The OR of the Future: Overcome Challenges to Reap Rewards

Gienna Shaw, March 23, 2010

Operating rooms are getting a lot more crowded. And the variety of new tools that are cropping up in ORs, from medical communications devices to major moveable medical equipment, will someday be as common and as essential as the operating room table, according to Terry Miller, executive vice president and chief operating officer and William Hinton vice president, of Gene Burton & Associates, a medical technology planning and project management consultancy headquartered in Franklin, TN.

Speaking at the recent Healthcare Information and Management Systems Society (HIMSS) convention in Atlanta, they talked about OR additions, such as interventional cardiac cath lab equipment, interventional vascular suites, and interventional MRIs. "It's an extremely busy room," Hinton said.

Of course, designing the OR of the future comes with plenty of challenges. For starters, the procedure room can exceed 900 square feet—plus a control room that runs about 200 square feet. If you have two ORs that share an interventional MRI that moves between rooms on ceiling tracks, you also need space in between to park the MRI when not in use. Other major considerations include radiation and magnetic shielding and emergency power backup.

There are also workflow issues. Just one example: If you have an MRI in the room, you can't use stainless steel surgical instruments—they must be nonferrous.

"The devil's in the details," Steve Ronstrom, president and CEO of Sacred Heart Hospital in Eau Claire, WI, told me for this month's HealthLeaders magazine cover story, "Medical Breakthroughs That Will Change Healthcare." Sacred Heart's smart OR includes a navigational device that's like GPS for the brain—four 57-inch plasma screens that allow the whole team to see what's going on at any stage of the operation in high-def 3-D, and an intra-operative MRI. Something as simple as the correct positioning of the patients' headrest, he said, can be a big deal.

Then there's the price tag. Although about 60% of hospitals are implementing a smart or hybrid OR, according to Miller and Hinton, the high cost of change is slowing progress.

These complexities—and many more—require a team approach among some groups that haven't always worked well together, such as surgery and imaging. And as OR equipment and systems become more computerized and integrated, sharing a common language and infrastructure, hospitals will have to lean on IT for help. There's a lot of data management from imaging equipment, video integration, and picture archiving, Hinton added.

The benefits, of course, are the additional procedures that can be performed in this new breed of OR and the potential improvement in clinical quality.

Minimally invasive procedures that can be performed in the hybrid OR include cardiac catheterization and peripheral vascular procedures with interventions, such as stent placement and carotid stenting. Surgical procedures include coronary artery bypass grafts, peripheral vascular grafts, and endarterectomies. Navigational tools allow surgeons to make the smallest possible incisions, resulting in faster recovery time and allowing the team to treat sicker, older, and more fragile patients.

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