Hybrid Operating Rooms: Infrastructure Impacts

August 15, 2014  |  Allen Smith

One reason hybrid operating room renovations are so challenging is the number of consultants and vendors involved. This week we discuss seven techniques we have found to be effective in bringing a project to market quickly with minimal headaches.

Hybrid ORs can overburden existing mechanical and electrical systems. If the existing building infrastructure is not adequate for the new equipment, reaching this conclusion during the Schematic Design phase enables the team to mitigate the impact of infrastructure adjustments to the schedule and budget.

In contrast, such a determination during Design Development or Construction Documentation phases can result in both cost and schedule overruns. As one example, perhaps the infrastructure simply cannot be upgraded and the only solution is to start over in another location, voiding all design efforts completed to date. Another scenario is that the space allows for an MEP equipment upgrade, but new chillers, air handlers, or electrical switchgear are expensive with long lead times. In both cases, the longer it takes to reach the conclusion that the existing infrastructure capabilities are insufficient, the more backtracking is required and the greater the impact on schedule and budget.

We typically include the space above the ceiling in our assessment of existing infrastructure. Nine foot ceiling heights as were commonly installed twenty years ago will not accommodate new hybrid OR imaging equipment without sacrificing functionality. On a recent project with 8’11” ceilings, we “pushed the envelope” and the low booms have proven to be head-knockers.

The magnitude of new MEP infrastructure required to update an older space can sometimes render an “ideal OR location” significantly less so. In those instances, when the cost and difficulty of installing supplemental MEP equipment is cost prohibitive, reconsidering the entire floor plan may be more achievable than the OR location with optimal adjacencies.

On a recent project, the dedicated HVAC unit specified for the imaging equipment electronics was replaced during construction. During the initial startup, the new system wasn’t able to handle loads resulting from 100+ degree summer temperatures. As a result, the imaging system electronics shut down, delaying procedures and causing tremendous issues for the facilities director.

Given the high value of the hybrid equipment and potential revenue loss from MEP system malfunctions, hospitals should consider the cost benefit of redundant cooling and other infrastructure for the equipment and hybrid OR room itself. While redundant infrastructure affects the budget, we can help facility managers understand the many factors involved in a cost-benefit analysis.

While no project feels cruises through the construction phase, design teams and owners can work together to make installations run more smoothly. In our experience, facilities directors feel as though they are set up for success when our coordination efforts minimize change orders and account for future conditions. The more the design team can do to lessen the potential that the facility director must report a schedule delay or cost increase to administration, the better.

Download our hybrid operating room design guide:  Faster Hybrid Operating Room Speed to Market and Fewer Construction Headaches with Seven Proven Techniques

Ask Allen:  asmith@freemanwhite.com

Allen Smith

Allen Smith is a natural problem-solver. His blend of experience and expertise enables him to evaluate physical spaces; conceptualize ideal heating and cooling systems; and create appropriate designs. His creative approach led to the development of design tools to better analyze building systems such as air-handler psychrometrics and more accurately design equipment. He has more than 15 years of healthcare mechanical design experience including multiple OR and Hybrid OR projects.




Leave a Comment

  1. Jonathan Johnson says:

    A major issue not brought up so far and can cause more delays than a lot of the others put together is not having the right customer at the table when designing the space. Physician preference, practice styles, individual idiosyncrasies can all add up to misplaced tables, lack of clarity on patient movement within the space and over sized, underutized areas within the OR that become “no mans” land because they are too far away or not within the appropriate surgical procedural area due to the irregular shape of the site. Existing spaces can lead to geometric anomalies that institute new challenges by being “out of the norm” when it comes to how the surgeon works! Ensure that your physicians are bought into the project and include all specialities that would use the hybrid room in the initial design and FF&E layouts. A simple example is Cardiac and Vascular surgeons both benefit from the hybrid OR but the position of the table’ can cause clearance issues from head or foot which lead to different problems to each specialty and can cause huge issues within the satisfaction of each group. Also don’t be surprised when others want to play with the new toys. Remember have all the users at the table. Determining who will be the primary user of the new room or users is extremely important but don’t skip or fly over the part about who else may practice in the space. The best developed BIM model or physical mock or thoroughly investigated MEP plans are useless and will fail in the end if you don’t have the right customers at the table. The shiny new toys will only go so far to satisfy your docs. Functionally useless space no matter how nice and well designed for one group, will be considered a loss by Administration when it is used only 20 or 30 percent of the time!!

    August 26, 2014

  2. Bill Jackson says:

    We retrofitted two EP labs in a 40 year old building which necessitated a steel beam in the floor below for the steroetastic system and a new AHU room to service both procedure rooms. This particular hospital has maximized its clean and EP and circuits are tripping in the ORs. You need lemons to make lemonade.

    August 27, 2014