Stretch­ing the OR'S ca­pa­bil­i­ties

New fa­cil­i­ties bring mar­riage of di­ag­nos­tic imag­ing and car­diac surgery

Modern Healthcare - - FRONT PAGE -

Dr. John Byrne, chair­man of the Van­der­bilt Univer­sity Med­i­cal Cen­ter’s Depart­ment of Car­diac Surgery, says he re­mem­bers the date April 4, 2005, as if it were the birth­day of one of his chil­dren.

That was the day Nashville-based VUMC’s first car­diac surgery/in­va­sive car­di­ol­ogy hy­brid op­er­at­ing room opened—af­ter six Byrne says, it cre­ates a fa­cil­ity that al­lows im­proved lo­gis­tics, lower costs and im­proved pa­tient sat­is­fac­tion—and oth­ers note it also be­comes a re­cruit­ing tool for top tal­ent when it comes to med­i­cal mat­ters of the heart.

“The idea was first met with a very high level of skep­ti­cism and re­sis­tance,” Byrne re­calls. “The bar­ri­ers were not the tech­nol­ogy but the peo­ple. … The real trick was get­ting Amer­i­can Jour­nal of Car­di­ol­ogy, Byrne and his col­leagues wrote how an all-pur­pose car­dio hy­brid can be used for “ev­ery car­dio­vas­cu­lar pro­ce­dure, in­clud­ing tra­di­tional car­diac surgery, tra­di­tional vas­cu­lar surgery, en­dovas­cu­lar aor­tic pro­ce­dures, elec­tro­phys­i­ol­ogy pro­ce­dures, or in­ter­ven­tional coro­nary pro­ce­dures.” They added that there were also fi­nan­cial ben­e­fits from the “syn­ergy of teams, crosstrain­ing per­son­nel, with over­lap­ping of the OR team with the in­ter­ven­tional team.”

Although con­struc­tion and de­sign costs can vary, it costs be­tween $2.5 mil­lion and $3 mil­lion to equip an OR-catheter­i­za­tion lab hy­brid, ac­cord­ing to Ed­ward Her­nan­dez, vice pres­i­dent of Bal­four Re­source Group, a Nashville­based com­pany that pro­vides health­care equip­ment and tech­nol­ogy plan­ning ser­vices.

“There’s some dan­ger of us­ing a for­mula to say, ‘This type of room costs X,’” Her­nan­dez says, be­cause con­struc­tion cir­cum­stances can have many vari­ables. (He adds that equip­ment costs for neuro or vas­cu­lar-spe­cific hy­brid ORs can cost from $1.75 mil­lion to $3 mil­lion to equip.) Byrne says the space for Van­der­bilt’s 750square-foot hy­brid opened up when its new chil­dren’s hos­pi­tal opened and VUMC’s ex­ist­ing pe­di­atric catheter­i­za­tion lab moved to the new fa­cil­ity.

When the Smilow Can­cer Hos­pi­tal at Yale-New Haven (Conn.) opened in Oc­to­ber 2009, it freed up space for a new car­dio hy­brid, says Ross Adam Cole, a prin­ci­pal with BAM Ar­chi­tec­ture Stu­dio in New York.

“As soon as a hos­pi­tal builds a new build­ing, a game of mu­si­cal chairs goes on,” Cole says.

But find­ing enough space isn’t al­ways easy. Byrne says at least one wall was knocked down to cre­ate Van­der­bilt’s hy­brid, and Cole says usu­ally 600 to 1,000 square feet is nec­es­sary for the sur­gi­cal space and ad­join­ing con­trol room. “I’ve never seen any­one do this at 400 square feet,” he says.

David Miller, a prin­ci­pal with Earl Swens­son As­so­ci­ates in Nashville, worked on the Van­der-

This hy­brid OR opened re­cently at YaleNew Haven Hos­pi­tal. It in­cludes a sur­gi­cal suite, above, and a “con­trol room” used in di­ag­nos­tic imag­ing pro­ce­dures.

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