CONSTANT COMMUNICATION One of the 18 integrated ORs at The Ohio State University Comprehensive Cancer Center.

Our health system's recent $1.1 billion expansion included the construction of a new cancer center with more than a dozen fully integrated ORs in which surgical video, navigation, robotics and other smart devices from departments throughout the hospital inform surgeons' decision-making by feeding clinically relevant information directly to the OR — all without disrupting the sterile field. From the first exploratory conversations about the project to the celebratory ribbon cutting, the following rules of thumb were essential to adding the high-tech rooms that would help lead us into the future.

1. Dig deep
When you're talking about adding integrated technology, you have to surround yourself with a team of visionaries. Our task force included leaders from several disciplines — surgery, clinical engineering, radiology, pathology, IT and purchasing, just to name a few. At the beginning stages, you're looking to answer one fundamental question: "What do we want from this building?"

From a perioperative services perspective, we started by defining the number of ORs we needed, based on projected volume, and then determined how to support those ORs in terms of pre-op rooms, PACUs, clean utility rooms and scrub sinks. At the same time, we began examining how to incorporate OR integration into the design.

2. Plan ahead
By considering all the procedures we were already doing and imagining what kinds of procedures we would be doing 5, 10 and even 20 years into the future, we forced ourselves to ask many more questions: Could we use room-to-room HD image routing to improve surgeons' decision-making? Would every OR need to be robot compatible? Could we benefit from illustrative types of equipment, like whiteboards and high-resolution touch-screen displays? Would surgeons like the ability to use hands-free technology to consult with a colleague or adjust room settings while in the middle of a case? Could we use telepathology to improve patient care both in and out of the OR?

The goal of OR integration is to give surgeons the tools they need to provide the best possible care, even beyond the OR. For example, we can now route surgical images and video out to consult rooms, so surgeons can have those visuals at their disposal when speaking with a patient's family after surgery.

Telepathology is another example. In a non-integrated OR, you'd have to send specimens out to the pathology lab for assessment. The surgeon would then have to leave the sterile field to talk to pathology over the phone before scrubbing back in to make his cuts and check the margins. The same sequence would be repeated as many times as necessary until the margins are clear, likely extending the surgery and increasing the likelihood of contamination.

With an integrated OR, the surgeon can stay in the sterile field while pathology orients the specimen and digitally routes the results back to the OR, where the surgeon can view them on a high-resolution monitor. The surgeon can then have a direct conversation with pathology without leaving the patient's side and circle a piece of tissue on the monitor — much like a football television commentator would do with a telestrator — while asking, "What about this spot here?" It's easy to see how this kind of progress can save time, improve accuracy and, in the end, provide the patient with better care.

PERSONAL PERSPECTIVE
Don't Wait to Get Involved in Project Management

LEAD ROLE When building or renovating ORs, have a hand in every decision involving technology upgrades and room layout.

I'm reminded of a past experience that speaks to the challenges surgical administrators face in building a new facility. During the planning phase of a new community hospital, I brought in a group of outside experts from multiple disciplines. As we sat around the conference room table going through the introductions, each person's credentials and experience were more impressive than the last

At one point, the expert in medical gases said to me, "Tell me about the gases you need for the anesthesia machines." I said, "You're the expert — why don't you tell me what I need?" Although he could tell me the minimum requirements, he wanted to know about the project's overall goals.

This taught me that, as an administrator, my role and experience were invaluable to the success of the project. It also taught me to get involved in construction projects from the very beginning, whether the conversation surrounds room layout, medical gases or surgical equipment. On the flip side, you have to realize that you do not have all the answers, meaning you need critical feedback from key stakeholders — not just the surgeons, but also the nurses, surgical technicians, anesthesia providers, lab/pathology, the business managers and the purchasing department, among others.

My advice: Pool your resources and always insist that you have a seat at the planning table. I took that approach when we built our new cancer center, and as a result found there are very few instances where I could say, "I wish we would have done this differently."

— Brenda Kendall-Bailey, RN, BSN, MS, CNOR

3. Work with a single vendor
As part of our due diligence, we visited a number of other hospitals that had successfully integrated their ORs. Some of the administrators we met said working with multiple vendors — one for surgical displays, one for video and one for integrated various technologies, for example — could result in finger pointing instead of collaboration if the project doesn't progress as planned.

We wound up vetting 3 different integration vendors. Because we're a state hospital, we had to get proposals from multiple vendors and put the project out to bid. Cost, support, ease of use and accountability were key considerations, but the feedback we got from those hospital visits confirmed our decision to work with a single vendor. Our integration vendor also manufactures OR equipment, so the company provided a central point of contact for everything we needed to integrate the ORs, with an exceptional service package to boot.

We also looked for ways to save money when vetting vendors. Our vendor's video equipment is backwards compatible, meaning it will work with a camera made 10 years ago or 10 years from now. That backwards compatibility made a huge difference in terms of cost-savings; it essentially means we'll invest in fewer upgrades for video towers and camera boxes in the years ahead.

FAR REACHING OR integration feeds clinically relevant information from different departments directly to the OR — all without disrupting the sterile field.

4. Standardize
This applies to room layout as much as it does to integration technology. Most of our ORs measure 650 square feet, although a few are as big as 800 square feet, and we decided every OR would have the same level of integration in terms of the image-routing system, as well as the light sources, camera boxes and other equipment needed for minimally invasive surgery.

That having been said, you have to be able to accommodate certain specialties; we have 2 ORs with intraoperative MRI capability, for example. This is where your friends from clinical engineering are invaluable, because they're the experts on everything from the cabling and wiring needed for any kind of video equipment, to the special hookups needed to accommodate robotics, to whether a 4K ultra-high-definition surgical display is the best fit for a certain OR.

Opening the doors
Being involved in the project from the very beginning has made me realize that, other than patient care, helping to manage building projects is one of the aspects that I like most about my job. You get to have a hand in making life just a little better for surgeons, staff and patients for generations to come. Today, because of the detailed planning we put into mapping out the new center, it's our turn to open our doors to other surgical professionals who are eager to learn from our experiences as they prepare to build integrated ORs of their own. OSM