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still be the star attractions in the operating theatre, but in today’s fast-paced, state-of-the-art surgical suites, high-tech digital integration and hybrid functionality gets top billing. "OR Suites have evolved dramatically from those of a decade ago, owing largely to the dramatic growth of MIS [minimally invasive surgery] SKYTRON-Philips Hybrid Room Suite featuring Philips interventional X-ray imaging. procedures across surgical fields," commented Randy Tomaszewski, vice president of marketing, SKYTRON. "In addition, the advancement of video, data and telecommunications within the OR to providing critical patient data at the fingertips of the surgical team (PACS, EMR, video images and more) has been a tremendous advantage in improving clinical workflows, staff and operational efficiencies, as well as the quality of patient care." Accompanying the trend towards minimally invasive, natural orifice, as well as robotic procedures, "integrated operating rooms are becoming the standard for quality patient care," remarked Lauren Ashley, marketing associate for Stryker Communications. "With advances in surgical technology, hospitals are utilizing this integrated platform to maximize efficiencies, increase the level of patient care, and minimize cost of ownership." "Hybrid" suites are also becoming the norm, observed Jim Norris, senior manager, market development, STERIS Corporation. "We see basic OR suites evolving into a combination of advanced ORs and general surgical rooms. As more procedures become minimally invasive (whether via an endoscope, a robot or trans-catheters), OR designers need to accommodate these new technologies by developing flexible room designs. High definition (HD) cameras, HD monitors, intra-operative imaging, 3D image capabilities and robotics are transforming patient care. Surgical room design must take all these advancements into consideration, and facilities must look into the future in order to make the most of scarce capital funds." Through its OR SuperSuite expert design services, BERCHTOLD Corporation has completed hundreds of designs for hybrid suites that combine a typical surgical environment with diagnostic imaging/interventional capabilities ranging from ceiling mounted C-arms, to CTs and MRIs, described Matthew Weismiller, president. "What we’re seeing today on larger projects is that the hospital will build two hybrid suites for every 12-15 standard suites. And we believe that ratio will continue to grow as surgeons perfect the use of imaging technologies in the surgical arena." According to Steve Palmer, director of marketing, TRUMPF, "the definition [of a hybrid room] can range dramatically, but it’s basically bringing high-end imaging and surgery together in the same room. Now everything can be done in sequence without having to wait." Generally speaking, operating suites that are flexible or "universal" are becoming increasingly popular, indicated Palmer. "Because technology and surgical procedures continue to evolve fairly rapidly these days, they don’t want a room that’s dedicated to one specific discipline, e.g., orthopedics or neurosurgery. They want to be able to use these rooms with as many disciplines as possible."
Eric Berger. hybrid (interventional) ORs that can address surgical procedures as well as angiography. business development specialist. Today. safety and prevention. noted. data management and archiving. For specialty ORs. BERCHTOLD. that’s demanding larger rooms and creative new room designs. "As technology has advanced in the surgical arena. video carts. marketing coordinator for ConMed Integrated Systems." he said. the larger the room. "A decade ago. most new suites will implement boom solutions. unit design and support services no longer adequately keep pace with the current and projected growth in volume. C-arms. few aspects are as critical in affecting the success of a healthcare facility as its workspace structure and flow patterns." A Philips-STERIS hybrid suite Commenting on the growing size of ORs. that has changed over the years as well." said Donna Ungvarsky. ‘the smaller the wound. Tomaszewski." In addition. Very often. including: "Larger suites to accommodate multi-specialty procedures and auxiliary equipment. the minimum requirement for new construction is 600-800 square feet." "Today’s healthcare structure increasingly focuses on quality. SKYTRON. most new suites will be HD-ready for digital integration and documentation. Weismiller. "Creating a workflow in the rooms that approaches maximum efficiency as well as maintaining all of the appropriate infection prevention criteria." . A desire to increase square footage is one of the key reasons that facilities choose to renovate their existing surgical suites. open systems and interoperability of devices. ORs were typically 400 square feet. Why? Because with the growth and advancements of surgical technology and equipment commonly used today.’" he said. navigation and robotics are part of the integrated OR with greater frequency. "Keeping this in mind. the space required for a fully capable and flexible suite is larger than in the past. The general OR rule of thumb is. Olympus EndoSite Consulting. even larger foot prints are the norm. Robotics. microscopes and more that make surgeons so proficient also require far more space. and more integration with EMR. smaller rooms would leave no room for the patient and clinical staff. Older operating rooms commonly have even less space. "the organization and workflow required to deploy the myriad technology while maintaining the sterile field. noted several trends in surgical suites. such as cardiovascular and orthopedic suites. change in procedure mix and/or other current trends in the healthcare arena. explained.
reliability. radiology. it’s important that OR integration systems are able to link to other rooms with integration as well as to other departments and software within a hospital." recommended Rich Schafer.MacBethPhoto. processes and technology that will create the system that will best accomplish your goals. cath lab. focus on purchasing equipment that complies with current video standards." . robotics. "ORs of today demand integration technology within the OR that delivers speed of access. integration is becoming a seamless operation. teleconferencing and more. director of project design and planning. training and technology. You will need to look at the people. "Advanced integration technology improves clinical support processes and workflow solutions both within and outside the operating room via video and data display in and around the surgical field. "Also. you must first thoroughly examine your needs and determine what you want integration to do for you. flexibility." For successful integration projects. interventional radiology. with C-arms. "buyers and planners should understand the goals of the end users. OR up time. STERIS. The best technology in the world can only have real impact if the people who use it buy into it and the processes applied are utilized to their fullest capacities. future proof expansion and more. "An OR integration system should be vendor-neutral in order to ensure the best images and data exchange possible. know the hospital’s five year plan for the operating rooms. to the main communications hub for access and routing of critical video and data images within and outside the surgical suite. accuracy." Noted Ungvarsky. linking the operating room with pathology. "When thinking of integrating your operating/procedure rooms. Stryker. The best possible outcomes with integration are a combination of process change (the elimination of waste in the process)." advised Ashley. Booms and surgical lighting play a key role forming the backbone of the integration framework required for key delivery of locations in and around the surgical field. ICU. ease of use. and select regulated medical devices for the OR. not simply audio/video equipment." said Tomaszewski.com BERCHTOLD SUPERSUITE Integration and the digital OR With the growing number of collaborations between interventional radiology and diagnostic imaging technology providers and surgical suite vendors.
" Digital technology. optimizing clinical use. streaming." described Berger." ConMed Smart OR Surgical suite planners should understand the various levels of integration options available. "Buyers should be aware of this as these systems may be priced within a desired budget they may not meet the functional requirement and goals of the facility. future proof expansion. reliability. accuracy. "The next level above these entry level systems is an advanced integration system which offers the equivalent functionality of the entry level system." . "Digital Capture Streaming.With integration capabilities ranging from "simple cabling through connection plates on the booms to a very sophisticated HD integration system which can include on-site and off-site conferencing. another operating room. hands-free phone. for example. said Tomaszewski. recording. OR up time. music accessories." he cautioned. Most of these are considered entry level systems and often times are not upgradeable or expandable in functionality. HD digital image quality up to 1080p over IP. ConMed. Some are a mix of analog and digital technology and recently. the all digital integration systems have been implemented. provides additional advantages. but these systems provide a platform for growth both in the number of video and imaging devices which can be managed as well as adding optional features such as image capture. he stressed that "the facility needs to be ‘prepped’ and ready to embrace future technology. physician’s office or other healthcare facility. simplifies audio and video communication over IP from the OR to any remote destination such as conference rooms." he explained. "Digital OR communications takes OR communications to the next level of flexibility with greater speed of access. such as with Skytron’s SkyVision Hybrid II digital integration system. "There are several integrated OR’s today and many of them are based on older analog technology. "A basic integration system enables clinical staff the ability to route video images within the operating room to LCD flat panel and wall-mounted displays. described Tomaszewski. workflows and efficiencies. video conferencing and more.
etc." reinforced Weismiller. Video routing device—The suite should have the ability to route any source to any display without distorting (upscaling) the image.." Future-proof suites While it’s impossible to predict exactly where surgical technology is headed.. For example.S." said Palmer.S. MAQUET’s VARIOP system is a prefabricated Modular Wall & Ceiling System that has been used in Europe for over 25 years. and the seams filled with a water-proof gasket. Francis hospital in Charleston. if in the future the customer says. For example. a new panel can simply be screwed into place. surgery. in terms of down time and cost involved. In addition. flat panel monitors. we can pull a new circuit and give them new capability. consideration should be taken to accommodate more than one simultaneously. . When modifications need to be made.’ we already have the conduits in place. panels are cut to the exact size. Palmer explained how the TRUMPF Clean Operating System – featuring pre-fabricated wall and ceiling panels – not only provides unique infection prevention benefits. Multiple displays—Due to the vast number of video sources. panels can be removed from the walls and replaced with minimal construction downtime. The Clean Operating System has been in use outside the U. instead of shutting down the room to knock out a wall. so flexibility is key.According to Ashley. and in a couple of days. and was launched in the U. the rooms can be reconfigured to accommodate renovation and expansion needs. shipped to the U. Windows. And we don’t have to come in with a torch and cut all your welded frames out of the ceiling. "every equipment boom that we ship has two empty conduits in it so that. "There are many key attributes critical to a successful hybrid suite including: Room layout— The hybrid suite should accommodate imaging. we can move the lights and booms. for many years.it simplifies the long term upgrade capability." "Technology advances very rapidly. SC. "If four years after you build your suite you decide you want to convert it from an endoscopy room to an orthopedics room and you want to move your equipment. We can go in after the last surgery on a Friday. so literally in a day. With the TRUMPF Clean Operating System. "With these wall panel systems. and TRUMPF’s first U. flush surface that’s easy to clean. and assembled onsite." Also.S. or imaging during surgery.. over a year ago with an installation at Spartanburg (SC) Regional Medical Center. installation is scheduled to be completed by late summer at Roper St. The rooms are built in MAQUET’s factory in Germany. there are several ways that facilities can build their OR suites to be "future-ready. we can do it. because they’re modular in design and pre-fabricated. are all recessed into the panels to provide a durable. if a facility wanted to add a 50-inch LCD screen..S. screwed into the wall studs. he noted. but can also make it easier and less expensive to reconfigure suites down the road. he described how a modular ceiling grid system can allow for easy repositioning of equipment mounts compared to traditional equipment mounts that are welded into the structure above the ceiling." In addition to "ceiling grids" that allow equipment to be easily moved without extensive construction downtime. ‘I need to upgrade my video cable and add ethernet. or additional electric outlets. wall controls.
It’s without a doubt the most challenging area of the hospital. and staying current with emerging technologies and the regulations that may affect them.An OR suite inside the Clean Operating Room System at TRUMPF’s Design & Innovation Center. wiring for total HD imaging." Berger." he stated. and just go all day and do everything you want it to do – and that’s a tough thing to do." Ashley. According to Schafer. "The technology in a room is so complex. "Selecting technologies that are modular and upgradable will provide the best ability to adapt to future requirements. request additional ceiling structure." Skytron’s SkyVision Hybrid II fully fiber optic digital integration system with its "plug-and-play" capabilities. allows for today’s HD digital sources as well as older. advised. and purchase an OR control system that is easily upgradeable (the easiest systems to upgrade are those that are board integrated. The ability to add modular devices such as HD cameras. "You have to assemble all the right user community . adding. "There is no area that is more dynamic and ever-changing" than the operating suite. EMR. Stryker. surgical-grade monitors and additional lighting to existing support systems allows the hospital to make modifications less expensively and more quickly. if you don’t do the early design process properly you can easily end up with a room that you’re very dissatisfied with. not rack mounted). STERIS. "It’s very chaotic. ConMed. "Request additional conduit runs. Mission-critical planning As Weismiller described. noted that future-proofing an OR suite includes "correct planning of boom placements. previous technologies to be connected to the integration system via a single strand fiber cable. PACS and other hardware/software solutions." Vendors all agreed that the best approach is a team effort guided by key hospital staff who have a good understanding of the hospital’s mission and care objectives. and when you design that environment. Future adaptability is seamless with swap-out expansion ports for simple upgrades. you have to create an environment that’s going to work from the 6am start to 7 at night.
and whatever can be anticipated for the future. Schafer advised. "It’s important to establish clearly defined functional and budgetary goals." said Weismiller. since this will reduce the number of iterative design steps and will assure that the space that’s created works for everyone." .from the hospital to identify all of the current needs.
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