Recent advancements in heart valves and minimally invasive surgery technology have paved the way for even more patients to qualify for endovascular/interventional procedures. Yet these patients present with very complex medical conditions and are at a high risk for poor outcomes. In an effort to improve these poor outcomes and accommodate surgeon and interventionist needs, many hospitals have implemented hybrid operating rooms (typically an OR with a fixed C-arm angiographic system), and many more are considering it.
Hybrid ORs come with steep price tags—some may cost more than $2 million. Add on another $3 million or more for the appropriate OR equipment, integration systems, and facility renovation costs, and your project may now cost north of $5 million.
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Cardiac surgeons clearly have a vested interest in hybrid ORs. But how can a hospital ensure that other physicians, their support staff and senior hospital/system leadership are also engaged in the planning of this very complex set-up?
Every successful project starts with an actively engaged foundational team. A hybrid OR project team should include vascular, neurovascular, and cardiothoracic surgeons; interventional cardiologists; interventional radiologists; OR nursing staff; cath lab nursing staff; and the radiology technicians from both the cath lab and interventional radiology. Involvement by the IT team is essential, as they will be key personnel in the integration of equipment booms, the system’s table, and the video monitors. The biomedical engineering department should be part of this initial team as well — they will be the “first responders” whenever there’s a technical glitch. Finally, administrative leaders from the surgical, cardiac, and radiology departments need to be on board as volume projections must be made and Finance has to be engaged to determine if the cost can be justified.
Managing this very large team is challenging with so many different opinions and interests to consider. Each clinical specialty has somewhat unique needs requiring specific equipment placements. While room drawings from various suppliers are helpful, only the most adept clinical user generally has the ability to imagine what they mean for your planned space. The 2-dimensional AutoCAD drawings an architect might develop during the planning stages are tough to interpret if you are not used to reading them. While 3-dimensional and REVIT models are more useful than the 2-D ones, an actual live space—or even a mock-up—really allows clinicians to understand the spatial relationships much more clearly.
One of the best ways to see how hybrid ORs work in actual practice is to visit clinical sites where they are currently installed and talk with frontline staff about their specific challenges. Ask users how they changed the room’s configuration when new clinical services began using the room. Delve into how they manage consumable supplies and where they are stored. Where are their video monitors placed? Are there any limitations due to the size of the room? Did they choose a floor-mounted or a ceiling-mounted C-arm? Why? Ask why they selected their particular angiographic system and how they coordinated the various installation efforts. In addition to all your fact-finding, you must keep your CEO, COO, and other leadership up-to-date with your progress. This may be one of the largest capital expenditures of the year, and in some hospitals it may be the largest of the decade.
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After all the fact-finding and installation challenges, your hybrid OR is almost ready. But before it’s fully operational, conduct some role-playing exercises to ensure that staff are well versed in how things will work in advance of the first official hybrid procedure. You may want OR staff to observe a cath procedure and for cath lab staff to observe an OR procedure. Slight differences – or actually major differences—in practice can create cause a great deal of confusion when staff expectations are mixed in a hybrid OR. Make sure credentialing and quality criteria are in place.
Once the hybrid OR is finally in full swing, monitor surgeon and interventionalist usage—monitor “actual” versus “projected” in the number of procedures to assure that goals are met.
With proper planning, a hybrid OR benefits both patients and your hospital’s performance. You may be so successful that you have to start all over again—with planning a second hybrid OR.
Photo: Simonkr, Getty Images
Robert P. Maliff is director of ECRI Institute’s Applied Solutions Group. He can be contacted at [email protected].
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