Facilities Planning for New Hospital Construction The Technology Perspective

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Facilities Planning for New Hospital Construction
The Technology Perspective

• CESO Conference, Thursday, October 30, 2003

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Todays Presentation

• 930 1000 Facilities Development Planning,
  Design Construction Nick Joosten
• 1000 1030 Planning Imaging Facilities
  Murray Rice
• 1030 1050 Coffee Break
• 1050 1120 Cardiac Telemetry Networking
  Issues John Leung
• 1120 1150 TGH Operating Rooms
• 1150 1215 Roundtable Discussion

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Project Background

• Toronto General Hospital Project 2003
• Initiated in 1998
• Funded through 300M Bond Issue
• New Imaging, OR and Patient Care Floors
• Architectural showpiece
• Flexibility for the future

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Facilities DevelopmentPlanning, Design
Construction

• Nick Joosten, Project Manager

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Project Management Prospective

• Our goals
• Leadership
• Managing expectations
• Keeping the drive
• Key construction points
• Lessons Learned
• Schedule Budget

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Our Goals

• Build something that never has been done before
• Account for the future
• Manage the multiple dynamics of the team
• Acquire 13.5 million of advance technology
  equipment managing over 10 million in
  construction
• Help transition the Team from the 60s to 2000s
• Managing to due all the above
• ON TIME ON BUDGET

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Leadership

• Understanding the Operating Teams (End User)
  Needs Operation
• Working with multiple stake holders
• Deciphering the Construction language
• Deciphering the Operational language
• Instilling Confidence

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Managing Expectations

• Framework of the Project
• Consultants Design v.s Users Needs
• Equipment Planning Deliverables
• Vendor demonstrations
• Fast Track OR
• Furniture Move Plan
• BUDGET

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Keeping the Drive

• Construction site walks
• Open communications with staff
• Moving from the 60s to 2000 beyond
• Fundraising tours
• Fun facts

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Sample Motivation
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Key Construction Points

• Some of Many
• Vendor participation
• Micro infrastructure details
• Changes Change Orders

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Lessons Learned

• Have Vendors Participate Early
• Deciphering Architectural Elevations
• Equipment Luxury v.s Practicality
• Avoid the budget juggle

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Planning Imaging Facilities

• Murray Rice, Manager, Medical Engineering

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Imaging Equipment Facilities

• Planning Steps
• Team
• Key Milestones in Time Line
• Conflicts in Time Line
• Detail Design Examples
• Administrative Coordination Issues
• Key Points

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Planning Steps

• Functional Plan Requirements of area with
  consideration of of staff, of patients, of
  procedures, etc. Happens years in advance of
  actual building.
• Initial Design Work flow, where the walls are
• Detailed Design Positioning of everything in
  the room, power requirements, etc. This is what
  the contractors build from.
• Construction
• Installation and Moving In

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Team Who, When, and the Right Time

• Functional Plan Clinical Team and Planners,
  Medical Engineering confirms technical details
• Initial Design Building Planners, Clinical
  Team, Medical Engineering, Infection Control,
  Hospital Support Groups
• Detail Design Above and Equipment Vendors
• Construction Everyone should monitor
  construction, involve vendors, clinical, and
  technical teams
• Installation Above and Hospital IS
• Commissioning

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Key Milestones in Timeline

• Functional Plan Size and number of Rooms
• Initial Design Shape of rooms, Equipment
  proximity (e.g. MRI)
• Detail Design Initially a generic design, but
  before finally built need Equipment Selection,
  need Complete detailed equipment list
• Detailed Technical Planning - Three Examples
  (Radiography Room, Interventional Room, MRI)
• Construction Need Ministry of Health X-Ray
  Inspection Service Site Plan Approval for X-ray
  systems before constructing x-ray rooms

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Conflicts in Time Line

• Technology Development/Changes (e.g. digital
  radiography) versus Construction Time Line
• Equipment Procurement Process versus Construction
  Time Line

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Radiography Room

• Drawing of Room

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Interventional Room

• Operating Room Environment
• X-Ray System
• Contrast Injector
• Ultrasound Machine
• Patient Monitoring
• Mounted on X-Ray table, or monitor on boom?
• Slave/Remote Monitors
• Anaesthetic Equipment
• CCTV

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MRI

• Weight and Access Route for Bore, Open Magnet
  (Slab on Grade)
• Magnetic Field Effect on Surrounding Area
  (Magnetic Shielding?)
• EMI Effect on MRI (RF Shielding), and effect of
  MRI on Surrounding area
• Noise and Vibration

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Administrative Issues

• Budgeting (Who pays for what)
• Capital
• Construction Changes
• Information Systems
• Tracking Changes to Plans
• Clinical Team, Technical Team, Project Manager,
  Architect, Consulting Engineers, Construction
  Manager, Contractor
• Decision Makers

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Key Points

• Need thorough understanding of process
• Take the time to capture as many details as
  possible at the detailed design stage. Making
  changes later is possible, but hard.
• Challenge of thinking of Plan versus Reality
• Vendor Involvement is key
• Medical Engineering acts as conduit for different
  groups as we are positioned to understand the
  whole process

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Cardiac Telemetry Networking Issues

• John Leung, Manager, Medical Engineering

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Cardiac Telemetry Project

• Two floors West wing 4th and 5th
• Total 76 telemetry channels
• Philips WMTS band telemetry system
• Coverage Area Patient rooms, hallways, Elevator
  lobby and Patient Court
• Project go-live June 19th and June 28th

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Telemetry System

• 4th floor 36 channels, central monitoring and 6
  satellite nursing station, 6 telemon monitors
• 5th floor 40 channels, central monitoring, 3
  satellite nursing stations, 6 telemon monitors
• Future stepdown unit with 6 Intellivue
• Future HL7 inbound interface

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Equipment Selection Process

• Consult Clinical User on Wish list
• Conduct Work Flow Analysis
• Specification RFP
• Vendor Fair
• Interface Assessment
• Negotiation

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Timeline

• May-June 2002 Consultation, Setup Team
• July 2002 Develop Specification Work Flow
  Analysis
• August 2002 Issue RFP
• September 2002 Vendor Fair
• Oct-Nov 2002 RFP Response Review Interface
  Discussion, Negotiation
• Jan 2003 Finalize Equipment List

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Timeline

• Feb-Mar 2003 Issue PO
• Apr-May 2003 SARS, Plan User Training
• Jun 2003 Delivery and Checkout
• July 2003 Go-Live

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Networking Issues

• Ensure Adequate Network Drops
• Oper. Room - 22 drops
• Bed with Monitor - 3 drops
• Bed w/o Monitor 1 drop
• Network Topology
• Stand Alone vs. Integrated

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Networking Issues

• Network Security
• NT Based Central monitors
• Switch Room
• Equipment Room
• Gateway/Web Server
• Network Support

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Lessons Learned

• Large projects with long lead-time
• Equipment budget anomalies
• User forgets what/why equip is needed
• Usability is important, should be part of
  selection process
• Plan extra network drops
• Identify who does what
• Blocking for Monitor mounts
• Patient Court Antenna

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TGH Operating RoomsOR Imaging and Communication
System

• Tony Easty, Director, Medical Engineering

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The Bottom Line for these technological advances
in OR Imaging and Communication is .
Clinical - better , safer, and more efficient
care for patients at UHN
(TGH,TWH,PMH) and from MSH,
HSC, and all of Ontario and beyond
- capture and storage of ALL records Education
- outstanding tools for undergraduate, postgrad,
fellowship, CPD, allied, and
public education Research - unprecedented
opportunity for research in
outcomes, innovation, educational models ...

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TGH Operating Rooms - July 2003
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.)
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.) - lights,
table, wider doors
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.) - lights,
table, wider doors - nursing station control
centre
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.) - lights,
table, wider doors - nursing station control
centre - generous anesthesia space
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.) - lights,
table, wider doors - nursing station control
centre - generous anesthesia space - equipment on
booms, compact
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.) - lights,
table, wider doors - nursing station control
centre - generous anesthesia space - equipment on
booms, compact - technology built in, intuitive
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.) - lights,
table, wider doors - nursing station control
centre - generous anesthesia space - equipment on
booms, compact - technology built in,
intuitive - sterile configuration, corridors
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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TGH Operating Rooms - July 2003
The 2003 OR - bigger box (550 sq.ft.) - lights,
table, wider doors - nursing station control
centre - generous anesthesia space - equipment on
booms, compact - technology built in,
intuitive - sterile configuration, corridors -
image capture, communication
The 1950 OR - a small box (400sq.ft.) - lights,
table, 3 doors - ergonomically poor for nurses -
cramped space for anesthesia - equipment,
additional technology on floor (clutter, hard
to clean) - nothing built in - sterile
environment compromised - no image capture,
communication
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Imaging Technology in ORs A very recent
innovation
When our design process started in 1997,
integrating this technology into ORs was unheard
of. We seized the opportunity to incorporate the
very latest advances on the fly during our
design and construction process, causing
significant trauma to out design and construction
team. Because this wasnt part of the original
scope, it was outside the project budget. We had
to fundraise directly for this system. By
opening day, we managed to fund and install 11 of
19 rooms.
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WIRED OCT 2002
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Imaging Technology in ORs What are the
advantages?

• Ability to select all video sources and display
  them on any flat panel screen.
• Ability to link ORs together, so that images from
  one OR can be viewed in another.
• Ability to capture and store still and moving
  images as part of the patient record.
• Ability to perform live teleconferences with
  remote sites.

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MSICU
Dialysis
CCU
The New ORs
CVICU
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Principles of OR design

• Patient/worker access and flow
• sterility protection
• communication issues
• ergonomic work spaces for nurses, anesthetists
  and surgeons
• modern equipment
• a pleasing work environment
• FLEXIBILITY for the future
• Imaging, connecting to the WORLD

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corridor
cor r i dor
PACU
c o r r i d o r
Sterile core
Sterile core
CVICU
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Light choice and placement
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Boom choice and placement
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Lights and Booms and LCD monitors
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OR Imaging task force

• Surgeons
• Biomedical Engineers
• Nurses
• Radiologists
• IT Staff
• Anaesthetists
• Planners
• Respiratory Therapists

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Elevation toward sterile corridor
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Elevation toward main corridor
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Elevation toward main corridor
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Elevation toward main corridor
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OR Imaging/Telecommunications

• cameras for open surgery, MIS

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OR Imaging/Telecommunications

• cameras for open surgery, MIS
• LCD monitors

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OR Imaging/Telecommunications

• cameras for open surgery, MIS
• LCD monitors
• PACS system in each OR

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OR Imaging/Telecommunications

• cameras for open surgery, MIS
• LCD monitors
• PACS system in each OR
• pathology, radiology, endoscopic images

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OR Imaging/Telecommunications

• cameras for open surgery, MIS
• LCD monitors
• PACS system in each OR
• pathology, radiology, endoscopic images
• image capture/storage systems in each OR for
  records, teaching and research

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OR Imaging/Telecommunications

• cameras for open surgery, MIS
• LCD monitors
• PACS system in each OR
• pathology, radiology, endoscopic images
• image capture/storage systems in each OR for
  records, teaching and research
• digitizing of images
• distribution of images to OR, seminar rooms,
  other hospitals, conferences

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OR Imaging/Telecommunications

• cameras for open surgery, MIS
• LCD monitors
• PACS system in each OR
• pathology, radiology, endoscopic images
• image capture/storage systems in each OR for
  records, teaching and research
• digitizing of images
• distribution of images to OR, seminar rooms,
  other hospitals, conferences

Central control
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So what?
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The Bottom Line for these technological advances
in OR Imaging and Communication is .
Clinical - better , safer, and more efficient
care for patients at UHN
(TGH,TWH,PMH) and from MSH,
HSC, and all of Ontario and beyond
- capture and storage of ALL records Education
- outstanding tools for undergraduate, postgrad,
fellowship, CPD, allied, and
public education Research - unprecedented
opportunity for research in
outcomes, innovation, educational models ...