scheduled to deal with any issues in real-time during the transition period. Schedulers will need to be sensitive to any variations in the rhythm of the surgical work- flows to calculate any required modifications in OR turnaround times and CSD processing. Senior hospital administrators will con- tinue to be concerned in very broad terms until sufficient data has been accumulated to validate the business case for making the investment in the first place.

What are some of the misconceptions or unrealistic expectations you hear from vari- ous stakeholders when planning/designing a new surgical suite?

encountered is that oftentimes the one controlling the dollars does not real- ize that to obtain the proper patient, staff, and materials flow requires additional square footage and other building requirements that add cost. This cost is realized in construction along with added square footage of the over- all center.

Cavallaro: A misconception that we have

Bluette: Most end-users think that the project can be built in a short

period of time. Healthcare design and con- struction is heavily regulated so it’s an exten- sive process that requires their participation at many points along the way.

Rodney Cadwell, Associate Principle, Vizient, Inc.

The most common miscon- ception can be summed up from the famous line from the movie Field of Dreams, “If

you build it, they will come.” This is particu- larly true when bringing in new technology. We have seen numerous hybrid operating rooms designed that do not function well because the input from various users was not blended. So the room may work well for one specialty but be a burden on another. These are not one-size-fits-all rooms. The advice would be make sure you have all potential users together during design so that each has a voice that is taken into consideration. Unless the design is specifically for one specialty, there will need to be some compromise.

Rockow: When it comes to OR renova- tions — in particular, multidis-

ciplinary hybrid surgica suites — managing expectations is just as important as managing each phase of the lengthy planning process. That’s because no amount of preparation can anticipate every workflow or equipment is- sue that could arise. That’s why it’s important that OR planners align themselves with highly knowledgeable and experienced partners who know what it takes to reconcile these unexpected problems and overcome the inevitable bumps in the road.

DiLalla: A big misconception is that retro- fitting an operating room with

integration is quite time-consuming. In reality, with the right vendor partner, the retrofit of an existing environment can be quick and seamless, getting the newly-renovated OR back up and running promptly. An efficient renovation can be key in allowing that operat- ing room to start generating revenue again as soon as possible.

Have you noticed any trends in surgical suite builds/renovation in recent years? Are buyers more likely to upgrade or build from the ground up?

Cavallaro: We are noticing that many hospi- tals are opting to take the less in-

vasive surgical cases out of the main hospital surgery space. This allows for the use of hos- pital ORs for the more acute cases. Further, we are noticing that many of the outpatient Am- bulatory Surgery Centers are geared towards quick turnaround cases. One of our latest projects, the Surgery Center at Shrewsbury, is a great example of a surgery center indepen- dent of a hospital campus that provides the same high-quality care but at lower costs and with improved efficiencies. To read the case study visit tershrewsbury/.

Bluette: The three big trends are imaging modalities embedded within the

operating room, the use of robotics-assisted surgical procedures becoming more common- place, and the shift of minimally invasive outpatient surgical procedures being decanted from the hospital to an offsite location that has more of a business structure rather than a healthcare structure.

Bridgen: What we are seeing with larger IDNs, as well as with physician/

surgeon groups, is a trend toward locating new, stand-alone ambulatory surgery centers away from the critical/acute care hospital setting. ASC’s are performing more complex procedures now than ever before. Patients tend to have a better experience in this type of setting and recover better at home. What this does for the inpatient side is free up valuable OR time for more complex inpatient proce- dures that need hospital care following sur- gery.

As hospitals renovate existing spaces, the

trend is toward flexibility. Generally speaking, they are not increasing the current building footprint but instead designing spaces that can be easily reconfigured for future demands. These flexible OR settings can be reconfigured for multiple cases or re-purposed for another use outside of surgery in the future (CCU/ ICU space).

typically reveals itself even be- fore the planning process begins once the

Rockow: Build or upgrade? The answer

objectives of the project have been established. If a traditional OR is simply being re-outfitted with new technology (lights, booms, table, cabinetry, ancillary equipment) to re-establish a state-of-the-art environment, it’s highly likely the current OR footprint can accom- modate these changes through a straightfor- ward room renovation.

However, once it has been determined that image-guided procedures will be performed in a Hybrid OR setting, the need for ground- up construction increases exponentially for the same reason why it’s impossible to place ten pounds of sugar in a five-pound bag. Space limitations become even more acute if the Hybrid OR is expected to be scheduled for multi-disciplinary use across an expanded list of specialties such as neuro, orthopedics, trauma, thoracic, oncology and urology — in addition to vascular, cardio and neuro-navi- gation procedures. In the Hybrid OR, space truly is the final frontier that needs to be conquered, and current footprints are most likely too small to comfortably and safely accommodate additional imaging equipment, integration technology and staff.

New construction is also called for when hospitals need to add capacity to handle an in- creased OR workload. For example, since 2010, more than 75 rural hospitals have closed their doors, and it has been reported that nearly 700 additional rural facilities could soon be facing a similar fate. In these situations, or when communities are experiencing explosive population growth, hospitals have little choice but to add brick and mortar to serve everyone in need.

augment their integrated operat- ing room for years after the initial installation, without undergoing complicated or costly construction to do so. By investing in inte- grated solutions that offer scalability, facilities can add new capabilities to their existing systems as the operating room’s needs grow and change.

DiLalla: Many customers look to regularly

For example, with the enhanced detail of 4K resolutions now entering the healthcare space, it’s more critical than ever to ensure that the integration installed today can easily and quickly accommodate these signals when the hospital chooses to adopt 4K imaging devices. Likewise, because technologies are rapidly advancing, hospitals want to ensure that any renovations, updates, or upgrades done now will accommodate future technology with minimal disruption and expense.

How is traditional surgical equipment evolv- ing to accommodate and facilitate use in a hybrid or integrated OR setting?

Cadwell: In most cases we see the operating room designs centered on multi- Page 18 • HEALTHCARE PURCHASING NEWS • October 2018 17

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