Complicated, high-risk, and time-sensitive. These are just some of the issues that come to mind when renovating one of the most critical functions of a hospital: the surgical suite.
This year, I was given the opportunity to attend the Healthcare Facilities Symposium in Austin, Texas. One of the more interesting sessions that I attended, “Renovating Operating Rooms with Surgical Precision,” was presented by a well-rounded group of architects from various SmithGroup offices around the country. The panel included Chester Schroeder, RA, Program Manager for Beaumont Hospital, Troy, and SmithGroup’s Melanie Hall, AIA; Tim Gregg, AIA, ACHA; and Andrew Brumbach, AIA, EDAC. The session gave great insight into three very different case studies at Beaumont Hospital in Troy, Michigan; Newton-Wellesley Hospital in Newton, Massachusetts; and Northwestern Memorial Hospital in Chicago, Illinois.
Beaumont Hospital, Troy: Phasing in a landlocked surgical suite
Beaumont Hospital, Troy was the first satellite hospital built for the Beaumont Health System. Chet Schroeder explained that the primary reason for renovating the operating rooms was change. In the past 40 years, the population of Troy has doubled in size and the hospital grew from a 200-bed to a 520-bed hospital—after over 40 years of renovations and additions since its opening, the hospital is now more than five times larger than its original size.
The scope of this project included 19 renovated and right-sized ORs, an increase from the existing 14, totaling 45,000 square feet. Some of the guiding principles for the project included implementing a universal design, improving efficiency and flow, and providing a clean core between the ORs and circulation.
Melanie Hall shared that the key to the project was “collaboration with everyone working together as a team. Beaumont was smart to bring on the construction manager early in the design process.” The design team was able to walk through the existing conditions with the CM to have a better understanding of the different mechanical and structural systems. One of the innovative solutions that came out of this early collaboration was a temporary staircase that was built outside the building. This kept construction circulation out of the main internal circulation, ensuring construction would not interrupt clinical flows.
This case study also demonstrates the complexity that comes along with phasing when renovating operating rooms. Chet went on to explain, “The phasing was the heartbeat of the project. When it came down to it, I used the K.I.S.C. process: “Keep it simple, Chet.” Simple diagrams were posted at the construction site and hospital staff lounges. These diagrams helped facilitate the phasing and flows for both the user groups and the construction team. Chet took something that was normally complex and streamlined it to ensure the clinical staff’s understanding and trust throughout the process.
Melanie and Chet also explained the importance of keeping the end users engaged and making sure they understood where they were in the construction process. “The phasing allowed them to have four new ORs come online while the rest of the renovation was still going on,” stated Melanie, “Once all of the ORs were complete, the design is so universal that the surgeons can work effectively in any room.” From an owner’s standpoint, the project is considered extremely successful as the number of surgical site infections decreased and there were zero complaints from surgeons throughout the process.
Newton-Wellesley Hospital: Overcoming a challenging infrastructure with inches to spare
In the western suburbs of Boston, Newton-Wellesley Hospital renovated two Interventional Radiology rooms. The rooms are designed as hybrid ORs as the client wanted that flexibility to use them for more procedures in the future. Each room is equipped with four booms and full AV integration with ImageStream. With most renovation projects come challenges in dealing with the existing facility and this project was no exception. The existing spaces were limited by the building boundaries of 700-square-foot rooms, when an ideal size is 1000 square feet. The two ORs were also located under inpatient behavioral health units that were susceptible to patient-induced flooding.
The major challenge of the project was the restricted ceiling height of 10 feet, 5 inches, leaving the design team only 16 inches for c-arm supports, boom supports, lighting, and the air delivery system. Working with their engineers, the team decided to implement the Huntair Cleansuite system. “The benefit of this system was that it is a structural diffuser that could incorporate the lighting and the Philip C-arm supports,” explained Andrew, “but we ended up with just three-quarters of an inch to spare.”
Another big challenge was having to fit the necessary conduit for the AV integration and the Philips equipment. With such a restrictive ceiling height to work with, the design team had to find innovative solutions like the Huntair Cleansuite for the mechanical, electrical, plumbing, and structural work associated with the project. Even though these challenges led to a delay in the project, once it was resolved they ended up with two great rooms that meet the client’s goals.
Northwestern Memorial Hospital: From a technology upgrade to design evaluation
The operating room renovations at Northwestern Memorial Hospital in Chicago, Illinois started off as a technology upgrade that eventually evolved into a full renovation. As the client realized that the upgrades would take each OR down for six months at a time, it was decided that they should reconsider the layout of the rooms. In the process of design, it was determined that some of the rooms could be more effective if they were enlarged or made like-handed with rooms of similar modality. This resulted in a redesign of the sterile core for each pod in addition to the operating rooms.
Similar to Beaumont Hospital, Troy, the phasing of the renovations for this project was crucial to allowing the surgical suite to continue operating. One of the major limitations on the team was that they could only take down 3 to 4 operating rooms at one time. Of those, there could only be one of any given specialty down. Overall, the project took six years to complete 32 operating rooms, and the design team held over 60 user group meetings. However, one of the benefits of this phasing process was that each phase informed and corrected issues for the next phase.
The existing rooms had cluttered CNL stations that required nurses to have their backs to the field, dilapidated surgeon PC stations, and outdated AV/CRT monitors. Tim Gregg added, “this project required an extensive analysis of what was going on in the existing rooms. There were issues with light booms and equipment booms that restricted a full range of motion.” The insights generated from that deep analysis gave the design teams an understanding of the requirements for the new rooms. In the end, the rooms are designed to be as universal as possible, which could not have been accomplished without the mutual understanding between the user group, design team and construction team.
The panel concluded their presentation with a list of top ten lessons for those renovating operating rooms:
- Although complex, consider renovation as a viable alternative to new construction, replacement, or shut down.
- Phasing is critical.
- The building’s history is important—know what’s behind the walls in any renovation.
- Have everyone in the room as much as possible to offer differing perspectives.
- Consider infrastructure constraints early on.
- Finalize vendor drawings as soon as possible.
- Confirm technology appropriate for user groups.
- Engagement of all stakeholders is vital.
- Inform participants regularly throughout the process.
- Measure four times, cut once.
It was clear from the three case studies that dealing with renovating operating rooms requires a certain level of trust among all stakeholders. Whether the renovation involves phasing, infrastructure, or technology upgrades, there will always be unforeseen circumstances that arise. These three teams showed that being successful in these projects requires truly understanding how your end users function in a space. With this understanding, each team was able to make a complex, multi-phased renovation an achievable end goal.