Elaine S. Larson Surgical Center Campaign - Allina Health

Elaine S. Larson
Surgical Center Campaign
UNITED HOSPITAL
FOUNDATION
A ProjECt of thE UnitEd hoSPitAL foUndAtion
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table of Contents
Importance of Surgery at United Hospital . . . . . . . . .1.
United Hospital Foundation’s Commitment . . . . . . . .2
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Hospital Economics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Today’s Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Patient Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Financial Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1.
Building for the Future . . . . . . . . . . . . . . . . . . . . . . . . . 1.2
Current Operating Rooms . . . . . . . . . . . . . . . . . . . . . . 1.4
Operating Room Renderings . . . . . . . . . . . . . . . . . . . . 1.6

the importance of Surgery
at United hospital
United Hospital is the hospital of choice for more than 200,000 people
who rely on it each year for their health care needs. Our goal is to provide
any patient, at any time and in any room, with immediate access to the
health care that he or she needs. United’s operating rooms, which were
designed and built in 1977 when procedures were much simpler, are
interfering with our ability to meet this goal. These rooms are antiquated
and undersized, contributing to inefficiencies, financial constraints and
patient, physician and staff dissatisfaction.
Throughout the past 150 years we have shown that we are dedicated
to the health and well being of those in the United community. More
recently, we have made major investments in technology, including
intraoperative magnetic resonance imaging, two robotic surgery systems,
a 3T MRI and the magnetoencephalography, among others. We have
invested in our facilities to improve service and expand specialty care
offerings on our campus through United’s Peter J. King Emergency Care
Center, Nasseff Heart Center and Nasseff Neuroscience Center. We now
need to invest in our operating rooms.
The United Hospital Foundation campaign to completely rebuild
the operating rooms has a goal of $18.5 million. The project
entails restructuring our existing operating rooms into larger, more
technologically advanced surgical suites that will increase efficiencies in
usage, patient flow and turnover. The average size will go from 350 square
feet to 600 square feet.
Please consider joining us in our efforts to serve our communities by
providing exceptional care, as we prevent illness, restore health and
provide comfort to all who entrust us with their care.
Thank you for your commitment to United Hospital and to the United
Hospital community.
Omer Sanan, MD
Medical Director of Surgical Services
United Hospital
omer Sanan, Md
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the United hospital foundation
the United hospital foundation recognizes that for United hospital to continue meeting the needs of the
community and of the practitioners who provide the expert care, the Surgery department needs to be
rebuilt, including renovating the existing operating rooms. in 2011, United hospital foundation launched
a campaign toward this goal. Some of the board members opted to get up close and personal with the
situation by touring the facilities and observing a surgical procedure. their experiences highlight the need
for this project.
joan thompson, Minnesota Wire
Thompson oversaw a neurosurgical procedure that involved replacement of a metal
plate in the patient’s spine. “I was left with an excellent impression of the surgeon, Dr.
Jerone Kennedy, and his inclusion of the skilled staff in the room. There were more
than 13 people who came into and out of the room during the five-hour procedure,”
said Thompson.
“The room was cramped, and it was apparent that efficiencies were difficult to achieve,
including moving equipment as needed. At one point technicians had to lay on the
floor under the patient to continue checking on all the wires needed to monitor the
patient.” She noticed inefficiencies in the way inventory was presented during the
procedure and the storage of medical equipment in the hallways. “Improving the space
in the Surgical Center will provide for the physicians and staff to do their absolute
best work. Patients at United Hospital deserve that,” Thompson said.
russell King, King Capital Corporation, Board Secretary
King observed several hours of a complex neurosurgical procedure that took more
than 23 hours in total. He said he never felt that the room had a direct impact on the
patient’s outcome, and that he wasn’t expecting any impact based on the expertise of
the physician and staff. He was struck, however, by the amount of “clutter” outside the
room. “It was almost oppressive, with all the carts, equipment, gurneys in the hallway.
I could see that this would impact the workflow, adding to the challenges for those
who work in this environment every day.”
“Everything comes back to the fact that United Hospital is a community resource,
with the operating rooms at its core,” he said. “United is a community resource that
needs to be the best it can be.”
dan Mott, fredrikson & Byron
Mott observed a half day of spinal fusion surgery from a step stool. He said the layout
of the room looked like it was out of the 1960s and 70s and very small, given the size
of the equipment used. “It was like buying a house with green shag carpeting; the
presentation was not great,” Mott said.
United’s operating rooms need to be modern and up-to-date. “I saw first-hand that
to provide 21st century care, our surgeons and caregivers need space that is larger and
can be adaptable,” Mott explained. “This will allow us to provide the highest level of
care for patients.”

the 21st Century operating room
Meeting the Community’s needs
Patients at United Hospital have come to expect
high-quality performance, precision and expertise
from our physicians and staff. They know when they
need surgery, United will provide exceptional care.
But this ability is being tested. United’s operating
rooms are too small and too antiquated for today’s,
as well as tomorrow’s, state-of-the-art technology
and capabilities. The fact that our physicians and
staff have continued to provide quality, exceptional
health care in undersized and antiquated facilities
is a testimony to their knowledge, expertise and
dedication.
The majority of United Hospital’s 20 operating rooms
were built in the late 1970s, before the advent of
electronic medical records, portable ultrasound units,
image-guided systems, robotic devices and many other
technological advances that have improved surgical
precision and results. Surgeons and staff often find
themselves crowded into small operating rooms, high-stepping cables, maneuvering
between portable carts and devices and often having to manually shift equipment
into and out of the room during procedures. All of which add time, thus incurring
additional costs and reducing efficiencies. In an era of reduced reimbursements and
increased medical costs, efficient use of the surgical spaces is paramount.
In 2010, 10,022 operations were performed at United Hospital in 19 surgical rooms.
(One of the 20 operating rooms is being used for equipment storage). The rooms
vary in size, but average between 315 and 469 square feet. Space restrictions mean
that many procedures can only take place in certain rooms to accommodate the
appropriate equipment.
“United’s operating rooms are half the size they need to be for surgeries of today,”
says Dan Foley, MD, United Hospital’s vice president of medical affairs. “When these
operating rooms were built, surgeries were simple and open. Today most surgeries
require minimal techniques. Anytime you convert to a minimally invasive technique
you need more equipment and additional staff.”
In addition to size limitations, storage issues are rampant. Hallways, a surgical room
and an autoclave room are routinely used for equipment storage. labeled, colored tape
permanently lines the hallway floors marking specific storage sites for equipment, such
as electron microscopes, beds and carts. The labeling helps make it easier to locate a
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Executive Summary
the Elaine S. Larson Surgical
Center Campaign will
completely rebuild United’s
operating rooms into
larger more technologically
advanced surgical suites.
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dan foley, Md, Vice
President Medical Affairs
Bob Plaszcz, Vice
President operations
needed piece of equipment but hampers movement and, in some cases, creates
hazards. This storage solution also means that equipment is manually moved,
sometimes across great distances, which increases the possibility of equipment
damage, as well as injury to staff.
A third issue is turnover. When everything must be moved into and out of
each room, it takes longer following one procedure to remove equipment,
clean the room and bring in what is needed for the next procedure. Surgeons
want to be efficient and will go where they can be assured of doing more cases.
Fourth is technology. Architects who designed United’s operating rooms
40 years ago could not have foreseen the technological advances typical
in today’s surgical procedures. The rooms do not have the technological
infrastructure needed, thus creating inefficiencies, as well as hazards in the
form of cables on the floors, physical restrictions to staff and other safety
problems.
Research has shown that for today’s surgical procedures, operating arenas
should have:
• 600 – 650 square feet for general, orthopedic and cardiac procedures
• 750 square feet for neurosurgery and robotics
• 200 square feet of storage for each operating room
The United Hospital Foundation is spearheading the campaign to rebuild-
United Hospital’s operating rooms. The project includes:
• Reconfiguring 15 operating rooms. Operating suites will be at least
600 square feet in size.
• Ceiling mounted booms for equipment to eliminate floor cabling and
reduce the need for equipment carts or towers.
• Multispecialty functionality for improved patient and surgeon access.
• Technology integration for connectivity issues, making it easier to display
data on one flat panel monitor, and integrate technological platforms,
systems and power outlets.
• Improved lighting.
• Improved storage space.
• Improved flow for both patients and staff.
• Remodeled Doctor’s lounge.
• Sterile processing will be moved to the surgical area from the basement.
“The cost of this remodeling project will be $18.5 million says Bob Plaszcz,
vice president of operations at United Hospital. “When completed, United
Hospital’s operating rooms will meet the needs of our community, our
surgeons and surgical staff.”

Surgery
A hospital’s Economic Engine
Surgery is the economic engine of any hospital. Most
hospital programs and services that are needed to
ensure a community’s continued health and well
being are not economically viable and must rely on
income from surgery to survive. The bottom line of
any surgery department has far-reaching effects on
all other programs.
In an era of diminishing reimbursements for most
medical services, the need is even greater for
hospitals to ensure that their surgery department
is strong, efficient, well-run and healthy. This
includes upgrading surgical processes and facilities as
technology and other advances are made, a goal that
is even more imperative given that every other east metro hospital has
invested in their surgical facilities over the past few years.
To continue to meet the needs of our community, and our physicians and
staff who provide the surgical service, United Hospital must completely
rebuild its operating rooms. These facilities were last updated in the
1970s and were state-of-the-art for that time. Open surgical procedures
have been replaced with minimally invasive techniques that require
more equipment, training and personnel, all crowded into spaces that
are too small and too antiquated. The fact that our physicians and staff
have continued to provide quality, exceptional health care in undersized
and antiquated facilities is a testimony to their knowledge, expertise and
dedication.
Scheduling and turnover Costs
“When you are limited to certain rooms because of space considerations,
access difficulties arise,” says Jerone Kennedy MD, a neurosurgeon with
United Neurosurgery Associates. He also serves as medical director of
Neurosurgery and Bentson Neuroscience Chair at United Hospital. “Such
difficulties mean delays in scheduling and slower turnover.”
“Scheduling is one of the biggest problems with our operating rooms
configuration,” says Pam Berg, RN, surgical patient care manager at
United. “There are only a limited number of rooms that are large enough
for the technology needed today.” In addition, she cites that with the
increase in equipment is an increase in the number of staff in the room.
“The more complex the procedure, the more staff are in the room.”
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hospital Economics
United hospital’s undersized
operating rooms slow down
procedures as equipment is
moved into and out of each room,
thus increasing surgical time and
reducing the number of procedures
that can be completed in a day.
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jerone Kennedy, Md,
neurosurgeon
Pam Berg, rn, Surgical
Patient Care Manager
Turnover refers to the process of transition from one procedure to the
next. When a procedure is completed, equipment must be moved out
of the room so the room can be cleaned. Then equipment for the next
procedure is brought in. When rooms are small, equipment placement is
similar to putting together a jigsaw puzzle. The pieces need to be placed
in the room in a specific order and precise to each other or they don’t fit.
Sometimes this means, moving the patient in first and the equipment in
afterwards. In addition, equipment may be stored in a location far from
the room, slowing turnover even more.
“United has longer turnaround times than elsewhere,” says Dr. Kennedy.
“Surgeons who could do four or five cases in a day elsewhere may only fit
in two or three at United.”
By renovating the operating rooms, many of these inefficiencies will be
eliminated, such as competition for the few large operating rooms that
currently exist. Delays in scheduling will be reduced and scheduling staff will
have less juggling to do. Turnover time will also be reduced, as much of the
equipment will be mounted on booms in the rooms, reducing the need for
carts to be moved to and from the room. Storage will be increased, making it
easier to locate equipment and supplies when needed.
Process improvement
In addition to the physical renovation, work began in January 2010 on
process improvements for the Surgery Department. For example,
perioperative staff and post-surgical staff have been trained to float
between these two areas so that staff is readily available to meet the
greatest need. Additional studies are underway regarding supply
distribution to reduce supply costs, improve inventory and make supplies
easier to access during a procedure.
“The supplies and equipment you use over and over should be centrally
located to decrease down time,” says Dr. Kennedy. “If you don’t address
process improvement, utilization and flow, you won’t improve efficiency.”
And without improved efficiency, the bottom line will be affected, as will
all other programs at the hospital.
Strategic Growth
United Hospital has strategically planned to increase surgical cases
based on the community’s need and growth for the hospital. The current
operating rooms interfere with that ability and can impact every other
program and service at United Hospital.

the Growth of Minimally invasive Surgery
Changing how Surgery is done
In the 1970s, when United Hospital’s operating rooms were last
updated, one of the most common surgical procedures was an open
hysterectomy. little equipment was needed outside of handheld tools,
strong lights and a table. Rooms that were 350 to 400 square feet were
perfectly adequate for such procedures.
Advances in medicine and technology throughout the past 40
years have changed the types of procedures and the way surgery is
being done. Many formerly open procedures have been replaced
by minimally invasive procedures. Such procedures mean smaller
incisions, faster recovery times, reduced hospital stays and less blood
loss for the patients and improved accuracy, precision and capabilities
for the surgeons. Conditions that led to open hysterectomies, for
example, now are often treated with medication, eliminating the need
for surgery altogether. For those patients with more complex cases who
need surgery, the procedures are being done laparoscopically or via
robot. What used to be five to seven day hospitalization stay is now
two to three days. Recovery is three to four weeks versus six to eight
weeks. good news for the patient.
“The more minimally invasive the procedure, the more likely the
need for additional equipment,” says Peter D. Sershon, MD, director
of the Minnesota Robotic Surgery Center at United Hospital. “This
equipment is stored on carts or towers. These towers are moved into
and out of each room, creating a maze and interfering with line of
sight and movement of staff.”
the Benefits of Minimally invasive Surgery
Although every patient and every surgery is unique, minimally
invasive surgery offers important advantages for patients, including:
• Smaller incisions and less scarring
• less pain and discomfort
• Shorter hospital stay
• Quicker recovery
• less blood loss and fewer transfusions
• Fewer side effects and complications
• Reduced risk of infection
• Better outcomes
continued on next page
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today’s Surgery
United hospital’s da Vinci® Surgical
System, funded by United hospital
foundation.
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Peter Sershon, Md,
director of the Minnesota
robotic Surgery Center at
United hospital
robotic Surgery
continued from previous page
robotic surgery is performed using advanced technology known
as the da Vinci ® Surgical System. the doctor sits at a console near
the patient, using hand and foot pedals to control four robotic arms
that hold micro-instruments and a miniature camera. the special 3d
camera projects a color image to the console, giving the surgeon a
view magnified 10 times.
the da Vinci robot is essentially an extension of the surgeon’s hands
and eyes, with the surgeon initiating and controlling every movement.
the robot perfectly duplicates the actions of the surgeon; it does
not perform the surgery by itself. the tips of the robotic arms rotate
like the human wrist, allowing surgeons to use many of the same
techniques they learned for open surgery. robotic technology gives
surgeons more flexibility, increased precision and greater reach even
while operating through tiny incisions.
in october 2010, United hospital added a second da Vinci robotic
system, funded by United hospital foundation. the demand for these
minimally invasive procedures is growing and the possibilities for
additional usage, such as in bariatrics and gynecological procedures,
is expanding. in addition, United has created the da Vinci Epicenter
for Women’s health and Gyne cology, which offers surgeons the
opportunity to learn the art of advanced robotic-assisted surgeries.
it is one of only 23 centers nationwide and provides training that
demonstrates the depth, comprehensiveness and best practices of
the da Vinci Surgical System program.
“Patients are aware of these benefits,” says Dr. Sershon. “They come in
with the knowledge about minimally invasive and robotic procedure,
which will only increase the demand for these procedures.”
A market analysis of the growth of minimally invasive surgery shows a
predicted 8.3 percent increase in growth every year for the next five years,
according to a 2009 report from Bharat Book Bureau. 1
The benefits and advancing technology guarantee that minimally
invasive procedures will be the norm and open procedures the exception.
Operating rooms designed with this in mind will be capable of meeting
today’s demand, as well as meet the needs of the future.
RefeRence
1. “Minimally Invasive and Non Invasive Surgery Market,” 2009,
Bharat Book Bureau. www.bharatbook.com/Market-Research-Reports/
Minimally-Invasive-and-Non-Invasive-Surgery-Market.html.
robotic surgery is quickly becoming the
preferred method for many common surgical
procedures —with some physician groups
at United hospital using it for 97 percent of
the surgeries they perform. the innovative
da Vinci system makes it possible for doctors
to perform complex and delicate procedures
that were impossible just a few years ago
without more invasive open surgery.

obotic removal of Uterine fibroids
jeannette Wittrock’s story
During her annual physical exam, Forest lake resident Jeannette Wittrock
talked with her family physician about her heavy, long menstrual bleeding.
She had uterine fibroids, noncancerous tumors of the uterus, a condition
that often runs in the family. Her symptoms were severe enough to
warrant surgery, so her doctor referred her to gerald Cunniff, MD, a
surgeon who specializes in the robotic treatment of uterine diseases.
Robotic surgery is performed using the advanced technology known as the
da Vinci ® Surgical System. The surgeon sits at a console and uses hand
and foot peddles to control four robotic arms that hold micro-instruments
and a miniature camera. The surgeon views the surgery through a
3-dimensional camera that magnifies the view 10 times.
The advantages of the robotic-assisted surgery are improved accuracy,
precision and control for the surgeon and reduced pain, discomfort, blood
loss and side effects for the patient. Studies have shown that roboticassisted
surgery has better outcomes than traditional open surgery.
“The primary advantage of robotic surgery is that it is less invasive,” says
Dr. Cunniff, an obstetrician and gynecologist at Allina Medical Clinic –
Parkview OB/gYN in Eagan, Minn. “Because it is less invasive, recovery
time is greatly reduced. In a traditional open procedure, the patient
typically stays in the hospital three to four nights and then has a six-week
recovery before she can return to work. With the robotic procedure, the
hospital stay is usually overnight, and she can return to normal activity in
two to three weeks.”
Surgical treatment for uterine fibroids can include myomectomy, removal
of the fibroids themselves, or hysterectomy, removal of the uterus, if the
condition is severe. Because of Wittrock’s condition and symptoms, a
hysterectomy was recommended.
continued on next page
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Patient’s Story
Gerald Cunniff, Md
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robotic hysterectomy
Wittrock had read about a woman who underwent a robotic-assisted
hysterectomy in a community newsletter and was glad to learn that she was
a candidate for the procedure. She had the procedure in early May, and her
recovery has been good.
“I knew others who had hysterectomies, and it seemed that the recovery and the
surgery were better with the robot,” says Wittrock, who is 49. “I was only in the
hospital overnight, and just two weeks after my procedure, I was feeling pretty
good.”
Wittrock adds that she experienced minimal pain that was easily controlled
with over-the-counter medication. She was able to return to her normal activity
relatively quickly and reports that four weeks after surgery she was back to
walking the dogs three to four miles a day.
da Vinci Epicenter for Women’s Health and Gynecology
teaching robotic-Assisted Surgery
continued from previous page
Surgeons from anywhere in the country now have the opportunity to
train in advanced robotic-assisted surgeries at the da Vinci Epicenter
for Women’s health and Gynecology at United hospital. this new
center focuses on women’s health and gynecology and is the first in
Minnesota.
the center is one of only 20 nationwide and provides training that
demonstrates the depth, comprehensiveness and best practices
of the da Vinci ® Surgical System program for minimally invasive
myomectomies, hysterectomies and sacrocolpopexies.
the center’s training surgeons are board-certified obstetrics and
gynecology surgeons ragnvald (ron) Mjanger, Md, fACoG, and Eric
English, Md, fACoG.
dr. Mjanger and dr. English practice at United hospital and Metro
oB/GYn. dr. Mjanger performs minimally invasive myomectomies,
hysterectomies and sacrocolpopexies and specializes in the treatment
of pelvic prolapse and urinary incontinence. dr. English practices
within the full range of obstetrics and gynecology and performs high-
and low-risk obstetrical care and focuses on minimally invasive surgical
techniques, from transvaginal pelvic prolapse repair to hysterectomies.
in october 2010, United hospital purchased
its second robotic system through funding
from the United hospital foundation.

Budget and funding Sources for the Project
Budget
Construction..................................................................$15,000,000
Design..............................................................................$1,000,000
Fixtures, furniture and equipment....................................$2,500,000
funding Sources
$18,500,000
Allina...............................................................................$7,000,000
United Hospital Foundation.......................................... $11,500,000
$18,500,000
To support the elaine S. Larson Surgical
center campaign, please contact the
United Hospital foundation at
651-241-8022 or unitedhospital.com/
unitedfoundation.
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financials
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future of Surgery
A thoughtful design
Just as designers in 1970 couldn’t envision robotic surgical procedures
in 2011, it is hard to predict where surgery may be in 2050. However,
there are indications regarding the future of surgery.
“Advances in surgical technology and knowledge are like advances
in computers today,” says William Rupp, MD, medical director of the
Bariatric Center at United Hospital. “Changes are going to be rapid
and continuous, and we need to stay at the forefront. Adapatability is a
huge part of any redesign of the operating venue.”
For instance, Dr. Rupp sees the training of surgeons evolving to become
more and more specialized. “As surgeons become more narrowly
focused, they will need to be able to consult with their peers more
rapidly and more quickly, even in the midst of a procedure.”
The technology for live, videoconferenced consultations already exists
and is referred to as telehealth. Through a telehealth system, physicians
consult live over the Internet with specialists who may be located in
another room, another hospital or another state. In August 2010, the
Allina Telehealth Network was launched. It currently provides 24-hour
access for regional hospitals to neuroradiologists and interventional
neuroradiologists at Allina for consultations in cases of stroke. The
potential for expansion of this technology is enormous, and Dr. Rupp sees
its value in the operating room.
“Telehealth features need to be fully integrated in the operating rooms,”
says Dr. Rupp. “Imagine the advantages of immediate consultation with
other experts that such a system would provide.”
More robotic Procedures
Dr. Rupp also sees the continued growth of minimally invasive
procedures, in particular the rapid adoption of robotic techniques in
areas beyond what is currently being practiced.
“Robotic technology is still in its infancy,” he says. “Its use and
capabilities are only going to continue to change rapidly.” He cites, for
instance, recent forays by surgeons using robotic surgery in the treatment
of pancreatic disease.
And as demand for robotic procedures grows, so will competition for
access to the technology.
William rupp, Md

A hybrid Concept
The goal of any redesign of an operating venue should always be what is best for the
patient and will ensure the best outcomes from the procedures. Studies have shown that
for a design to evolve into the future, it must be flexible, adaptable and multidisciplinary.
Such an operating room is often described as a hybrid room, which allows for quick
conversion into the arena needed for a particular procedure. A study by Philips and
Skytron, hybrid surgical room manufacturers, states, “A hybrid surgical suite delivers the
enhanced ability to efficiently perform both minimally invasive procedures and open
surgery with the imaging support and surgical tools that the surgeon and surgical team
requires.” 1
Growth of Surgery
“The Surgical Center Campaign is a strategic project, designed to help United Hospital
and grow surgical opportunities,” says Omer Sanan, MD, medical director of surgical
services at United Hospital. “We need to grow our surgery volumes. We need to reach
out to our community base to let them know that United Hospital has the facilities they
need, when they need them.”
The United Hospital Strategic Plan recognizes that future trends in surgery will occur in:
• heart
• orthopedics
• bariatrics
• robotics
• neurology and spine
RefeRence
1. “Optimizing workflows & efficiency with digital OR integration,”
Executive Healthcare, www.executivehm.com/article/
Optimizing-workflows--efficiency-with-digital-OR-integration/
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Current View of the operating rooms
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Current View of the operating room
United Hospital’s operating rooms, which average between 315
and 469 square feet, are too small for today’s minimally invasive
procedures. Today’s community standard for an operating room is
approximately 600 square feet.
The images on this page were taken on a typical day in the United
Surgery Department.
Images on the following pages show preliminary architect drawings
for the new surgical center.

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Architect’s renderings*
Patient waiting area
Physician lounge
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hallway to the Elaine S. Larson
Surgical Center
*renderings by hdr

operating room
United Surgical Center floorplan
renderings by hdr
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333 Smith Avenue North
Saint Paul, MN 55102
651-241-8022
unitedhospital.com/unitedfoundation
the United hospital
foundation exists to
enhance the health of
United hospital patients
and the wellness of the
community we serve.