Key Issues Circulation is one of the most important issues because it greatly impacts patients and staff. Access to cath labs is usually determined through one or two circulation paths. When possible, two circulation paths are always recommended. A walk-through should be done when planning an expansion or renovation. This step provides an avenue for asking questions while in the space. Design team members can identify inefficiencies and begin base discussions regarding how best to modify the space. Planning staff should discuss four key areas, the first of which is where the cath lab is and should be situated. This obviously is more challenging when a renovation or expansion is involved, but it is very important to select the optimum location in light of availability to other services and/or procedural areas. Identifying who needs treatment and where patients come from within the facility is the second issue. Up to 80 percent of cath lab users may be outpatients, so this impacts room requirements. The route of treatment involving check-in, prep, procedure, recovery and discharge must be planned and discussed thoroughly. The inpatient, outpatient, family, staff and physician needs encompass the next issue, which include access to ancillary areas such as food service and lounges. Depending upon institutional preferences, healthcare providers may prefer to use a single-room model for patient prep and recovery, an arrangement that minimizes patient transfers while maximizing patient and family satisfaction. Or, if throughput is the facility goal, a dedicated staff for each step along the way can maximize efficient care in individual areas. These and other issues must be addressed early in the planning phase to minimize, or hopefully eliminate, changes once design begins. Circulation The particular internal flows of physicians, staff, supplies (clean and dirty), and patients must be evaluated. The goal should be to minimize the conflict of flows and the crossing of patients with materials to the greatest extent possible. More than one circulation path to accomplish the individual flows involved is preferred. This type of arrangement can minimize conflicting flows, but will add anywhere from 20 to 25 percent more departmental area. This obviously has a higher initial cost, but may actually save money in the long run due to the overall efficiency of the plan. One healthcare provider, as an example, elected to implement a double circulation system when expanding its cath lab suite. The walk-through and discussions with staff revealed that an extensive number of people were using the one path, and this was causing a number of difficulties for patients and their families, and for staff. The provider believes that the double circulation system will minimize conflict of flows, reduce stress for those involved in care giving, and create a more soothing environment for everyone. The benefits outweigh the higher cost for this institution. Minimizing the institutional feel of the cath lab also is important. Scrub sinks, physician reading areas, lockers, supply cabinets and equipment should not be in the same path that patients travel. A patient™s stress level can be increased if he or she is taken past busy areas or past equipment that could be used during his or her procedure. Minimizing the institutional feel of the area also is accomplished through the flow of natural light into the space, artwork and soothing color schemes. Sizing Sizing is determined by three main factors: demographics, technology and modality. Providers continually must evaluate the demographics of the potential patient population serving the facility. Are the demographics of those within specified radiuses of the institution likely to use the cath lab™s facilities at an increased or decreased rate? Does the institution see cath lab and associated services as a primary or secondary market? The answers to these and other pertinent questions can help determine current and future cath lab requirements. Fifteen years ago, cath labs were not as high-tech as they are today, and 350 square feet per lab was adequate. Today, the average size per new cath lab is about 650 square feet, an increase largely attributable to building codes, advances in technology and the accompanying larger size for equipment. One healthcare provider recently requested that 800 square feet be provided for its cath labs in order to accommodate potential future technology advances. Future requirements also will be impacted by the potential for doing more surgical procedures within the cath lab. As this occurs (and it is already happening in some hospitals), the need for additional spaces such as sub-sterile rooms and surgical storage will be required. Healthcare providers should not box themselves into a corner. Always plan for expansion, including the potential changing of procedural needs. Cath labs typically include a mix of heart, electrophysiology (EP), vascular and sometimes even neurodiagnostic services. The current versus the potential future combination of services must be determined to the greatest extent possible. The rooms should be designed to maximize flexibility in order to accommodate future changes in modality. A single versus a double circulation path again comes into play with this issue. A double path initially may cost more, but also may provide a more cost-effective avenue for future expansion. Here™s how: Future growth can be handled in three ways. The first is to use shell space or enclosed space without equipment. The second is to use soft space, or space around the cath lab which could be moved later, such as storage rooms, offices and lounges. The final alternative is to build out from the cath lab™s exterior wall. Having two circulation paths allows for easy extension of the cath labs™ core areas without internal disruption. Control Rooms Control rooms should be internal to the cath lab and separate from the outside corridor. The best solution is to have one control room per cath lab. This facilitates communication between control room staff and those in the cath lab, and is not significantly more expensive than having one control room for two cath labs. As with other issues, the decision is based on institutional preferences. The one-to-one ratio reduces potential miscommunication since only one patient is being discussed by one set of personnel. At the same time, the overhearing of patient information is also reduced. A few well-thought-out steps can help minimize cath lab design challenges. Mike Tangney, AIA, is a senior healthcare designer in HDR™s Dallas office, and has planned and designed healthcare facilities for more than 20 years. He can be reached at (972) 960-4000 or via e-mail at: firstname.lastname@example.org.