Smart Integration for Your New OR

When people think of “integrated” or “hybrid” ORs, they tend to think of huge monitors and innovative new features such as augmented reality, virtual reality and robotics. Cutting-edge tech is great, but the fact is, integrated ORs don’t need to be filled with the newest — and most expensive — equipment to serve as an extremely powerful upgrade to your facility.

Our new integrated OR at Medina (Ohio) Hospital isn’t packed with technology for technology’s sake. It leverages tech and informed design to provide our staff with the real-world ability to perform more procedures with better quality outcomes than they could before.

As part of the Cleveland Clinic system, we rebuilt an existing catheterization lab based on our parent organization’s standards for next-generation ORs. We wanted to provide more services out of this room — not just cath lab procedures, but also vascular and interventional radiology cases.

Thanks to our integrated OR, surgeons and proceduralists benefit from clearer images on in-field monitors. They can easily pull images from remotely stored EMRs and view those records during procedures in real time. They can zero in on images in an unprecedented way to make more informed clinical decisions intraoperatively. Plus, they don’t need to navigate a cluttered workspace because the floor is notably free of wires and other tripping hazards. Here’s a closer look at the renovation and expansion of our integrated OR project.

• Planning and design. The room we converted was a cath lab in need of an upgrade. Its imaging equipment was coming to end of life and needed to be replaced. Because we wanted to add additional services to the room, we needed to make it work for everyone involved. Many meetings were held with a wide variety of stakeholders — including myself, cardiology, imaging, IT, pharmacy and anesthesia.

The original idea was to take the room as it was and renovate it. To meet Cleveland Clinic’s requirements, however, we needed to increase the size of the existing space. This expansion ended up taking over part of a hallway and part of the surgery locker room but was well worth the effort. 

• Physical space. The resulting integrated OR is 700 square feet, which is significantly larger than our six other ORs — nearly the size of two of the other ORs combined. From a practical standpoint, we took care to think of our providers’ workflow requirements in designing the room. For instance, we installed easy-to-disinfect metal cabinetry in the walls. Vascular cases require numerous specific supplies, with different types of catheters for different procedures. Our surgeons need sizes from A to Z on hand because they won’t know what size they’ll need until they see the intraoperative images and understand what they’re up against. In the cabinets, all our catheters, which can be long, are stored in a tiered configuration that makes it easy to see and grab the right size instantly. Because catheters are behind glass that is disinfected between every case, the risk of any contamination is extremely low.

Another example of smart design is the anesthesia area. Although we could bring an anesthesia machine into the previously existing room, it wasn’t ergonomically savvy because the oxygen and air outlets weren’t close enough to it. Now those outlets are in a much more suitable place, eliminating the need for cords on the floor that present tripping hazards. 

We focused on how to use space most efficiently because three services with different equipment needs work in the same OR. Now, everything they need is there. In an equipment room where towers for the data-networking and radiology equipment reside, additional equipment can also be comfortably stored.

• Video monitors. Two 25-inch high-definition (HD) in-field monitors hang from the ceiling. The monitors are attached to articulating boom arms, while another screen is set up outside the field displaying vital signs. One in-field monitor displays images from the live surgery, while the other allows the proceduralist to pull up films from the patient’s chart. That second screen can even be split to show two images concurrently. With this setup, our surgeons can see what’s happening in the procedure in real time while also viewing X-rays or other images.

The screens aren’t super large, but they can articulate on booms to become as accessible and visible as possible to the proceduralist, and their HD resolution allows for much more precise visualization. The quality of images is spectacular. During vascular and cardiology procedures, surgeons can even view very small vessels with stunning clarity. Thanks to our new video system, providers really dig in and magnify images to see, for example, if a condition has progressed since a stored image was taken. These monitors aren’t touchscreens, of course, since everybody’s sterile at the field. When the patient is draped, the table is draped. On the side of the bed, where the surgeon and the technician stand, a touch remote control allows them to easily increase or decrease the sizes of displayed images. And if we’re doing a cardiac catheterization, a nurse sits in the cath room behind a large glass window, where she can freeze the screen to capture a waveform or manipulate the in-field monitor to provide relevant information and images.

• New capabilities. Our teams can now do numerous things in our integrated OR they simply couldn’t do before. Take advanced interventional radiology, for instance. Because the visual acuity our equipment produces is so precise, we’re able to do more complex procedures than we could with our previous imaging system. Our vascular surgeons can better visualize even the smallest clots. We couldn’t perform endovascular aneurysm repairs in our ORs before; now we can. If a patient has gastrointestinal bleeding, surgeons insert a coil that leverages very precise imaging to see where the coil is landing and where the bleeding is coming from. 

The best part? Even though this new OR was designed with a strong cardiology/vascular focus, it’s equipped to handle several other procedures. 

Successfully building a next-generation integrated OR requires careful consideration of the types of procedures you want to perform and how the technology you select can enable and improve the performance of those procedures. Your guiding principle should always be to make both the technology and the space work harmoniously for you, your providers and your patients. If you adhere to that focus from day one, you’ll greatly enhance your facility. OSM