Creating Efficiencies in Cath Lab Design

In the past, patients commonly began their diagnosis in the emergency unit; today they arrive at the cath lab through varied treatment doors. They may have arrived on an emergent basis from the ER, a cardiologist’s office or heart scan clinic, or as an inpatient from the medical cardiac unit. Likewise, when their diagnostic procedure is complete, patients are referred to diverse places. While some could require surgery, others are given less invasive courses of treatment such as coronary angioplasty, arterial stenting, or non-invasive medical treatment. Consequently, patients not only originate from various diagnostic areas but they depart for disparate courses of treatment as well, like the surgical suite and/or the medical cardiac unit. When building a new lab or designing a major expansion or renovation, the question arises: which discipline cardiology, radiology or surgery is best to attach to a cath lab? The answer, unfortunately, is a complex one, and probably best decided on a case-by-case basis. Because each hospital operates on a different set of business practices, each solution will have its own nuances. In order to make an informed decision, cath lab administrators and other professionals need to analyze patterns at their individual health care facility. Do patients come as outpatients, from cardiac medical beds or from the ER? Are the numbers evenly distributed or are they weighted in a particular direction? Armed with a basic understanding of patient treatment patterns, lab directors should develop an adjacency matrix to determine which departments require mandatory adjacency and which may not require direct adjacency. Of course, a smaller hospital may be able to create adjacencies easily, where a large medical center may need to plan a more enterprising solution. Form Follows Function At the Mayo Clinic in Rochester, Minnesota, a cath diagnosis may result in surgery, medical treatment, or dismissal. As a result, it may be logical to locate the cath lab near surgery or the medical cardiac unit. But the 3-million-square-foot Saint Mary’s Hospital facility is designed with an entire floor dedicated to 61 operating rooms plus support areas, leaving no space for the 12 cath labs, along with their specific support needs. Complicating matters, numerous units, such as the ER, intensive care and radiology would also prefer to be adjacent to surgery. When planning adjacencies within an intricate medical scheme, careful programming by planners is critical and alternative contingencies must be devised. While horizontal adjacencies are important, vertical adjacencies can also work as a viable option. One artful provision employed at the Mayo Clinic is a trauma elevator that travels express from the ER to and from the heliport, with the ability to stop on the surgical floor. This elevator may also be used for cardiac patients transported from the ER. Another option can be seen at the cath lab at Children’s Hospital (Omaha, Nebraska). It contains six ORs and is built directly into the surgical suite. In contrast, the former Christian Hospital Northeast in St. Louis designed its cath labs as an expansion of its radiology department. While pediatrics is often separate from general patient populations, the Mayo Clinic integrates pediatric and adult catheterization procedures within the same space. To create a less threatening environment for its pediatric patients, two isolation rooms in the pre- and post-op area were designed in conjunction with the Mayo Eugenio Litta Children’s Hospital within a Hospital to create an extension of the children’s spaces. Entry to the isolation rooms can be gained through the cath lab pre-op area, post-op area, and also via an exterior circulation corridor. Air pressures are addressed to segregate certain patient populations. As an ancillary benefit, the room can be soundproofed so a child is not thrust into a threatening environment. The Mayo Clinic’s cath isolation rooms were also made more comfortable with the addition of oak casework, distracting ceilings, children’s artwork, and even a homey rocking chair for visiting parents. As noted, catheterization procedure rooms have not changed much since the early 1980s. However, in a children’s hospital that performs many pediatric cath procedures, storage needs do tend to be greater because catheters are based upon the size of the patient who may range from neonatal to 18 years of age. Communications Gear Today, one emerging trend in cath labs is the ability to confer medical information via high-tech electronic audio and video communications. Using CAT-5 hard cabling, fiber optic trunks and satellite transmissions routinely installed by health care planners, architects and engineers, surgeons can broadcast procedures for teaching or real-time counsel. At Children’s Hospital in Omaha, Nebraska, for example, cardiologists can consult hands-free from anywhere within the surgical suite and cath lab. In addition, they can transmit live video of procedures or document activity in the OR to a large screen in a conferencing/education center for teaching purposes. Mayo Clinic can also broadcast procedures or activities. This world-renowned clinic, in addition to the Rochester, Minnesota site, has two other primary sites in Scottsdale, Arizona, and Jacksonville, Florida and can broadcast via satellite in real-time or recorded form among the remote locations. Along the same lines, cine tape is yielding to digital storage media such as CD-ROM. The new media require less space for storage, although viewing areas need to be larger; adept design will reflect this shift. Multi-Purpose Clean Cores If the catheterization labs are located within the surgical suites, the potential for a shared central sterile surgical supply, or clean core, space allows for maximum efficiency of support product delivery. Similarly, due to integration of the cath lab into the cardio-surgical suite at Children’s Hospital in Omaha, efficiency is gained by storing joint medical supplies and sterile equipment in a so-called clean core. Further efficiencies can be gained through shared support spaces, such as lockers, staff rooms, etc., when cath labs are blended into other departments instead of floating on their own. 23-Hour Service Everyone is aware of the trend toward outpatient services in many types of health care disciplines from endocrinology to OB/Gyn. Cath labs, therefore, need to be designed architecturally with an eye toward patients that are admitted and released in what is referred to as a 23-hour time period. More consideration must be given for lockers to store patients’ personal items and to increased waiting areas for visitors who tend to remain for an entire procedure. Finally, increased traffic deep within a hospital tends to cause disorder. Consequently, cath room directors need to plan well-executed space for circulation in order for patients and visitors to be able to arrive and exit quickly. Designing proper adjacencies at a project’s outset often lead to efficiencies later. In the end, streamlined operations lead healthcare providers to improved internal efficiencies and better patient comfort and care.

NULL