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HIROSHI YASUHARA MD – OR MEDICAL DIRECTOR, THE SURGICAL CENTRE AT THE UNIVERSITY OF TOKYO HOSPITAL, JAPAN THEATRE DESIGN


Optimising theatre size to meet demands


Hiroshi Yasuhara MD, presents what he dubs ‘a universal model for estimating the appropriate size for new operating theatres’, to suit different surgeries.


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 .


On the other hand, the 2018 FGI Guidelines for Design and Construction for Hospitals state that a standard operating room (OR) requires an area of 37.2 m2


, and that an


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


.6 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


, 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


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.


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 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.


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


Hiroshi Yasuhara


Hiroshi Yasuhara is the 11th President of the Healthcare Engineering Association of Japan (HEAJ), which takes a wide view of the whole healthcare system. Before starting a career as a healthcare


professional, he spent over 25 years as a surgeon and a professor in the Teikyo University and the University of Tokyo in Japan. As an OR Medical Director, he also managed the department of OR suite in the University of Tokyo Hospital. After a successful career treating many surgical patients, he has been in his current position as a Director of Tokyo Teishin (Telecommunications) Hospital since April 2019.


38


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.


IFHE DIGEST 2020 outside of the circle were designated to the traffic space.


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