October 1, 2011
All in One Place
Surgery and medical imaging come together in a new breed of operating rooms.
Medical practice is continually changing as doctors discover new, more efficient technologies and techniques for taking care of patients. Medical imaging, catheter-based interventions, and surgery were once considered largely separate disciplines, and were performed in separate spaces. But the latest cutting-edge hybrid operating rooms (ORs), now beginning to appear in hospitals across the country, bring these disparate pieces to the table together, allowing doctors to see inside the body and make repairs in real time, with technology like fluoroscopy (moving X-ray machines that capture motion) and sonography.
That shift requires redesigning the traditional operating room—something that the architects at New York’s BAM Studio have been contemplating while building a handful of hybrid ORs at Yale-New Haven Hospital and St. Vincent’s Medical Center in Bridgeport, Connecticut. “You can’t just take this technology and dump it in an OR,” says BAM principal Ross Adam Cole. “There are a lot of obstacles that have to be overcome.”
For starters, hybrid ORs need to be much bigger—about 600 to 800 square feet at minimum, compared to 400 square feet for a traditional OR—to accommodate all the machines. “The equipment is all-encompassing,” Cole says. “It’s almost like you have to unwind a mummy to get the patient in and out of the room. You have to figure out how the equipment is going to move and fold up. It’s like a choreographed dance.” There is also a team of technicians that runs the machines, which needs to be accommodated, either in an adjoining windowed room or in the same room, behind lead glass.
Beyond practical concerns, BAM has also been using the projects to explore possibilities for improving the patient experience through design. In its pediatric hybrid OR at Yale-New Haven, for instance, the architects installed color-changing LEDs around the perimeter of the space and lined the walls with frameless frosted glass, so that patients can request changes to the color of the room. “Giving people a sense of control over their environment and really thinking about the visual aesthetics of the operating room has been having a pretty impressive effect,” Cole says. “They are finding that they’re giving the patients much less anesthesia, because they’re less anxious.”
“Before this concept of a dedicated space, there was the development of a more integrated approach to managing complex heart disease,” says Yale pediatric cardiologist Dr. Jeremy Asnes, who uses the pediatric hybrid OR. “People started to realize that we didn’t have a good working environment for it. When we started, we were doing these procedures either in an operating room that didn’t have fluoroscopic equipment, and we were wheeling things in, or in a catheter lab, where we were trying to accommodate the surgeons with appropriate lighting and a table that can move.”
Now, however, “We have a full cardiac OR right next to us when we’re doing complicated procedures,” he says. “It lets us offer patients and families a really different approach to how we handle heart disease. It’s less invasive, it combines the tools of both a surgeon and interventionist, and it’s not limited by one or the other.”