Cath Lab Management

Building an Interventional Department

Dennis L. Kaiser, AIA, NCARB, LEED® AP, principal, Perkins and Will, Boston, Massachusetts
Dennis L. Kaiser, AIA, NCARB, LEED® AP, principal, Perkins and Will, Boston, Massachusetts
Consolidating catheterization and surgical units is an economical solution, once cultural objections are overcome. The economic case for consolidating a hospital’s catheterization and surgical units, is, in many ways, a no-brainer. In an era of tightened money belts for facility expansions that can cost up to $400 per square foot, choosing consolidation instead can free up space and cut costs indicative to this type of renovation project, usually by half. With consolidation, there is also potentially greater savings pertaining to daily operation costs over time of use, associated with streamlined staffing — since, generally, it takes fewer people to staff one large department than it does to staff two small departments. The economic advantages become even more compelling when evaluated from the perspective of how easily a successful renovation can be accomplished. A renovation that consolidates traditionally separate spaces is a simple, cost-effective strategy, because usually the facility’s structural capacity will fit the needed changes, ample support services are located conveniently nearby, and the physical move itself is often easily managed. So why don’t more hospitals take advantage of the synergies inherent in a consolidation of the surgical department and catheterization labs? Because it is a major cultural paradigm shift, so consolidation isn’t done often or it’s often done wrong. With an impending consolidation, staff in both departments may fear being given short shrift within the cultural hierarchy of the renovated space. With the blending process, physicians, nurses and administrators will have to adjust from an autonomous culture and familiar surroundings to a more collaborative culture and changed surroundings, regardless of the fact that their procedural space — surgical or laboratory — will be very familiar. Those who are moved during the shuffle will have to acclimate to new and unfamiliar offices, locker rooms and operational adjacencies. Those who don’t have to move will have to get used to new neighbors. Is Consolidation Spatially Possible? First things first! Before broaching the notion that staff members in separate spaces will have to adapt to a departmental consolidation, it makes sense to first ask whether a consolidation is even physically possible. Since it is easier to move, say, two or three catheterization labs, rather than eight to ten operating rooms, the most economical renovation would typically be that the cardiology department moves to a space adjacent to the surgical suite. Can the hospital make space available around the surgical suite to accommodate the necessary number of cath labs? Further, can such a move result in an integrated and singular “Interventional Department”? If so, it is important to consider the implications of locating the center for all invasive procedures — surgery and catheterization, as well as possibly invasive radiology — in a single location. For such a renovation to optimize cost savings, the number of adjacent critical beds needed should be considered, as well as the many other hospital services that invasive procedures rely on, such as the emergency department, imaging, sterile processing and clinical lab. It is extremely important to avoid creating extensive and inefficient walking distances for staff that must traverse quickly between the cath lab, surgical suite, and support services. If existing services will support both surgery and minimally invasive procedures, the next step is to determine whether the building’s structural design will accommodate the renovated or new department. The key structural question speaks to the location of the support columns in the space being assigned to the new department. A cath lab typically requires 600 to 650 square feet of open, generally rectangular floor space, unencumbered by structural features — such as a column in the middle of the room. Ideal layouts would have 25 to 30 feet between columns. Another structural consideration is the floor load that a cath lab requires. If necessary, installing a steel floor plate would support the floor load. Similarly, the existing HVAC system, as well as the electrical system, should be reviewed for capacity. In some cases, these systems will require added capacity. But generally, the existing OR systems should not need significant change if the additional load is minimal. Eliminating Redundant Areas Space efficiencies arise through the elimination of redundant support spaces such as recovery beds, locker rooms, staff lounges and family waiting rooms that are typically required to be positioned with each geographically independent procedure area. For example, 12 operating rooms might require 36 recovery beds, while three cath labs might need nine recovery beds. Should these departments be consolidated to around 15 procedure rooms, the total required recovery beds might fall from 45 to 38, freeing up space that would ordinarily be devoted to seven beds. Two locker rooms for 30 people will take up much more space than one locker room for 60 people, so consolidation of the two into one will maximize that square footage. The same goes for multiple staff lounges and family waiting areas. Architects think three-dimensionally about these issues as well. The locker room might move to a floor above or below with a dedicated “clean” stairway, allowing the space that has been freed up to serve as procedure space. In addition, waiting areas need not be directly adjacent to these procedure spaces. Visitors might wait upstairs or downstairs, or even elsewhere in the hospital. And if their cell phone or other handheld device is programmed appropriately, notification is instant. Dynamic scheduling may be utilized by staff to manage the flow of procedure-related activities, as well as report to families on status and progress of the procedure. Operational Efficiencies Consolidating these two departments also offers opportunities to make more efficient use of nursing and administrative support staff. Consolidated staffs can reduce overtime through coverage synergies. For instance, a cross-trained nurse can cover patients coming out of either surgery or the cath lab, making it easier to maintain a 40-hour week. In addition, a consolidated staff can more easily manage end-of-day tasks. The consolidated recovery area may end the day with two patients from surgery and two patients from the cath lab. If the departments and recovery rooms were separate, staff would be required in both areas. But in a consolidated recovery area, the number of patients would determine necessary staffing. Overcoming Cultural Objections Clearly, the physical challenges involved in consolidating a surgery department and a catheterization lab are not that difficult to satisfy. The notion of a consolidation strategy begs a forfeiture of control and acceptance of the shift in the traditional paradigm. Most folks don’t like it when they are not in control, let alone feeling as though they are being forced to submit to change. But the real problems arise in the cultural changes demanded by a departmental location. Suppose the cardiologists don’t want to be in the same area of the hospital as the surgeons. Walls between these departments developed years ago. Indeed, all organizations develop cultural preferences that can devolve into barriers from progress. With physicians, it is perhaps possible to overcome their objections by noting all of the improvements that could be applied to patient care, not to mention the reduction in costs that are possible with the consolidation. It’s important to note that a cross-trained staff ensures that a larger number of nurses, technologists and other support staff will always be available to care for patients. Perhaps even more important, however, is a consideration of the benefits to be had from surgeons and cardiologists working nearer each other and consulting with one another about their cases, resulting in a collaborative environment — by proximity. Working side-by-side, instead of separately, offers a bridge across the cultural divide since physicians, whatever their specialty, will generally choose consultation over going it alone. About the author. Dennis L. Kaiser, AIA, NCARB, LEED AP, is a Principal with Perkins+Will — a 1,700-person architecture firm focused on services to the healthcare industry. Dennis offers over 30 years of experience in the design and planning of the healthcare environment, including over 4.5 million square feet of built projects. His award-winning recognition includes projects throughout the U.S. and overseas. Based in Boston, Dennis directs the firm’s healthcare practice for New England and may be contacted at dennis.kaiser@perkinswill.com. For further background on Perkins+Will, please visit: www.perkinswill.com.
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