Increasing role of imaging in surgery turns architects’ attention to hospital redesign

As the shadow of radiology stretches across the medical landscape beyond its typical venue of diagnosis into therapy and monitoring, architects are considering changes in hospital design.

The increasing prominence of imaging in surgery may lead some to locate the radiology department nearer to the operating and emergency rooms, according to a presentation at the Computer Assisted Radiology and Surgery congress in Berlin. RRB Architects in Los Angeles has two projects under way that site imaging departments adjacent to emergency and surgical facilities.

"It's very difficult to justify a $1.5 million MRI device that is used just once or twice a week (for surgical purposes)," said Carlos L. Amato, director of healthcare planning for RRB.

Making MR more convenient to surgeons will allow the same scanner to be shared for diagnostic and surgical applications.

During a special CARS session on imaging and surgery, Amato described the demands of planning new surgical facilities. His firm helped the University of California, Los Angeles design a new hospital, a process that is taking nine years.

The lengthy time frame, caused by the scope of the project but also by regulatory requirements, presents a challenge. Technology and other needs envisioned at the outset are almost certain to change before the project is completed, he said.

Among the most important considerations, when designing surgical suites, are the growing role of imaging in surgery and the need to bring a wide range of information into the surgical suite, said presenters and panelists who participated in the session. The problems are compounded by the difficulties that go along with anticipating changes in technology, practice, and procedure likely to affect surgical suite requirements.

Minimally invasive therapy techniques, for example, are gaining ground. As a result, sterility requirements are reduced. This has consequences for suite design, Amato said.

Planners should also anticipate increasing levels of automation that will monitor surgical room events for a variety of purposes, said Joe Dachuk, a workflow expert with EJB Technologies, a Canadian firm.

The financial industry has adopted certain technologies that architects may turn to hospitals' benefit, Dachuk said. Technologies that allow financiers to monitor money transactions could be adapted for medicine and the operating room. The devices might be interconnected to monitor OR events. Participants, patients, and resources would be electronically tagged so that the "workflow engine" could record their participation.

This engine would contain contextual information, including the patient record and the progress of the operation, thus providing grounds for interpreting data and triggering alarms, if necessary. It would also be aware of the impact of the procedure on the enterprise, including resources consumed, scheduling, and postop implications.