By definition, a hybrid operating room is a surgery environment with advanced, fixed imaging equipment.

Although the definition may appear simple, there are various layers to the planning and design phases. However, this type of high-performance environment can still come together as simply as it’s defined—when the focus is on the right elements.

The three key issues associated with designing a hybrid OR are planned utilization, equipment selection, and room size and location.

Planned utilization. Planned utilization is the result of both physician and departmental collaboration. Departments will need to develop protocols for how the new space will be used by various specialties: cardiology, surgery, and interventional radiology. These specialties will require specific procedures, room layouts, and budgets—elements that will have the most influence on equipment selection, a defining factor for a hybrid OR.

Bringing everyone’s needs to the table early will ensure the most effective outcome for staff and personnel. It will also shorten the equipment selection process.

Equipment selection. As technology advances, more equipment options become available to best serve the space’s purpose. The planned utilization step is necessary to establish, for example, that a single-plane installation meets the needs for cardiology and vascular cases, but neurosurgery and electrophysiology physicians prefer biplane configurations.

Additionally, ceiling-mounted imaging equipment can be more easily “parked” out of the surgical field than floor-mounted equipment. However, floor-mounted equipment with a robotic arm helps move the c-arm out of field and offers additional benefits like better 3-D imaging.

The options can seem endless, which is why technology planning assistance makes selecting and receiving equipment much more seamless.

Room size and location. Although we’ve seen a fairly wide range of sizes for hybrid ORs, from 750 to 1,200 square feet, the typical target, including the control area, is 1,000 square feet. The additional area for supplies and equipment adds 200 to 300 square feet. The predominant departmental location is in surgery, due to clinical and staff requirements, although some hybrid rooms have been successfully located in the cath lab area.

The need for specialized staff can impact the departmental location and the design response to both staff and patient flow. Although similar to surgery, pre-procedural contact with the patient is expanded for hybrid cases. Patients are not only surgical patients, but cardiac, vascular or neuro patients, too. Therefore the post-procedural routing should respond to the patient’s need for the most appropriate staff and clinical care.

Effectively designing a hybrid OR for multiple specialties requires an initial glimpse at the collaborative future to successfully achieve efficient and patient-centered healing environments.

Kevin Downey, AIA, ACHA, is principal at BSA LifeStructures (Indianapolis). He can be reached at