5 Considerations for Building a Hybrid Operating Room

An advanced operating room — one that allows clinicians to perform open-heart surgery, complex vascular surgery and minimally invasive procedures in one location — has garnered the attention of hospitals across the country as they vie for the latest in technology and outcomes. Saint Thomas Hospital in Nashville, Tenn., Greenville (S.C.) Hospital System and Paducah, Ky.-based Lourdes Hospital are just a few of the facilities building hybrid ORs. In January, the ECRI Institute listed transcatheter heart valve implants as a technology issue hospital C-suites should pay attention to, asking "Is your hospital prepared for a surge in demand for hybrid ORs?" In addition, Millennium Research Group estimates the OR integration market, valued at $2.4 billion, will increase approximately 15 percent annually through 2015.

Before jumping on the hybrid OR bandwagon and investing millions of dollars in the technology, however, hospitals should consider these five issues, according to Jacob DeLaRosa, MD, chief of cardiac and endovascular surgery at Idaho State University, Portneuf Medical Center in Pocatello, Idaho, which opened its newest  hybrid OR in May 2011.

1. Volume. Hospitals should assess the potential use of a hybrid OR based on the current number of procedures surgeons perform using a portable C-arm in the operating room and how often surgeons use an existing catheterization lab. Dr. DeLaRosa estimates that a hospital that has five to 10 vascular C-arm procedures a week and/or uses a cath lab three times a week could support a hybrid OR. The hospital should have "one or the other or both, but there has to be a need or it makes no sense for the administration to move forward," Dr. DeLaRosa says. "'If you build it they will come' is not necessarily the case. There has to be the volume in order for [the hybrid OR] to be functional."

2. Block time. One of the challenges of building a hybrid OR is ensuring fair use by the different surgeons and interventionalists who need it. Dr. DeLaRosa says a highly desirable space such as a hybrid OR could generate a turf battle, with surgeons and physicians from different specialties competing for its use. Discussing a scheduling process before developing the OR can avoid this problem, he says.

3. Space and location. The physical construction of a hybrid OR can also be a challenge for hospitals because they demand more space and infrastructure than a typical OR. Sometimes a hospital will need to collapse two standard ORs to construct one hybrid OR, for example. In addition, cardiologists, interventional radiologists and surgeons typically want the hybrid OR build near their respective departments. Dr. DeLaRosa says the best location for a hybrid OR is one that has the infrastructure needed to support the equipment and personnel. Transforming surgical ORs into hybrid ORs is usually the easiest solution because it has an existing sterile core, which a cath lab does not, he says.

4. Endovascular program. Hospitals considering a hybrid OR for vascular surgery need to commit to providing a complete endovascular program, according to Dr. DeLaRosa. For example, the hospital should have a vascular diagnostic suite and a wound center. The hospital also needs to have the capacity to follow vascular patients long-term, he says. "You usually become their primary doctor because you work from their head to toes."

5. Specialties. Currently, hybrid ORs are devoted to cardiovascular and endovascular procedures. In the future, specialties such as neurosurgery, urology, cardiac surgery and gynecology could benefit from similar imaging technology, Dr. DeLaRosa says.

Related Articles on Hybrid ORs:

4 Benefits of a Hybrid Operating Room
High-Tech Hybrid ORs Becoming Profitable

10 Technologies to Keep Hospitals Competitive

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