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Capitalizing on the New Wave of Hybrid Ors SPECIAL REPORT Capitalizing on the New Wave of Hybrid ORs Published by OR Manager and Access Intelligence Introduction www.ormanager.com SENIOR VP/GROUP PUBLISHER Jennifer Schwartz • 301-354-1702 An increasing number of hospitals nationwide now have hybrid [email protected] PUBLISHER, DEFENSE AND HEALTHCARE operating rooms. Building a new hybrid OR takes careful planning, Thomas A. Sloma-Williams • 301-354-1696 requires specialized and advanced audiovisual and imaging [email protected] EDITOR equipment, and involves the collaboration of many decision Elizabeth Wood • 301-354-1786 [email protected] makers. And once a hybrid OR is in place, procedures often require CLINICAL EDITOR teams from several disciplines to work together as one. This process Judith M. Mathias, MA, RN CONTRIBUTING WRITERS may be daunting, but the results may leave you in a better position Paula DeJohn, Cynthia Saver, MS, RN WEBINAR COORDINATOR to offer a variety of surgical procedures, enhance patient safety, and Ellen Lord, MS, RN, CNOR CONFERENCE DIRECTOR achieve long-term cost savings with improved efficiencies. Jess Tyler ART DIRECTOR Regardless of whether you’re building a new hybrid OR or Yelena Shamis remodeling to accommodate the new room within existing space, [email protected] SENIOR PRODUCTION MANAGER you must commit considerable financial and human resources. Joann M. Fato • 301-354-1681 [email protected] This special report provides insights from professionals who have ADVERTISING transitioned to a hybrid OR, offering tips and strategies to help National Advertising Manager Jamila Zaidi Account Executive, OR Manager you through the process. As with any transition, getting input from [email protected] 301-354-1678 physicians, anesthesiologists, nurses, technical staff, and other Fax: 301-340-7136 members of your team is crucial to success. It is our hope that this REPRINTS Wright’s Media report lays the groundwork for a successful conversion. 877-652-5295 • [email protected] OR Manager (ISSN 8756-8047) is published monthly by Access Intelligence, LLC. Periodicals postage paid at Rock- ville, MD and additional post offices. POSTMASTER: Send address changes to OR Manager, 4 Choke Cherry Road, 2nd Floor, Rockville, MD 20850. Super subscription (in- cludes electronic issue and weekly electronic bulletin) rates: $219 (plus $10 shipping for domestic and Canadian; $20 shipping for foreign). Single issues: $39. For subscription inquiries or change of address, contact Client Services, [email protected]. Tel: 888-707-5814, Fax: 301-309-3847. Copyright © 2015 by Access Intelligence, LLC. All rights reserved. No part of this publication may be reproduced without written permission. OR Manager is indexed in the Cumulative Index to Nursing and Allied Health Literature and MEDLINE/PubMed. Access Intelligence, LLC President & CEO Don Pazour Chief Operating Officer Heather Farley Executive Vice President & Chief Financial Officer Ed Pinedo Exec. Vice President, Human Resources & Administration Macy L. Fecto Senior Vice President, Chief Information Officer Rob Paciorek Senior VP, Customer Acquisition and Retention Sylvia Sierra Senior Vice President, Digital Development Alison Johns VP, Production, Digital Media & Design Michael Kraus Vice President, Financial Planning and Internal Audit Steve Barber Vice President/Corporate Controller Gerald Stasko 4 Choke Cherry Road, Second Floor Rockville, MD 20850 • www.accessintel.com 2 OR Manager Special Report Capitalizing on the New Wave of Hybrid ORs Table of Contents Clear vision critical to successful hybrid OR development ........................ 4 Case Study: Operationalizing the hybrid OR .............................................. 6 Lessons learned from hybrid OR installations ............................................. 8 Specialized equipment serves hybrid and standard ORs equally well .....11 Endovascular hybrid ORs in community hospitals: Driving success ....... 13 Include infection prevention in your hybrid OR design .............................17 Perceptive leadership fosters collaboration among hybrid OR staff ....... 19 Building the business case for a hybrid OR ................................................ 23 Capitalizing on the New Wave of Hybrid ORs OR Manager Special Report 3 Clear vision critical to successful hybrid OR development About 100 US hospitals now have a hybrid operat- converting to an open procedure, so they must be ing room, and a 15% increase is projected over the large enough to accommodate staff and equipment next decade, according to experts who have man- for two separate clinical teams, Ingle explains. aged installations at numerous facilities. Whether your hospital is considering converting a Procedures conventional operating room into a hybrid OR or The list of procedures that can be performed in a hy- building a brand new room, it’s important to know brid OR is growing. Among these are many cardiac where you want to end up before you take the first procedures that in the past have been done in the step to get there. cath lab, but Ingle notes that “hybrid ORs should not “Knowing what you want to accomplish—having be glorified cath labs.” Newer procedures include a business plan—is the most critical part of plan- transcatheter aortic valve replacement (TAVR) and ning. Just knowing that you want to have a hybrid mitral valve clipping, endoscopic abdominal aortic OR isn’t very helpful,” says Lynne Ingle, MHA, aneurysm, and aortic arch repair. BS, RN, CNOR. As a project manager with Gene Burton & Associates, a health care technology con- Some hospital leaders have mistakenly believed sulting company in Franklin, Tennessee, Ingle has that for a procedure such as an aortic valve replace- overseen several hybrid OR installations. As a for- ment, a cath lab can be turned into a hybrid room, mer director of surgical services, she is well versed she says. However, some valve vendors won’t enter in the kinds of improvements hospitals hope to into a contract with a hospital if these procedures achieve with the new technology. are to be performed outside the restricted area of the surgical suite. “You need to have all the capa- bilities for converting to an open procedure if need Planning be,” Ingle says. Key players in the planning process are hospital administration, interventional cardiologists, open Form and function heart and vascular physicians, neurosurgeons, an- esthesia providers, department heads and staff from The most common configuration for a hybrid OR the cardiac catheterization lab and the OR, a charge includes a single-plane angiographic x-ray imag- nurse, a staff nurse, and information technology, ing system and surgical equipment for open cardiac Ingle says. Participants from the nonclinical side surgery. include architects, vendors, and engineers. And for Lights for the hybrid OR must have a longer arm any remodeling project, it’s critical to consider in- reach, especially depending on who’s doing the fection prevention, she emphasizes. imaging, Ingle says. Whether a ceiling-mounted or Start by determining just how your hospital defines floor-mounted C-arm is the best choice depends on “hybrid.” Consider questions such as: which procedures will be done in the room. Place- ment of lights and booms is important because • What is the hospital’s goal? anesthesia staff must be able to have access to the • Who is driving the function of the space? head of the table. • What procedures are planned? Knowing how the space will be used is especially important for determining the type of table that’s • What is the budget? needed. If most procedures will be interventional, A traditional OR is about 700 square feet, whereas at the table selected should be one that communicates least 1,000 square feet is needed for a hybrid room, with the imaging system, which is typically pur- and 1,200 square feet is preferable for accommo- chased from the imaging vendor. If the room will dating the imaging equipment within the room plus function primarily as an OR, however, the table the control room from which procedures are moni- should be appropriate for surgical procedures and tored. Hybrid ORs must allow for the possibility of thus it won’t be able to communicate with the imag- 4 OR Manager Special Report Capitalizing on the New Wave of Hybrid ORs ing system. Some OR vendors offer a table with a Previously, patients in that area of Nevada who fixed base and two tabletops—one for surgical pro- were too ill to undergo aortic valve replacement cedures and one for imaging procedures. with an open procedure usually had to go to south- ern California, Ingle says. Installation of the hy- Well-funded facilities may have a dedicated wall brid OR allowed them to have TAVR without hav- for imaging. But in general, facilities need to have ing to travel. a “live” monitor and a reference monitor from the imaging vendor, displays at the OR table for the surgeon and assistant, and displays on the wall— The future as few or as many as hospitals can afford or want, In 2013, the interventional trauma operating room Ingle says. (ITOR)—a $6-million 1,600-square-foot hybrid Knowing the visuals needed in the control room operating suite—opened at the Foothills Medical is an important factor in deciding on vendors, she Center in Calgary, Alberta, Canada. The facility is notes, because the technician in the control room “the first of its kind designed specifically for trauma must be able to see and understand what the sur- patients [and] is more than twice the size of a tradi- geon needs. tional OR,” according to Andrew Kirkpatrick, MD, As an example of the efficiency gain that’s achieved Alberta Health Services’ medical director of trauma with a hybrid OR, Ingle says, troubleshooting can services. The angiography equipment, which al- be done in one place instead of moving the patient lows surgical and diagnostic imaging teams to work from room to room. “For cardiac surgery, some- on patients at the same time, makes it possible for times a patient is taken from the cath lab directly patients with severe bleeding to go directly to the to the OR, and measurements are taken for vessels ITOR for treatment.
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