Surgical suite design has changed significantly over the past ten years and will continue to evolve over the next decade. Some of the key changes that have already had an impact include:
The shift from separate suites for Pre-op, PACU, and Stage 2 Recovery to more unified suites that can better accommodate shifts in population during the day, share staff, and most efficiently utilize space (see sidebar).
The increase in size of the Operating Room (OR) to the point that most surgical suites built now in hospitals have an average OR size of at least 600 square feet versus the former standard of 400 square feet.
Development of suites using smaller clusters of ORs versus larger groups of ORs organized around a sterile core. The cluster concept has often been developed to allow a more focused environment around surgical subspecialties.
Trends in the design of surgical suites that will continue to result in an evolution of these environments include:
The increased utilization of minimally invasive surgical (MIS) techniques, including robotics. This increase has helped to spur the need for larger ORs. As MIS technology evolves, especially toward smaller and more remote equipment, the OR environment will continue to evolve, potentially feeding a reduction in the size of the OR.
The development of special high-technology ORs, including intra-operative MRI rooms.
The integration of interventional and surgical environments is in its infancy, but will continue to feed the development of suites that are side-by-side departments sharing certain support spaces, including prep and recovery, and suites that are truly merged with side-by-side surgical and interventional rooms, as well as blended or hybrid rooms.
There are other developments that are affecting surgical techniques and procedures, including cryogenics and ultrasound, but these developments are not anticipated to have a direct impact on the design of the surgical suite or the operating room.
Operating room size
It is now uncommon for a surgical suite to be programmed with operating rooms of less than 600 square feet, unless the focus of the unit is purely outpatient procedures. Even in outpatient centers with increased use of MIS techniques, the need for larger ORs approaching 600 square feet is still present. Certainly the equipment is the same, but in an outpatient setting, the cases are typically less complicated and are more predictable and require smaller surgical teams. This often feeds into decisions to allow for slightly smaller ORs. In addition to the perception that outpatient facilities can be designed with smaller ORs, budget constraints are often involved in the decision to limit the size of outpatient ORs. Nonetheless, most outpatient suites are still being designed with ORs of over 500 square feet.
As the room becomes larger, the distance between the support and supply areas and the surgical field can become inefficient. Courtesy of KMD Architects
The major debate now in the design community is how large does an OR really need to be. At Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City, the average OR was designed to be 600 square feet. This size has been working very well based on the first six months of operation.
Of particular interest, however, are six of the ORs at MSKCC, because they are not 600 square feet, but roughly 560 square feet. This was the result of these ORs being within an existing building; the existing columns would not accommodate a 600-square-foot OR. These six ORs are reported to be working as well as any of the other ORs.