The Operating Room

Contributions to this section by Frank Zilm

The primary goal of an operating room environment is to provide a controlled space where surgical procedures can be performed with the highest reasonable level of asepsis - (the reduction or elimination of contaminants) - resulting in the minimal risk of post-surgical infections. This is achieved through a combination of physical barriers, layout, and sterile technique.Operating Room

Surgical procedures are performed in a variety of settings - the emergency service, obstetrical care, outpatient treatment room. Surgical procedures undertaken in operating rooms have one, or more, of the following characteristics:

  • Anesthetic agents are utilized to minimize pain and patient discomfort.
  • Pre-filtered air supply, sterile supplies, are used to maintain a "sterile" field around the areas of surgical incisions.
  • Specialized equipment, such as microscopes, robotic controlled knives, CT, MRI, are utilized.

Determination of the required number of operating rooms and the characteristics of each room are a critical task in the planning of new services.

Factors that should be incorporated in the analysis of room requirements include:

  • Total projected surgical cases by major clinical categories (cardiac, orthopedic, etc.)
  • The mix of unscheduled patients, including trauma emergency cases, that arrive during the primary scheduled surgery day or in evenings and weekends.
  • The average case time by major clinical categories, measured from time into an operating room to time of departure ("In-to-out" time.)
  • Estimated room clean-up and set-up times.
  • Dedicated equipment or room characteristics that limit utilization to one type of procedure.

Tools to estimate room requirements range from basic spreadsheet templates to sophisticated simulations models.

Some state maintain regulations regarding the required cases per operating room, or target room utilization that must be achieved to approve a new operating room. Operating rooms designed for specific procedures or equipment, such as cystoscopy, intra-operative MRI, robotics, may have limited capacity to accommodate other procedure types and, therefore, typically experience lower average annual utilization. Level 1 trauma centers may also be required to assure immediate access to an operating room for high risk trauma cases. This may also limit a hospitals ability to achieve high overall utilization.

Operating room size can contribute to flexibility and utilization. The minimum clear net square footage in a new operating room 400 nsf. Although this will typically accommodate most outpatient procedures, it's functional ability to support complex orthopedic, cardiovascular, neurological, or other procedures is limited. The 2006 Guidelines for Design and Construction of Hospitals and Health Care Facilities recommends 600 nsf for cardiovascular, orthopedic and other complex procedures. Sizing the "standard" operating room to accommodate the more complex procedures assures maximum potential utilization of a room. However, this comes at the cost of additional net square footage of very expensive space, and addition gross square footage for circulation.

Determining the correct operating room size should be established based on three principles:

  1. The area required to support current procedures. This should be determined based on the staff, equipment, sterile zone areas, patient access and staff access.
  2. Establishing a strategy for management of inpatients and outpatients. Will outpatients be focused in dedicated rooms, or will all standard operating rooms be available for inpatients and outpatients?
  3. The ability to adapt an operating room to new technology, such as robotics, intra-operative MRI, radiation therapy or other technologies. This is accomplished through one of two strategies: 1.) oversizing the room, or 2.) placing "soft" space, such as equipment storage, adjacent to the operating rooms, allowing future expansion.
VCU Operating Room
Translating existing practice into a vision of the future requires open exploration and discussion of new systems and techniques. For example, articulated power columns allow the relocation of monitors and other equipment off the floor, freeing space for staff and other equipment. The initial capital costs, and the integration of the columns with surgical lights and HVAC systems are major planning issues which must be weighed with the potential benefits.

Information technology also present new opportunities for the operating room environment. Mobile, wireless charting, full screen image visualization, and "dashboard" information management system are effecting the flexibility and efficiency of operating rooms.

References and suggest
ed reading:

"Trends in Surgery Suite Design, Part I," Gordon, Douglas, Healthcare Design, 06:07, pages 22-28
"O.R. Theater of the Future," Osborn, Charles, Healthcare Design, 05:06, pages 58-62
"Patient friendly, high tech facilities a trend in O.R. construction projects," O.R. Manager, Inc. Vol 20, No3, March 2004, pages 1-5
"The O.R. Challenge," Constance Nestor, Health Facilities Management, April, 2007, pages 33-39
"O.R. of the Future," The Boston Globe, August 15, 2004
"Advance Devices for the Operating Room of the Future," Rattner, David and Park, Adrian, Seminars in Laparoscopic Surgery, Vol 10, No 2, June 2003, pages 85-89

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