Designing an Integrated Surgical/Interventional Suite: Form follows function in design to maximize efficiency, flexibility and versatility

Efficiency, flexibility, versatility ... these are the guiding planning and design objectives for today’s surgical/interventional hospital suites. Hospitals can achieve their goals for cost-effective delivery of quality care when planners and designers implement strategies to increase the efficiency of operations, staffing, and the flow of people and supplies; improve flexibility for a range of surgical and interventional procedures; and enhance versatility for procedures that require imaging and robotic technology.

First, planners and designers must recognize that many surgical and interventional procedures potentially share a number of common functions and characteristics. Both types of procedures involve invasive diagnostic and/or therapeutic interventions, including invasive imaging, and are utilized by inpatients and outpatients. Also in both, patients are under conscious sedation, local or general anesthesia, and in (varying degrees of) a sterile environment.

While surgical and interventional facilities each can be freestanding, for maximum efficiency, flexibility and versatility — now and in the future — ideally, these facilities are co-located in the hospital as an integrated surgical/interventional suite. This type of configuration also yields economies of scale through shared patient, family/companion, staff, supply and support spaces:

• Patient in-processing
• Prep/hold
• Induction
• Procedure rooms
• Post Anesthesia Care Unit (PACU)
• Family/companion waiting area
• Staff lockers/gowning space
• Staff lounge
• Central Sterile Processing (CSR) supplies 
• Sterile supply storage

The New Surgical/Interventional Suite

Beyond the traditional patient, staff and support components, today’s surgical/interventional suite is designed to facilitate the interaction of multi-disciplinary clinical care teams. Indeed, many procedures have blurred or erased the traditional borders between clinical specialties, for example, with the advent of image-guided and robotic procedures. 

Suites are also being designed with an integrated digital environment to facilitate electronic patient record, point-of-care testing, and tracking systems, as well as web-based multimedia conferencing systems to transport data in real time.

Hospital leaders frequently consider the importance of design to reduce the physical and emotional stresses experienced by patients and family/ companions, as well as staff.

Conducting a Demand Analysis

A demand analysis is an important step in determining whether the hospital needs highly efficient general operating rooms or specialty rooms. It has a number of important benefits for the owner, enabling planners and designers to right-size the surgical suite and  increase efficiencies, minimizing both the initial capital and long-term operational costs of the facility.

Planners conduct a demand analysis based on a number of parameters:

• number of surgeons/interventional specialists
• procedure types and volumes 
• annual volumes calculated in minutes 
• inpatient/outpatient mix 
• prep/hold/recovery configuration 
• supply and instrument processing

The results enable planners to determine the total number of operating rooms and perioperative and postoperative bays that will be needed to meet demand throughout the day.

From Design Objectives to Concrete Plan

How are the guiding design objectives — efficiency, flexibility and versatility — translated into a concrete plan?

Cost-effective delivery of care is enhanced over time through innovative functional designs and spatial relations. Employee costs are the largest part of a hospital’s operational budget, so it stands to reason that streamlining operations and decreasing staff footsteps will increase facility efficiencies.

In particular, standardization in design allows for flexibility in operations and improved safety by reducing risks and errors. Identically equipped and sized procedure rooms of 600 square feet, while seemingly large, is optimum — allowing for the scheduling of most procedure types in any room.

Consider the following ideal single-floor configuration for the surgical/ interventional suite. It includes operational care delivery models, on which this platform is designed, for separation of inpatient, outpatient, service and public functions, and pedestrian circulation.

Rooms should be standardized to include flexibility in both structural design and interior space planning to allow for future growth.

The configuration should allow for similar functions and staff to be located adjacent to one other, decreasing the duplication of spaces while increasing utilization of staff.

Additionally, a central waiting space should be provided for inpatients, family, and outpatients who are being treated, yet patients are processed through a centralized patient hub or the prep holding and stage 2 recovery area.

The single-floor configuration, with appropriate adjacencies among patient, staff and support spaces, decreases the overall space required for the suite. It allows for optimal staffing as walking distances between each area is lessened, thereby reducing fatigue and increasing efficiency of service.

Enhancing Infection Control

There are several design concepts to enhance infection control. Although there are many arrangements of the spaces within the suite, contemporary models provide a clean core with a direct elevator connection to the central sterile supply room for transport of instruments and materials.

Locating the procedure rooms at the perimeter allows patients, physicians and staff to enter procedure rooms from the semi-restricted corridor. A “back” door into each procedure room allows instrument case carts and sterile supplies to enter from the restricted clean core.

Procedure rooms should be grouped into three zones of cleanliness or air quality. These zones are categorized into unrestricted, semi-restricted and restricted. The unrestricted area allows free public, patient, staff and materials movement. The semi-restricted zone limits access to gowned clinical/surgical staff, patients, and associated material flow. The restricted area, which is located in the operating rooms and clean/sterile supply core, provides a sterile field during the surgical procedure.

Facilities are in a constant state of flux with accommodating the evolution of technology and changes in patient volume. Designers need to anticipate that changes are inevitable and thereby include enough space to allow for cost-effective restructuring and growth.

Blurring Traditional Boundaries

A number of design trends reflect a blurring or even an erasing of traditional clinical boundaries, as well as incorporation of new technologies. 

Some hospital leaders are considering the investment in intraoperative magnetic resonance imaging (MRI) capability, especially for neurosurgical procedures. Because of the considerable investment required both for the MRI technology, as well as for the structural and radiofrequency shielding requirements of the facility, designers must develop cost-effective plans to optimize utilization.

For example, locating the MRI suite in between the outpatient imaging department and the surgical/interventional procedure room, with controlled access from both directions, increases overall utilization of the equipment. The MRI suite can be used for complex therapeutic interventions requiring a sterile environment, as well as for outpatient procedures, because outpatients enter the MRI suite without passing through the restricted zone.

Lessons Learned

In recent years, planners, designers and hospital leaders have learned a number of critically important lessons in designing surgical/interventional suites to optimize efficiency, flexibility and versatility.

There is no substitute for an objective analysis of the types, percentages and frequencies of procedures for which the surgical/interventional suite will be designed. Conduct a careful demand analysis early in the programming phase of the project, and account for projected changes during the project period. A typical project period is eight months in design and 18 to 24 months in construction to complete. Include all participating medical personnel in the programming phase, interactive sessions, and in visits to other hospital sites and equipment vendors.

For example, the demand analysis, in conjunction with the programming performed during a midwest hospital project, identified an equal demand for inpatient and outpatient procedures.  This resulted in co-locating all the interventional suites and positioning them on one floor. Surgical waiting was combined for inpatient and outpatient family members. An integrated pre-op/holding suite functioned as a core to prepare patients for procedures. Surrounding the core were the waiting and the interventional components that comprised the surgery, interventional imaging and endoscopy suites. This allowed convenience for family and patients, and implemented effective staffing models.

Three-dimensional (3D) computer modeling can be used to produce a design that enables all participants to witness a “real-life” look and feel of the design elements from every angle of the space, including the precise placement of furniture, and critical wall- and ceiling-mounted equipment.

Efficiency, flexibility, versatility ... simply put, form follows function in designing an integrated surgical/ interventional suite to meet today’s needs and anticipate tomorrow’s challenges.

Udo H. Maron, AIA, ACHA can be reached at umaron@arrayhfs.com.