JRFHHA V Siddharth et al 10.5005/jp-journals-10035-1015 REVIEW ARTICLE Planning Premises and Design Considerations for Hybrid Operating Room 1V Siddharth, 2Sunil Kant, 3R Chandrashekhar, 4Shakti Kumar Gupta ABSTRACT in the great changes that have developed in regard to the The hybrid operating room can be defined as the combination construction, and organization, of the modern operating 1 of imaging system and operating table installed in an operating theater suite. ‘OT has been defined as that specialized facility theater room for, e.g. use of an angiography imaging system of the hospital where lifesaving or life improving procedures and operation table in an operation theatre or use of an are carried out on the human body by invasive methods operating table in angiography room. Shorter patient recovery under strict aseptic conditions in a controlled environment time, decreased length of stay, streamlined care delivery, improvement in cross-specialty communication, minimized risk by specially trained personnel to promote healing and for communication-related errors across clinical specialties cure with maximum safety, comfort and economy’.2 and lower overall cost of care are some of the advantages of Imaging has a long history in the operating room (OR). the hybrid operating room. Although no/limited data exists in In the 1960s, X-ray units were mounted on the ceiling, the literature, the potential disadvantages of hybrid operating suite are cost, infection, prolonged anesthesia and radiation as they might be today. But the surgeon had to go to an exposure. The primary components of a hybrid operating suite adjacent room to view the image, and images could only are an imaging system and imaging compatible operation table. be stored for 10 minutes. Mobile C-arms, introduced in 2 Area required for hybrid operating suite varies from 80 to 150 m . the late 1960s, have been a mainstay of OR imaging. But The most common configuration of hybrid operating suite includes a flat panel angiographic X-ray imaging system and more hospitals are finding these C-arms are no longer surgical equipment for cardiac surgery. meeting their OR imaging needs. Increasingly complex surgical and interventional approaches require more Keywords: Operating room, Hybrid operation room, Intra- operative imaging. advanced imaging. In response, many larger facilities have replaced the conventional OR configuration with How to cite this article: Siddharth V, Kant S, Chandrashekhar R, Gupta SK. Planning Premises and Design Considerations for new configurations known as hybrid ORs. The word Hybrid Operating Room. Int J Res Foundation Hosp Healthc ‘Hybrid’ originally refers to the result of interbreeding Adm 2014;2(1):50-56. between plants or animals of two different species. These Source of support: Nil combine surgical equipment and instrumentation for open procedures with a fixed and dedicated imaging system as Conflict of interest: None well as an imaging-compatible surgical table, lights, and INTRODUCTION surgical booms to accommodate open, minimally invasive and interventional procedures.3 It can function as either In recent years, we have seen ‘winds of change’, in medical a conventional operating theater, or as a radiology faci- science and nowhere can this be more aptly applied than lity, but crucially allows intra- and postoperative on-table 1Senior Resident, 2DDGAFMS (Coord) imaging and intervention, and overcomes many of the 3 4 Chief Architect, Head limitations of standard facilities. 1Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India Need for Hybrid OR 2 Ministry of Defence, Government of India, New Delhi, India The introduction and rapid growth of minimally invasive 3 Ministry of Health and Family Welfare, Government of India surgery (MIS) has stimulated interest in OR design. Hos- New Delhi, India pitals and surgi-centers have been inundated with requests 4 Department of Hospital Administration and Medical Superin- for construction and renovations to facilitate the practice tendent, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India of MIS. Other surgical disciplines and endoscopic environ- Corresponding Author: V Siddharth, Senior Resident ments also recognized the potential to create a procedural Department of Hospital Administration, All India Institute of environment that would better meet their specific needs.4 Medical Sciences, Ansari Nagar, New Delhi-110029, India Trends are driving the need for more imaging in the OR Phone: 9013844255, e-mail: [email protected] because of following reasons: 50 JRFHHA Planning Premises and Design Considerations for Hybrid Operating Room • A growing aging population means more people are living longer to require surgery best performed with image guidance. • More than 60% of all patients having surgical procedures are overweight or obese and often have comorbid dia- betes and cardiovascular disease. These trends increase the likelihood of more compli- cations during interventional procedures, often leading to the need to convert to an open surgical procedure3 and moreover: • The lines between interventional and surgical specialties are blurring—interventional procedures are becoming more complex, and surgical procedures are becoming less invasive. Graph 1: To demonstrate multispecialty usage of the • Increasing numbers of patients with complex disease are hybrid theater5 forcing cardiac surgeons and interventional cardiologists a. Lighting to collaborate more frequently. b. Monitors and video switching More complex procedures in the interventional suite c. X-ray/imaging system mean patients will require more clinical supervision and d. Other OR requirement possibly a more intense level of care. This has been an impor- 4. Radiation safety tant factor in shift from conventional operation theaters 5. Capital cost. toward integrated and hybrid operating theaters. Following table describes the advantages and disadvantages of hybrid Planning for Hybrid OR operating room (Table 1). From the outset, it should be recognized that effective Procedures Which can be performed in design of a hybrid operating suite is a complex process Hybrid Operating Theater which in most cases will require at least 6 months to over a year. The operating theater suite must be so well designed Because of its versatile nature it can be used by various and so attractively set out, that not only will the work done clinical specialities mainly for endovascular surgery, inter- there be of the highest order, but the personnel engaged ventional radiology, open vascular surgery, open surgical 5 therein, will find it a real pleasure to work in such ideal and radiological procedures (Graph 1). surroundings. Fatigue will be minimal, boredom nonexistent, efficiency at its highest peak, and pride of achievement the Planning and Design Challenges driving force.1 Following are the challenges associated with designing of Before planning a hybrid operating room, a clear vision hybrid operating room: for the utilization should be established. Planning of the 1. Multiple stakeholders hybrid room is truly an interdisciplinary task. It involves 2. Required space much more co-ordination and multiple departmental 3. Co-ordination with multiple vendors involvements than planning for a conventional OR or Table 1: Advantages and disadvantages of hybrid OR3,6 Advantages Disadvantages Shorter patient recovery time Cost Decreased length of stay Infection risk Streamlined delivery of care Prolonged general anesthetic Overall lower cost of care Prolonged radiation exposure Potential for revenue growth Minimized risk for communication-related errors across clinical specialties Effectiveness and efficiency in training, teaching and research High quality imaging vastly superior to portable systems Promotes the multidisciplinary process and allows for efficient use of staff and equipment International Journal of Research Foundation of Hospital & Healthcare Administration, January-June 2014;2(1):50-56 51 V Siddharth et al be possible but clearly in the absence of new construction, creation of such a space in an established operating room can present considerable challenges.8 The expense of these constructions and modifications can vary up to $100,000 depending on the original condition of the room, local contracting costs, architect’s fees and companies that market fixed imaging systems.9 Location The following things should be considered while deciding on the location of hybrid OR:10 • Relative ease of access to/from emergency department, radiology department, intensive care unit (ICU), inpatient Fig. 1: Hybrid operating room (Providence Sacred beds, etc. 11 Heart Medical Centre) • Proximity to blood bank, labs, pharmacy, etc. catheterization laboratory alone. These rooms are used not • Materials Support only by surgeons and interventional cardiologists, but also – Supply restock support by electro physiologists, neurosurgeons, and cardio thoracic – Standardize inventory vascular surgeons.7 – Mobile or stationary storage. Visits to established hybrid operating rooms, and discus- • Flow management sions with experienced users help tremendously during the – Ease of patient entry/exit planning process. Key stakeholders need to be identified and – Away from heavy traffic areas for sterility reasons. for planning should be included at an early stage. • Adequate electrical service to support new imaging In most cases, the design team will be led by a vascular equipment.