The design of any healthcare space is an intricate process with hundreds of variables. But when the space is a hybrid OR, the complexity level reaches new—and precisely calibrated—heights. This was especially true in the case of Akron General Medical Center’s (Akron, Ohio) new integrated operating room and diagnostics services suite. Completed in February 2013, the 6,200-square-foot space encompasses three new ORs, each coupled with dedicated diagnostic imaging machines and a surgical positioning and imaging system. It’s one of only four hospitals in the country to offer both intraoperative CT and MRI services and, as part of a larger neurology initiative that included the addition of a neuroangiography room and a Gamma Knife, the new suite is primarily used for brain and spinal surgical procedures.

“Multiple layers of technology had to fit into these rooms,” says Dave Everhard, principal and project manager with Hasenstab Architects (Akron, Ohio). “It was all constructed on the third floor of the existing hospital, so space was limited. Additionally, the rooms function by having moving parts that allow diagnostic procedures during surgery. Retractable doors, CT scanner, surgical tables, etc., all add to the complexity of the radiation shielding, acoustics, and environmental control systems of all the connected spaces.”

The finish floor had to be raised 5 inches via terrazzo-topped aluminum support panels that would accommodate the mobile CT’s rail system. And the floor-to-floor heights, says Everhard, “made fitting everything in the ceilings of the rooms an intensive design and construction process.” 

Several considerations relating to the heavy, loud MRI equipment really put the design team to the test. For one thing, in order for the MRI unit to be financially feasible, the machine also had to be available for general use by the radiology department for both outpatient and inpatient diagnostics. The adjacent OR, likewise, would also be used for separate procedures. “The MRI room had to be designed to be accessible for nonsterile patients and staff as well as gowned and scrubbed surgical staff,” Everhard says. “And the MRI generates a high level of noise during certain tests, which would have been disruptive to delicate neurosurgery procedures in the adjacent OR.”  Joe Plavecski, associate vice president of facilities for Akron General, says the problem was addressed through substantial insulation (including specially designed vibration isolation pads), heavy walls, and two layers of operable sound-mitigating doors.

In addition, the new intraoperative suite was built over the top of Akron General’s existing MRI—“so we had to be cognizant of the new MRIs’ proximity to the existing one so as not to adversely affect the fields of each,” says Hasenstab’s Ed Paine, project architect. Not to mention the sheer weight of all the new equipment: Fortunately, adds Everhard, the foundations in the area were able to carry the additional structural loads.

Plavecski is happy with the finished space, even beyond what it adds to the hospital’s reputation and care capabilities. “The finishes and look of the rooms are extraordinary,” he says. “With terrazzo floors, [solid-surface] walls, and stainless cabinets and doors, the room looks just as high-tech as the computerization and medical equipment are.”

This is the third part of Healthcare Design’s three-part special report on hybrid operating rooms. To read the first installment, visit http://healthcaredesi.wpengine.com/article/redefining-operating-room. To read the second installment, visit http://healthcaredesi.wpengine.com/article/tight-fit-designing-hybrid-or-limited-square-footage.

Kristin D. Zeit is editor-in-chief of Healthcare Design. She can be reached at kzeit@vendomegrp.com.

 

Source List
Completion date: February 2013
Owner: Akron General Medical Center
Total building area: 6,859 sq. ft. (addition and renovation
Total construction cost: $5.2 million
Cost/sq. ft.: $758
Architecture and interior design: Hasenstab Architects
Contracting: Krumroy-Cozad Construction Corp.
Engineering: Scheeser, Buckley, Mayfield—mechanical; Peters, Tschantz & Associates—electrical/IT; 
Hasenstab Architects—structural; William R. Thornton—vibration and acoustics
Construction: Krumroy-Cozad Construction Corp.
AV equipment/electronics/software: Brainlab (OR surgical integration system)
Carpet/flooring: O.A. Bertin Co. (terrazzo flooring, epoxy flooring in OR)
Doors/locks/hardware: Won-Door (acoustical OR door), Pitts Little Corp. (X-ray shielded doors)
Headwalls/booms: Trumpf Medical Systems (OR booms and tables)
Lighting: Trumpf Medical Systems (OR surgical lights)
Surfaces—solid/other: DuPont, Avonite Surfaces
Other: ETS-Lindgren (RF shielding), Siemens Healthcare (CT equipment), GE Healthcare (MRI equipment), Pratt & Lambert (paint)