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Facilities Planning for New Hospital Construction – The Technology Perspective CESO Conference, Thursday, October 30, 2003.

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Presentation on theme: "Facilities Planning for New Hospital Construction – The Technology Perspective CESO Conference, Thursday, October 30, 2003."— Presentation transcript:

1 Facilities Planning for New Hospital Construction – The Technology Perspective CESO Conference, Thursday, October 30, 2003

2 Todays Presentation 9:30 – 10:00Facilities Development – Planning, Design & Construction – Nick Joosten 10:00 – 10:30Planning Imaging Facilities – Murray Rice 10:30 – 10:50Coffee Break 10:50 – 11:20Cardiac Telemetry & Networking Issues – John Leung 11:20 – 11:50TGH Operating Rooms 11:50 – 12:15Roundtable Discussion

3 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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7 Facilities Development Planning, Design & Construction Nick Joosten, Project Manager

8 Project Management Prospective 1.Our goals 2.Leadership 3.Managing expectations 4.Keeping the drive 5.Key construction points 6.Lessons Learned Schedule & Budget

9 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

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

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

12 Keeping the Drive Construction site walks Open communications with staff Moving from the 60s to 2000 & beyond Fundraising tours Fun facts…

13 Sample Motivation

14 Key Construction Points Some of Many Vendor participation Micro infrastructure details Changes & Change Orders

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

16 Planning Imaging Facilities Murray Rice, Manager, Medical Engineering

17 Imaging Equipment Facilities Planning Steps Team Key Milestones in Time Line Conflicts in Time Line Detail Design Examples Administrative Coordination Issues Key Points

18 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

19 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

20 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

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

22 Radiography Room Drawing of Room

23 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

24 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

25 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

26 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

27 Cardiac Telemetry & Networking Issues John Leung, Manager, Medical Engineering

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

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

30 Equipment Selection Process Consult Clinical User on Wish list Conduct Work Flow Analysis Specification & RFP Vendor Fair Interface Assessment Negotiation

31 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

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

33 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

34 Networking Issues Network Security NT Based Central monitors Switch Room Equipment Room Gateway/Web Server Network Support

35 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

36 TGH Operating Rooms OR Imaging and Communication System Tony Easty, Director, Medical Engineering

37 The Bottom Line for these technological advances in OR Imaging and Communication is …. Clinical 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 Education - outstanding tools for undergraduate, postgrad, fellowship, CPD, allied, and public education Research Research - unprecedented opportunity for research in outcomes, innovation, educational models...

38 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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40 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

41 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

42 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

43 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

44 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

45 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

46 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

47 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

48 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

49 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.

50 WIRED – OCT 2002

51 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.

52 The New ORs MSICUMSICU CVICU CCUCCU Dialysis

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55 Principles of OR design Patient/worker access and flowPatient/worker access and flow sterility protectionsterility protection communication issuescommunication issues ergonomic work spaces for nurses, anesthetists and surgeonsergonomic work spaces for nurses, anesthetists and surgeons modern equipmentmodern equipment a pleasing work environmenta pleasing work environment FLEXIBILITY for the futureFLEXIBILITY for the future Imaging, connecting to the WORLDImaging, connecting to the WORLD

56 corridorcorridor corridorcorridor corridorcorridor Sterile core Sterile core CVICU PACUPACU

57 Light choice and placement

58 Boom choice and placement

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60 Lights and Booms and LCD monitors

61 OR Imaging task force SurgeonsSurgeons Biomedical EngineersBiomedical Engineers NursesNurses RadiologistsRadiologists IT StaffIT Staff AnaesthetistsAnaesthetists PlannersPlanners Respiratory TherapistsRespiratory Therapists

62 Elevation toward sterile corridor

63 Elevation toward main corridor

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68 OR Imaging/Telecommunications cameras for open surgery, MIS

69 OR Imaging/Telecommunications cameras for open surgery, MIS LCD monitors

70 OR Imaging/Telecommunications cameras for open surgery, MIS LCD monitors PACS system in each OR

71 OR Imaging/Telecommunications cameras for open surgery, MIS LCD monitors PACS system in each OR pathology, radiology, endoscopic images

72 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

73 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

74 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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76 So what?

77 The Bottom Line for these technological advances in OR Imaging and Communication is …. Clinical 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 Education - outstanding tools for undergraduate, postgrad, fellowship, CPD, allied, and public education Research Research - unprecedented opportunity for research in outcomes, innovation, educational models...


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