way without needing to encounter other surgical activities they will be more comfortable and calmer. It may be impossible to get four independently separated pass ways in the flatly arranged operating rooms. They are limited to having only two doors in each room. Several lines must intersect each other. However, in the QCOR, two instrument passage lines are separated by a supply dumbwaiter and collecting outer corridor with an elevator.
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Figure 4: Separation of Lines – Lines for instruments and people can be completely separated. Lines of supple of sterilised instruments and collection of contaminated instruments are also isolated.
Patient passage line is also isolated by private elevator. Although patients and surgeons go in and out of the same door of an operating room, they rarely meet with each other due to the time differences. As a result, four lines can be separated in the stratified unit operating rooms and this is one of the advantages of the concept. Storage and transport of heavy operative
devices is another problem that needs to be looked at. The number of devices are rapidly increasing, and this can cause a lack of storage space. The passageways around the operating rooms are often occupied by unused devices. Operating room housekeeping is now quite difficult even in the most up-to-date university hospital and this can result in adverse events. To avoid such a situation, heavy devices often need to
be stored in distant places with the devices needing to be carried long distances whenever they are needed. It is also not efficient to maintain the appropriate function of operating rooms this way. In the stratified unit operating rooms, this problem may have been solved. Because the concept sees each operating room not being for universal use, but for specific application such as trauma surgery, laparoscopic surgery, or surgery of the ophthalmology. If the operating room is specific, then heavy devices that are also specific can be stored in the room, saving on storage space. In case of emergency, the devices can be relatively easily carried from one room into another by the elevator and the short passage. In this system, elevators are vital to
maintain the function. And some may worry IFHE DIGEST 2015
a b c d
Figure 3: Creating a larger room for Hybrid, CAT Scan, and MRI is made possible by connecting two rooms. A larger room over 100 m2
in size can be easily constructed by connecting two facing rooms.
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