CLEAN SLATE New OR designs solve common issues associated with equipment clutter.

New York-Presbyterian Hospital is poised to open a multimillion dollar expansion on Manhattan's Upper East Side that will feature 12 sleek new ORs designed specifically for outpatient cases. Beryl Muniz, RN, MAAS, the hospital's vice president of perioperative services, can hardly contain her excitement. "Outpatient surgery can be done more efficiently, and with better quality of care, when ORs are dedicated to ambulatory cases," says Ms. Muniz. "I've gotten my wish." Thanks to the new space that's she's been planning for years, her surgical team will achieve excellent outcomes faster than ever.

Out with the old
The new construction project was conceived in order to move outpatient cases out of the hospital's main ORs, where patients arriving for straightforward knee scopes went through the same painstaking pre-op registration process as inpatients readying for complex neuro surgery.

In the new patient-centric surgery center, patients will no longer be forced to find their way through a maze of windowless corridors to find the surgical waiting room. "We wanted to create an environment that shows a great deal of respect for our patients," says Ms. Muniz. "That's something we all feel on a daily basis, but we're not always able to demonstrate it in older facilities."

The surgery center's 12 ORs will each have 3 dedicated prep/PACU rooms where patients and their loved ones gather before and after surgery. The 36 rooms were intended to provide patients with privacy, but they're also designed to maximize efficiencies on the day of surgery; staff members won't have to constantly pull linens on and off of stretchers or try to figure out which bay patients should be wheeled to after surgery, which will save time between cases. Ms. Muniz says the 3 bays that are dedicated to each OR will be numbered (1.1, 1.2, 1.3/2.1, 2.2, 2.3/3.1, 3.2, 3.3, etc.) so staff know exactly where their patients are being prepped for surgery and which rooms they should be returned to in order to recover.

ROUND TRIP Prepping and recovering patients in the same space improves perioperative efficiencies.

The space will be laid out in 6-room "avenues." Arriving patients will walk down a window-lined corridor before turning down their assigned avenue. The creative setup prevents patients from having to make their way down a seemingly endless straight-line hallway to the end of the line where they'll find prep/PACU room #36.

Providers from numerous disciplines who converge on pre- and post-op areas often need to enter clinical data, so the facility's designers installed a pair of computer terminals in each pre/PACU space, a nicely appointed workspace just outside the avenues of rooms and touchdown workstations throughout the area. The computer stations and work areas are relatively minor design features that address the needs of an efficiency-minded staff.

Room for improvement
It's counterintuitive, but standardized OR setups actually allow for greater flexibility, says Jennifer Nussbaum, an architect and planner at Freeman White, a healthcare design firm in Charlotte, N.C. "If every room has identical equipment arranged the same way, each room can be easily manipulated for any type of procedure," she explains.

Ms. Nussbaum works with her clients to "zone out" OR spaces based on where the surgeon will stand, where the sterile field will be located, where clean and dirty instruments will be kept, and how staff members will move around the room, in order to determine the most effective way to lay out the table and surrounding equipment.

Ms. Muniz agrees that standardized OR setups let staff turn over and set up rooms quickly, because the location of equipment and supplies becomes second nature. In fact, the layouts of all procedural spaces within New York-Presbyterian's new building will be identical, so staff members know intuitively how rooms function and where equipment is kept, no matter where they're working.

"We focused on making the rooms state of the art, but we also spent time thinking about where to place equipment to promote surgical efficiencies," says Ms. Muniz. She learned from a previous building project that mirror-image ORs don't provide the flexibility needed to move cases along in the most efficient manner possible. To that end, the ORs in the new space are the same size and set up to accommodate same-sided surgeries.

There is such a thing as building too big, according to Ms. Nussbaum. "Extra-large OR designs inhibit efficiencies by increasing the amount of steps staff must take to access different spaces," she explains. "Much of OR design is based on the procedures you host, but it's also dependent on the way staff will function within the room."

EVERY LAST DETAIL Every aspect of facility design, down to the location of the scrub sinks, should streamline perioperative care.

She suggests you sit down with your architect or facility planner to map out exactly where each member of the surgical team will work, the supplies they need to access during cases and how those factors will intersect with high-traffic walkways and where patients will be wheeled into and out of the rooms.

There's a general assumption that getting equipment off the ground and onto booms improves efficiencies by eliminating tripping hazards that can slow the movement of cautious staff members. Boom-based monitors can also be placed around the table in positions that promote the ergonomic comfort of surgeons, who might be able to operate faster if they're not dealing with the aches and pains of repetitive-use injuries.

Ms. Muniz and her colleagues decided to outfit each OR with off-centered booms. The unique design limits the collection of arms hanging around the surgical table and has a higher weight capacity than traditional boom systems, so they can accommodate more monitors linked to the integrated displays of clinical information and images. The new surgery center's integrated ORs will allow for the sending of clinical data and images to monitors positioned at the sterile field, so surgeons can make treatment decisions based on updated information and proceed with surgery without leaving the OR table. "That integrated technology is what we need to speed access to information and improve communication among different providers within the hospital," says Ms. Muniz.

Fatigue mats placed over traditional OR floors improve staff and surgeon comfort during long days of standing and operating. Ms. Nuss-baum says an increasing number of facilities are opting to install a rubber sheet flooring, which provides slight give to surgical team members who are on their feet all day, and which is able to hold up well against the chemicals used to clean surface areas between cases. Ms. Muniz says the walls of New York-Presbyterian's new surgery center were constructed with modular stainless steel panels, which can be refitted literally over a weekend to accommodate future technology upgrades, such as larger high-definition video monitors. The walls are also easier to clean between cases, says Ms. Muniz.

Some facilities also want to keep a group of standardized supplies stored in the OR for easy access, but infection control concerns can arise, depending on a surgical team's methodology for retrieving and handling items during cases. "We instead like to build clean rooms adjacent to the ORs to keep often-needed supplies," says Ms. Muniz.

Dream come true
Ms. Muniz also oversees 23 ORs in a building that's 20 years old, and 15 suites embedded deep within a hospital that's been in service for almost half a century. Now she's preparing to open the ORs in New York-Presbyterian's stunning new surgery center. "We've been planning for this for a very long time," she says. "It's become a labor of love that's finally starting to take shape." OSM