Whether you're in the middle of a renovation or a construction project, one thing's for sure: You won't want to do it all over again five or 10 years from now to accommodate emerging technology. "But if you build only for the present, your operating rooms will be obsolete by the time they open," says Robin Ramsey, RN, the director of operating rooms at Poudre Valley Hospital in Fort Collins, Colo. Here's how to plan and prepare today for the operating room of tomorrow.

Conduct a needs analysis and visit other sites
First things first: Figure out what you're going to use the ORs for now and a few years down the road. Will they be used strictly for surgery or will teaching also take place? What types of data will be sent and received? What kinds of surgery will be performed? By knowing how the ORs will be used, you can better plan for what types of equipment you may need in the future, say the experts we interviewed.

How to do this? Conduct a needs analysis, which is a fancy way of saying you'll want to assess the needs of your patient base and your surgeons. This is precisely what Jayne Mitton, RN, the executive director of surgical services at Memorial Hospital in South Bend, Ind., did before she began planning a new surgery center and the renovation of her existing facility. In doing so, she discovered that there was an unmet need for more gynecological surgery procedures in an outpatient setting.

Over at Poudre Valley, the hospital is embarking on a four-year upgrade that includes surgical expansion. The administration wanted integrated ORs with surgical robots, video, AV equipment and more space. "So we planned with these goals in mind," says Ms. Ramsey. "Technology is the driving force behind what the hospital wants to accomplish."

Visiting other surgery centers can also benefit administrators who are in the process of planning a surgical upgrade. Several site visits let Memorial's administrators explore future technologies and equipment that they would like to plan for in their project, says Ms. Mitton. "Administrators and people involved with an OR project should do as much research as possible" before the actual construction begins, says Ms. Ramsey.

Put the patient first
Patient care is always the No. 1 priority in the OR, and planning for the future should take into account the patient experience. Larger ORs make it easier for the operating team to work on the patient, and many hospitals and surgery centers are adding more square footage to their operating rooms. Experts report seeing general ORs being designed in the 600- to 650-square-foot range. Poudre Valley Hospital's expansion includes the construction of four new ORs, each measuring 700 square feet, and the enlargement of several existing rooms. Calumet Surgery Center in Munster, Ind., is also planning for larger ORs as it converts into a surgical hospital, says administrator Denise Cheek, RN. This extra space will allow more room for future equipment.

Now, what if your OR is starving for space and locked into a footprint? If you're creative, you can still work with the space you have to design an OR of the future, says architect Michael Pomarico of Pomarico Design Studio Architects in Newburgh, N.Y. Relocating rooms can be a solution, he says, citing a recent project where he relocated several storage rooms to free up enough space to build two technologically advanced ORs.

Memorial's surgery project includes upgrading six outpatient surgery rooms to meet the future needs of the hospital's patients. All of these ORs will be multi-purpose, meaning that each room is equipped with video capability, anesthesia booms and equipment booms to perform a multitude of procedures, says Ms. Mitton. "We can do any case in any room," she says.

Think about infrastructure
Make sure that your OR has enough conduits, electrical power and ceiling structure to support new and emerging technology. "Data ports and outlets are going everywhere [in Memorial's ORs] to prepare for future equipment," says Ms. Mitton.

Running extra pipe and conduits into ORs during construction can also help you prepare for the future. "You can never put in too much conduit," says architect Thomas Harvey of HKS, Inc. in Dallas. "You should provide empty conduit runs into or adjacent to the OR to bring in future fiber and you should run extra pipe before the OR is operational." His suggestion to facilities concerning the amount of conduit to install would be "to think of everything that needs conduit and add another 25 percent to that amount."

Higher ceilings can also be an important factor to consider in planning for the future. With more equipment being suspended from the ceiling (or mounted on freestanding booms) today and potentially in the future, a ceiling height of 10 feet to 10-and-a-half feet may be more suitable, say experts. As you attach more equipment to booms, more space between the OR table and the ceiling can help alleviate future concerns of space constraints.

When purchasing booms, consider the future adaptability of the product. Two questions you might ask the supplier: How will the piece of equipment adapt to future technologies? How much is the company thinking of the future in the design of their equipment? By understanding how the company is preparing for the future, you can determine whether or not the long-term investment will hold up several years down the road.

Memorial is also installing many ceiling mounts in its outpatient operating rooms that can be changed to accommodate more equipment. By making sure your ceiling can support docking stations and booms, you can ensure that your OR will be able to handle future technologies while also providing more flexibility and efficiency with less clutter.

Poudre Valley Hospital is adding access doors in the ceiling to give maintenance workers easier access during future equipment installation or repairs, says Ms. Ramsey.

Give control to the OR team
In planning for the future, take into account the staff who'll be using the room. When Memorial's outpatient surgery renovation is complete in late 2007, two of the surgery rooms will have a communications control system that will let the circulating nurse control various pieces of OR equipment with the touch of a button. The system operates by touchscreen, can control room lights and can route images from camera systems, C-arms, ultrasound devices and endoscopes to various monitors inside or outside the OR suite. Ms. Mitton says Memorial is wiring its other outpatient surgery rooms for future use of this system.

Like Memorial, at Poudre Valley the ORs will each have a control console with a cockpit-like design that lets the nurse face into the room, which is beneficial to both the nurse and the surgeons, says Ms. Ramsey.

Even if your OR doesn't yet have a high tech "documentation station," you can still designate space for one. Control consoles are one of the top items brought up by project team members who are renovating or constructing an OR, says experts. These systems can be prefabricated or specially constructed by the contractor to meet the needs of the OR, notes one equipment planner.

Plan for wireless technology and communication
Does it make sense to prepare your OR for robotics and telemedicine capabilities? If so, plan for it now. "To keep up with robotic technology, you will need to have room in the OR to not only store this piece of equipment, but also enough space in the operating area to use it," says Mr. Pomarico. By designating space in the inside corner of the operating room or creating a whole other equipment room where you can house such a piece of equipment, you can prepare for future robotic systems without having to find space five years from now, he says.

Telemedicine is another emerging technology that will surely be a part of the OR of the future. Ms. Mitton says the communications control system will, at some point, let her surgeons send video signals from OR to OR as well as off-campus to educational institutions for teaching purposes. These telemedicine connections will let a surgical team train other doctors via video conferencing at a remote location as the surgery is underway. "Although there is not too much application of telemedicine yet, ORs can be pre-wired ahead of time to support this technology," says Mr. Palmer.

Integration of data in the OR is another important technological advancement you shouldn't overlook. A planned equipment room within the surgery suite can serve as a hub for various technologies that may be developed in the future to provide immediate access to patient history, lab tests and digital imaging. Memorial's new system will let the surgeons obtain PACS information and patient records while in the OR. Poudre Valley already has begun to phase in a state-of-the-art electronic health records system that allows authorized users access to patient records, tests and lab results from their homes or offices at any time. "An OR should plan to add at least 200 square feet to allow for equipment that supports technological information sharing," says Mr. Pomarico.

Merge radiology and surgery
Emerging technology suggests that the radiology and surgery departments may work much closer together in the future. These two departments, typically located away from each other, are now migrating to the same part of the facility, and architects are beginning to design to accommodate the merging of the two disciplines, experts say. This is evident in the creation of intraoperative MRIs that are being used in an increasing number of hospitals and surgical facilities around the country.

In order to plan for this merge, you need to provide additional space in and around the OR, says Mr. Pomarico. "Intraoperative MRIs are a huge consumer of space, with floor load requirements because of the magnet and the lead shielding enclosure which needs to surround the room." ORs need to be larger to accommodate this technology as it will become standard in the future.

Make sure that you consider any infection control issues that may arise from merging radiology and surgery. "Because there is a push to co-locate interventional and surgical suites, it will become more of a challenge to maintain a clean and sterile environment in the OR," says Mr. Harvey. This is especially important if you're constructing an adjacent room to house an MRI. Although this allows easier access to the MRI (the patient can be moved on the table from the OR into the MRI room) infection control procedures must be in place.