The Integrated Interventional Platform

Design&Health Australasia 2010 ♦ Sydney, Australia ♦ April 30, 2010T h e I n t e g r a t e d I n t e r v e n t i o n a l P l a t f o r m :f o r t h e C o n v e r g e n c e o f S u r g e r y a n dI n t e r v e n t i o n a l P r o c e d u r e s© 2010 Anshen+AllenBill Rostenberg, FAIA, FACHA Principal and Director of Research

C o n v e r g e n c e o f S u r g e r y a n dI n t e r v e n t i o n a l P r o c e d u r e s© 2010 Anshen+Allen

Are Planning Models C u r r e n t w / Medical Practice?• Surgical andinterventional procedureshave changeddramatically in recentdecades and in manyways are converging• Why do the designs of“surgical” suites and“interventional” suitesremain so different?• What new design modelsshould be considered?

7/25/2013Transitions as a New PractitionerStudent MenteePreceptor MentorDefining MentorshipWikipedia‐“Mentorship is a personal developmental relationship in which a more experienced or moreknowledgeable person helps to guide a less experienced or less knowledgeable person.However, true mentoring is more than just answering occasional questions or providing adhoc help. It is about an ongoing relationship of learning, dialog, and challenge.”Merrium Webster“Mentor: a trusted counselor or guide”Kimtionary:Someone a person highly respects and trusts who one looks to for guidance, wisdom,encouragement, and/or assistance in one or multiple endeavors with which the mentee isunfamiliar or less experienced4

G r e a t e r “ S u r g i c a l ” U t i l i z a t i o n o f I R S u i t e• Historic IR utilization:60-70% = diagnosticprocedures• Many diagnostic IRprocedures nowreplaced by lessinvasivemodalities(CT, MR, SPECT,PET/CT, etc.)• Future utilization willfocus on moreinterventional procedures

C o n v e r g e n c e o f S u r g e r y a n d I m a g i n gSurgery Requires• Greater reliance on imageguidance & PACS• Often have sub-optimalambient lighting /ergonomic design• Increasing IT/data needs• May require radiology techto “run” advanced imageguidance devicesImaging (IR) Requires• Surgical-quality Heating,Ventilation and AirConditioning (HVAC)• “Surgical-like” restrictedworkflow• Increased Prep / Recoverybeds• More invasive procedures© 2010 Anshen+Allen© 2010 Anshen+Allen

I n t e g r a t e d I n t e r v e n t i o n a l P l a t f o r mDefinition:The consolidation of various interventional serviceswithin a common area and operated as an integratedprogram.Interv Card. Interv Rad Surgery© 2010 Anshen+AllenLevel 2RecoveryPACUShared prep/recoveryIntake/Prep

I n t e g r a t e d I n t e r v e n t i o n a l P l a t f o r mPotentialBenefits:• Accommodate future clinical / operational practice models• Multi-disciplinary collaboration• Consolidation of Prep, Recovery, Support areas / staff• Improved infection control for interventional procedures• Long term flexibility/adaptability

I n t e g r a t e d I n t e r v e n t i o n a l P l a t f o r mChallenges:• Staffing ShortageCrisis / New Types ofPersonnel• Planning for FutureTechnology• Maintain IndividualService Line / BrandIdentities• Politics / Culture /Turf Battles

D i s r u p t i n g A T r a d i t i o n o f S e p a r a t i o nKingdomofSurgeryKingdomofImagingKingdomofCardiology

© 2010 Anshen+AllenH u m a n i z i n g D i a g n o s t i c &T r e a t m e n t E n v i r o n m e n t sW h i l e I m p r o v i n g E f f i c i e n c y

F l e x i b i l i t y / A n t i c i p a t i n g t h e F u t u r e• Excess infrastructurecapacity• Identify a zone for“extreme” futureconversion (i.e. I-MRI)• Anticipate new types ofpersonnel and new flowpatterns• Modality-adaptableprocedure rooms• Soft space to convert toimage-guidance controlrooms

D e s i g n i n g t h e H o s p i t a l o f t h e F u t u r eD AY- L IGHTING THE DEEP FLOOR PLATEAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO Architects© 2010 PPH

F l e x i b i l i t y / A n t i c i p a t i n g t h e F u t u r eHOSPITAL DESIGNED LIKE A RESEARCH LAB:Locate vertical “fixed” elements at perimeterAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO Architects© 2010 PPH

F l e x i b i l i t y / A n t i c i p a t i n g t h e F u t u r eR O B U S T I N F R A S T R U C T U R E :• High floor-to-floor height • Strategic placement of soft space• Robust floor loading & • Long structural spans (optional)vibration control (I-MRI) • “Future Technology Zone”• “Loose fit” programming • Phasing instructions in specsAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO Architects© 2010 PPH

F l e x i b i l i t y / A n t i c i p a t i n g t h e F u t u r eHOSPITAL DESIGNED LIKE A RESEARCH LAB:Long span truss supports open floor plate below & green roof aboveAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO Architects© 2010 PPH

D e s i g n i n g t h e S a f e a n d H e a l t h y H o s p i t a lAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO ArchitectsImage courtesy of CO Architects.© 2010 PPH

M R I i n t h e O RMAGNETTYPES• Stationary• Pivoting• Traveling• PortableROOMTYPES• Single Room• Dual Room• MultipleRooms

M R I i n t h e O RDESIGNI M PLICATIONS:• Design for MRI safety(ACR safety guidelines may notapply as they do for diagnostic MRIs)• Locate MRI for either“scrubbed” or“street clothes” access• Protect against RF and/ormagnetic interactionswith adjacent occupants© 2009 Anshen+Allen

M a t e r i e l F l o wSurgery• Mostly re-usableinstruments• Strict adherence tocontrolling flow ofmaterials behind “redline”• Frequent use of casecartdelivery systems• Materiel handlinggoverned by strictAORN criteriaInterventional Radiology /Interventional Surgery• Mostly disposablesupplies• Limited recognitionof “red-line”• Supplies not typicallydelivered in case-carts• Materiel handling notgoverned by strictAORN criteria

R e t h i n k i n g t h e C l e a n C o r eFLEXIBLE PLANNING MODULES:© 2010 Anshen+Allen

R e t h i n k i n g t h e C l e a n C o r eC O L L A B O R AT I V ES TA F F C O R ET Y P I C A L C L E A NS U P P LY C O R E© 2010 Anshen+Allen

S t a f f F l o wSurgery• “Always” preppedto cross redline• Strict protocol forscrubbing, masks, etc.• Extensive tradition of“surgical workflowcontrol”• In the future procedureswill continue to becomeless-invasive• Flow often follows“clean-core “ layoutInterventional Radiology /Interventional Surgery• Lack consistent philosophy of“red-line” workflow control• Adopting surgical protocoloften seen as a nuisance• Dual diagnostic & therapeutic= confusion about “red-lineworkflow control• In the future procedures willcontinue to become moreinvasive• Flow often follows “staff-core”layout

P r o c e d u r e R o o m s w i t h C o n t r o l R o o m sBENEFITS:• Accommodatesvarious forms ofimage guidance1• Support staff canparticipate inprocedureswithout enteringprocedure room• Electronicshoused outside ofprocedure room1© 2010 Anshen+Allen

Support TeamP r o c e d u r e R o o m s w i t h C o n t r o l R o o m sSuppliesPatientScrubbed TeamControl Room© 2010 Anshen+Allen

P r o c e d u r e R o o m s w i t h C o n t r o l R o o m sF L E X I B L E P L A N N I N G M O D U L E S :Procedure RoomFUTURE ControlRoom + ElectronicsSurgeryProcedure RoomControl Room+ ElectronicsInterventional RadiologyInterventional CardiologyProcedure RoomControl Room+ Electronics© 2010 Anshen+Allen

P r o c e d u r e R o o m s w i t h C o n t r o l R o o m sF L E X I B L E P L A N N I N G M O D U L E S :CathAngioFutureControlORControlCathAngioControl Cont.CleanCoreORORInterventionalI-MRIFutureControlORSurgery© 2010 Anshen+Allen

“ V i r t u a l R e d L i n e ” C o n c e p tAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO Architects© 2010 PPH

P a t i e n t F l o wSurgery• “Always” preppedto cross redline• May have sedation,local anesthesia orgeneral anesthesia• Frequently have dualstagerecoveryInterventional Radiology /Interventional Surgery• Don’t always cross ared-line• Infrequent use ofgeneral anesthesia(except peds)• Typically less intense, butsometimes longer recoveryduration within one location

P a t i e n t F l o wPROCEDURE ROOM CLUSTERS ANTICIPATE CHANGE:Future Scenario: OR of the future = cath lab configurationAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO Architects© 2010 PPH

P a t i e n tF l o wPROCEDURE ROOM CLUSTERS ANTICIPATE CHANGE:Future Scenario: OR of the future = cath lab configurationCO Architects Lead Design and Architect of Record. Anshen+Allen, Associate Architect, is responsible for the medical planning and interiorarchitecture of the diagnostic and treatment block and interior design for the project. © 2010 PPH

P a t i e n t F l o wPROCEDURE ROOM CLUSTERS ANTICIPATE CHANGE:Future Scenario: OR of the future = cath lab configurationAnshen+Allen Associated Architects for Palomar Pomerado Health: an association of Anshen+Allen and CO Architects© 2010 PPH

H y b r i d P r o c e d u r e R o o m sVascular accesssurgery utilizes“interventionalradiology”equipment withina surgicaloperating room© 2010 Anshen+Allen

“ M o d a l i t y A d a p t a b l e ” P r o c e d u r e R o o m sD E S I G N C O N S I D E R AT I O N S :Room Size:RoomConfiguration:Universal vs.Dedicated:TableOrientation:Orientation ofpatient’s head:Room “zoning”and workflow: 750 NSFSquare; rectangular;“handed” vs. mirroredA question of flexibilityParallel; perpendicular;diagonal to corridorHead to corridor; feet tocorridor; head to sideSterile; circulation;anesthesia;documentation zonesSURGICALINTERVENTIONAL

“ M o d a l i t y A d a p t a b l e ” P r o c e d u r e R o o m sC a r d i a c C a t h / I n t e r v e n t i o n a l R a d i o l o g y

“ M o d a l i t y A d a p t a b l e ” P r o c e d u r e R o o m sS u r g i c a l O p e r a t i n g R o o m

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