Operating rooms go under the knife
If you ask Dr. Scott Reeves, operating rooms resemble an airplane cockpit. There is sophisticated equipment, tight spaces, blinking lights and a cacophony of sound.
On top of that, “they’re often cluttered, people can trip, surgeons and nurses can stick themselves with needles, and side infections from dust and other contaminations are a growing problem,” said Reeves, chair of the department of anesthesia and perioperative medicine at the Medical University of South Carolina.
When he became involved with the design of the operating rooms at the R. Keith Summey Medical
Pavilion, part of the children’s hospital of the university, Reeves focused on how to make surgical suites more accommodating for technology — including imaging machines and robots — as well as for staff and patients.
Reeves’ actions are part of an increasing recognition that hospitals are “human centered,” said Anjali Joseph, director of the Center for Health Facilities Design and Testing at Clemson University, who worked on the design for the ambulatory center that opened in 2019. “We cannot think of patient safety without thinking about the health of everyone in the room. They are interlinked.”
Their goal is to rethink the layout and plan for the future, and the South Carolina team is not alone.
The problem of squeezing people and a variety of machines — not to mention robots — into surgical suites designed decades ago is forcing a change.
From increasing in size to reorienting the layout, hospitals — especially those that are part of large university medical centers — are bringing surgeons, anesthesiologists and nurses together with architects, engineers and administrative staff to rethink the modern operating room. But even older community hospitals, with more limited budgets, are getting creative, since surgeries are an all-important source of revenue.
While new construction is more straightforward than retrofitting an older building, not every hospital has the financing or the space to begin anew. Building a new operating room can cost from $1 million to $3 million per surgical suite, Reeves said. The cost of a new hospital can exceed $1 billion.
Configuring new surgical suites in existing buildings requires creativity, said Joan Saba, a health care architect and partner with NBBJ, an architecture and design firm.
For example, older operating rooms may have ceiling heights as low as 10 feet, while 12 to 16 feet is now considered optimum, in order to house electronics, cables and ductwork, she said. Some have captured space from the floor above to gain the extra height. When that is not an option, some hospitals have repurposed adjoining rooms to house electronics and other infrastructure.
New equipment and new surgical techniques are largely driving the redesigns. Those who designed operating rooms even 20 years ago could not have foreseen the explosion in technology, which often requires more space.
“Imaging management” is the biggest challenge that operating rooms have,
said Mary Hawn, chair of the department of surgery at Stanford University, which opened a new hospital in November 2019. (Stanford’s new children’s hospital opened in 2017.) “Twenty years ago, we would operate on exactly what we were looking at, possibly magnifying it with loupes,” the specialized glasses that augment a surgeon’s vision. Now, monitors provide high definition to guide the surgeon.
In addition, for very complicated surgeries, hospitals hope to have equipment such as CT scans and other imaging machines in the operating room. This not only saves time — it lessens the risk of infection.
“Patients need not be closed up, taken out for imaging, see that you missed something and then bring them back to the operating room and open them up again,” Saba said.
Of all the imaging equipment, the piece generally unsuitable for the operating room is the one needed for MRIS because of its size. As a result, Saba said, some hospitals essentially are stationing them adjacent to an operating room in case an MRI is needed. A separate space has an added efficiency benefit, because the equipment can also be used for nonsurgical patients.
Noise is distracting at best, but it may also cause physical repercussions, such as high blood pressure, especially for staff exposed for long periods. High decibel levels are “associated with increased difficulty in communication, which is the largest source of preventable errors in the hospital environment,” John Medina, an affiliate associate professor at the University of Washington’s department of bioengineering, said in an email.
At California’s Loma Linda University Medical Center, which is expected to open a new hospital on campus this year, the operating room walls are built to mitigate outside noise as well as vibrations, and air-duct silencers are also being used, said Allison Ong, head of campus transformation.
Overall, perhaps the biggest question in these renovations is how to “future proof” the operating rooms, in addition to the entire hospital. With technology changing so rapidly, such an exercise is particularly challenging.
At Loma Linda, Ong said, “We had to decide very early on what the future of health care was going to look like. How many ICU beds, how many medical surgical beds and how many ORS. You make your best guess.”
Part of that is adopting a more modular approach, to allow flexibility for new equipment.
As Reeves said: “The takeaway from COVID is how rigid many operating rooms are. I think you’ll see a lot of architecture firms be more nimble in their designs. And while that comes with an increased cost, it’s a question of either pay me now or pay me later.”