A Different Kind of Diagnosis:How to limit potential pitfalls in catheterization lab design

There are many pitfalls when it comes to designing cath labs. Many of these are common for both new and renovation projects, but renovations also have several unique challenges. In either case, myriad questions must be answered to avoid potential pitfalls. The Foundation Cath labs are expensive. A new project may cost from $400 to $450 per square foot, while renovations can cost more than $500 per square foot. That translates to a ballpark cost per cath lab of between $2 and $2.5 million, based on traditional square-footage requirements of 1,000 to 1,500 square feet per cath lab and support spaces. These numbers include all project costs such as cath equipment, construction, A/E fees and permits. Extensive upfront information gathering and other techniques can eliminate or minimize late-blooming brilliance or I wish I’d thought of that before scenarios. All stakeholders must be involved from the start. Physicians, administrators, nurses, facility architects, maintenance personnel and equipment vendors all have knowledge that is invaluable. Physicians, radiology technologists and nurses obviously bring patient and procedural knowledge to the table. Facility and maintenance personnel will lend their expertise regarding daily and long-term cleaning and operational requirements. The team’s architects and engineers should be proactive diagnosticians based on their design expertise and experience, and will help lead the team through planning. For Saint Mary’s/Mayo Clinic in Rochester, Minnesota, facility architects, along with HDR Architecture, Inc. created a mock-up prior to finalizing the design for 12 new cath labs. The effort simulated where all services would be situated, and the equipment vendor built a full-scale cardboard model of all of their equipment. This process, which would be an ideal undertaking on all projects, allowed the design team to eliminate numerous pitfalls because the design was evaluated and re-evaluated until the best solution was found prior to producing working drawings. Constructing 12 cath labs means that one mistake or oversight is magnified by at least 12. A solid foundation makes the opportunity to achieve success greater. Equally important, it helps eliminate or reduce change orders, an often-costly proposition that all hospital administrators should avoid. Common Ground New and renovation projects share some commonalities. Planning carefully, maximizing efficiencies, creating a soothing environment and using resources wisely are always project goals. Testing where patients come from or the entry point, and where they may need to go is vital. Adjacencies are critical, and mandatory arrangements have priority. Discussion on this topic may be limited for a renovation, since only one proposed new location might be available. However, for a new facility, carefully evaluate the relationships and interrelationships among the emergency room, radiology, surgical suites, the intensive-care unit and other facility components. Keeping current with codes and guidelines is a priority. For example, codes and guidelines regarding scrub stations are changing in many instances. Previous requirements and recommendations allowed scrub sinks to be within the cath lab proper. New recommendations have the scrub station outside the room in a similar arrangement to surgery suite. Failure to keep current regarding codes and guidelines can cause many problems. Cath labs traditionally have featured 4-foot-wide patient entrance doors. Hospital personnel increasingly are requesting the installation of side-by-side swinging doors, again similar to surgical suite entrances, which makes it easier to get transport carts in and out of the area. The desired door width and configuration should be configured early in the design process. Flooring with some degree of cushion is ideal, but cleaning, sterilization, and stain- and slip-resistance issues must be addressed. Seamless surfaces such as epoxy, terrazzo and welded sheet vinyl are excellent flooring materials when it comes to creating a sterile and easy-to-clean environment. However, they also are hard, which can lead to discomfort for individuals who must stand in the cath lab for long periods of time. At Saint Mary’s/Mayo Clinic, the solution being tested in one lab is to use seamless sheet vinyl with a cushion underneath. This type of product is more user-friendly; however, it dents with heavy wheel traffic and makes it harder to push equipment such as transport carts. (Epoxy may not be appropriate for renovations because the smell generated during and following installation likely will become overpowering within the existing occupied spaces in the hospital). Walls are another important consideration. Cath lab walls that can be fully scrubbed are ideal. Vinyl, as one example, is easy to clean and also will add color in the room, which helps to create a softer and more soothing environment. Many health care organizations prefer epoxy in new applications as this product is durable and fully scrubable. Since cath lab walls are shielded with lead because of radiological requirements, electrical outlets installed in a shielded wall also must be shielded, which is more costly. One option is to put the outlets in another wall that is built in front of the shielded wall. Although there are two walls, this may be a more economical. Many times, in both new and existing projects, these walls are fire rated, which adds another construction consideration. Two Major Differences New and renovation projects often differ when it comes to ceiling heights and HVAC. On new projects, the design team creates the floor-to-ceiling height based on requirements for tubes, monitors, anesthesia columns and other equipment, with current standards calling for heights in the 14-foot to 15-foot range. Renovation projects are often worked into existing spaces where 12-foot heights are standard. The team may have to compromise in order to create the best possible solution. On a new project, the team has a clean slate to work with, allowing them to design the HVAC system to accommodate all suspended equipment. A renovation may result in a situation where the HVAC system is adequate but there is not enough space to accommodate the redundancy that is required for the cold room. Often, tradeoffs have to be made. Equipment A Major Diagnostic Challenge A new cath lab may take three years to construct, since it is most likely being constructed along with the rest of the hospital. The design team may not know what equipment will be installed when the project bids. The cath lab’s physicians often have the final say when it comes to selecting equipment. Understandably, they want to wait until the last possible moment to select the equipment, knowing that what is current now might not be current a year before the project opens. This requires the designers to generate drawings for the space based on the potential equipment that could be specified, but may not be what is ultimately selected. This will require changes to the drawings and a subsequent change order. Children’s Hospital in Omaha, Nebraska, solved this problem by remaining in its old facility a little longer following completion of its new home. Those involved knew that the equipment vendor they preferred was going to have a new generation of equipment. Rather than moving into their new site, they remained in their old facility a little longer, avoided a change order and achieved the desired results. This problem sometimes is avoided in renovation projects since equipment may just be moved from one location to another. If new equipment is involved, however, the same situation may arise. The Bottom Line Hospital personnel and their architects and engineers can help each other maximize success and avoid pitfalls by asking questions early and often. Teams that carefully diagnose all project requirements will create cath labs that operate efficiently and that serve staff and patients for the long term. This positive result represents a different kind of diagnosis. Bernie Gehrki, AIA, senior vice president, HDR, has more than 20 years of experience in the planning and design of renovated and new cath labs and other healthcare facilities. He has worked with clients throughout the country. Bernie can be reached at bernie.gehrki@hdrinc.com.

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