What's Up, Doc?

What's Up, Doc?

As advances in medical technology allow surgeons to use less invasive procedures, more architects are heading to the operating room to radically rethink its design. New surgical suites called “hybrid ORs” are cropping up across the country. While few institutions have the money to afford them, empirical and informal evidence of their success is gaining attention from both design and medical professionals.

Traditionally, diagnostic medical procedures are performed in labs, not in operating rooms. But medical specialists are beginning to move these procedures to sterile ORs in a coordinated effort to let real-time imaging inform surgery. With this approach, patients spend less time on the operating table and in recovery.

The strategy is good for a hospital’s bottom line, too. Though one hybrid operating suite may cost several million dollars, hospitals are able to schedule more procedures per day. Getting healthy patients out the door also reduces costs and the chance of hospital infections.

“So many hospitals are interested now. It is still very much a new concept,” said Ross Cole, a principal at BAM Studio in Manhattan. At Yale New Haven Hospital, BAM designed a Class C hybrid OR for the hospital’s pediatric catheterization lab. The lab’s control room is open to the main OR, allowing the space to feel larger and encouraging natural conversation without microphones or speakers between technicians and surgeons.

Beyond the latest technology, the space integrates materials that are more pleasing. Frosted glass shields the ugly plastic bins ubiquitous in most hospitals. New LED surgical lights are more maneuverable and give off less heat than fluorescents, and a perimeter band of LEDs can be changed according to patient preference. “It helps make the patient feel a little more in control of their environment,” said Cole.

The University of Michigan’s new children’s and women’s hospitals will have a hybrid OR for neurosurgery designed by Detroit-based SmithGroup Health Studio. The project shows how much of a hybrid OR’s design is driven by equipment according to Ann Kenyon, who co-leads the Health Studio. An IMRIS MR machine docked in a room adjacent to the OR will move along ceiling-mounted rails should the surgical team want to examine a patient’s brain immediately following a procedure. Previously, a patient would be sent to recovery, then to diagnostic testing weeks later to examine results.

Upfront costs are still the largest deterrent for many institutions. Depending on the amount of infrastructure in place, projects can cost $1,000 per square foot without equipment, versus the $600 per square foot average for most hospital projects. Space is also a concern. A code-compliant OR can be as small as 400 square feet, but most hybrid spaces are closer to 1,000 square feet because of equipment, which also necessitates greater floor-to-floor heights and large column-free spaces. Some imaging equipment requires structural isolation to prevent vibrations.

Institutional reluctance is another challenge. Doctors and U.S. healthcare regulators often prefer a tried-and-true approach. So far, most American hybrid ORs are affiliated with research institutions. In Europe, acceptance has been greater, perhaps because of regulatory issues more conducive to change. “When you talk with Philips, Siemens, or GE, the first thing they do is talk to you about what they did in Europe,” said Cole.

Along with medical technology innovators, product makers are advancing hospital design. Last year Michael Graves collaborated with medical equipment manufacturer Stryker on a new line of healthcare furniture including patient room tables and chairs. Kvadrat, Carnegie, and Armstrong are all expanding lines for healthcare that include new bacterial- and slip-resistant materials, not to mention new colorways and finish options.

After completing BAM’s Yale project, one head nurse told Cole that anesthesiologists had been using less medicine on adult patients. “They didn’t need anesthesia to get them past that apprehension point,” said Cole. Concrete numerical evidence about the hybrid OR’s efficacy is still being collected, but the best measure may be anecdotal.