Operating operating rooms to form a common facility,
Operating theatres are expensive to build and equip, but the experience of many institutions indicates that the individual operating rooms or the operation theatre suite (OT suite) have been usually under designed. If the initial planning or use was for multispecialty hospital, giving little consideration for future growth have landed some hospitals into problem situations. In smaller hospitals (50-100 beds), a single operating room may have been sufficient to meet the need.
For a larger hospital, departments of eye, ENT, Obstetrics and Gynecology, and the super specialty disciplines will also need the services of operation theatres. In the general hospital, the trend is to have all major operating rooms as nearly identical as possible to facilitate scheduling of various surgical procedures in any one of them. Grouping of operating rooms into a surgical suite or OT suite has now been accepted as a solution for optimisation of facilities and economy of manpower. Grouping together of all operating rooms to form a common facility, the OT suite, has several advantages. The standard of air hygiene established for operating rooms demands a complicated and expensive ventilation system, which would be difficult to provide at a number of different points around the hospital. It is obvious that optimum utilisation of operating rooms is possible if they are not reserved rigidly for use by a particular department or surgeon as a rule.
The operating rooms should further be similar in design and character to make it easy for all surgeons to use them without a new set of conditions. In some of the hospitals where a few operating rooms are allotted to Neurology, Urology etc. and other rooms to General Surgery, the use coefficient of the operating rooms of the latter category was low compared to that of the rooms shared by more departments. Reasons for demand of separate OT suits for different specialties should be thoroughly debated. There will always be a conflict of interest between the administrative and specialists point of view. The relationship between the delivery suite and obstetrical and gynecological surgery should be studied, if there is a demand for separate operation theatre with the delivery suite. So also, the desirability of having separate OT located in the outpatient department for performing outpatient surgery instead of carrying out all surgery in the main OT suite Nevertheless, most surgeons and administrators agree that one operating room should be earmarked for endoscopic surgery and a separate room for emergency surgery of accident cases, both potentially septic.
A rigid separation of “clean” and “dirty” traffic for reasons of control of infection imposes limitations on the plan of the department, which usually needs to embody a two-corridor system, with three major circulation patterns: patients, staff, and supplies. Whether a single operating room is being considered or an OT suite, it is essential to develop a written functional programme for the benefit of the architect. This document will incorporate all aspects for planning, like possible workload, number of surgical beds, air hygiene, sterilisation, artificial ventilation, zoning, workflow, future use and expansion, equipment and so on. From the above discussion, it becomes apparent that; grouping of all operating rooms in one central location in the form of an OT suite has many advantages. A central multiuse operating theatre suite results in: i. efficient use of staff and facilities ii.
Effective supervision of personnel iii. Flexibility in scheduling operations iv. Better operating room discipline v. round the clock service vi. Improved aseptic discipline vii. Better training of nurses and other personnel vi. Economy in terms of engineering maintenance ix.
Problem of supplies of materials simplified x. Can result in reduction of ancillary accommodation by up to 50 per cent. In the past, surgical suites were located at the top floor of multi-storeyed hospitals. There are advantages and disadvantages of locating OT suite on upper floors of multi-storeyed hospitals, but the suite has now come to lower floors where it is possible to spread out and achieve the desired shape. Location of the suite must ensure that patients can be moved to and from surgery with a minimum of travel through other hospital areas. The location of OT suite should not only be considered in relation to surgical wards but also to the outpatient department, if daycare surgery has to be catered for. Approximately 37 per cent of hospital-based surgery has been carried out as outpatient surgery in many American hospitals. Their analysis indicated that more than 95 per cent of myringotomies, tonsillectomies, adenectomies as well as substantial proportion of carpal tunnel releases, lens extractions, sterilisations, circumcisions and inguinal hernia repairs were performed in outpatient settings as day care surgeries.
Surgical load on the operation rooms from outpatient surgery has gradually increased in all hospitals because of the many advantages to patients and relieving of the pressure on hospital beds in urology and orthopedics. The main points to be considered in the location of the OT suite on a hospital are: i. Accessibility to a.
Surgical wards b. CSSD c. Emergency d. Blood bank ii. Access to bed lift iii. Internal hospital traffic flow iv. External traffic and disturbances.
The location of OT suite should ensure quietness, free from external disturbances and close to the surgical wards. Corridors leading to this unit should not be used as thorough passages. An important factor in the location is future growth. If expansion is envisaged in the future, the present location and plan must permit for expansion in an orderly fashion without upsetting the basic relationship of the internal organisation.