OR, ER, and radiology could soon become neighbors

The increasing use of imaging in surgery and the need to make better use of imaging equipment will require that radiology departments be located adjacent to operating and emergency rooms in hospitals, an architect said Saturday.

Carlos L. Amato, director of healthcare planning for RRB Architects in Los Angeles, said his firm has two projects under way in which imaging departments are sited adjacent to emergency and surgery facilities.

"It's very difficult to justify a $1.5 million MRI that is used just once or twice a week," he said.

If a facility can be designed so that radiology is next to surgery, equipment such as an MR scanner can be more easily accessed by the surgery department while the radiology department continues to conduct its imaging studies, he said.

During a special 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 took 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 in 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 difficulty of fully anticipating changes in technology, practice, and procedure that will affect surgical suite requirements.

Minimally invasive therapy techniques, for example, are gaining ground. As a result, sterility requirements are reduced, which 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.

Technological advances that have allowed the financial industry to closely monitor the process of money transactions could be extended into medicine and the operating room, Dachuk said. All devices might be interconnected and able to communicate with one another to monitor OR events. Participants, patients, and resources would be electronically tagged so that the "workflow engine" could record their participation.

The workflow engine will possess contextual information, including the patient record and the progress of the operation, and it will be able to interpret data and raise alarms if necessary. It would also be aware of the impact of the procedure on the enterprise, including resources consumed, scheduling, and postop implications.