Anatomy of a Hybrid OR

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Hybrid OR - Don't use until 3/1/12 - 74.83 Kb
The hybrid OR at St. Joseph Hospital Heart and Vascular Center in Orange, Calif., was designed to accommodate cardiac, vascular, interventional and surgical procedures.

Hybrid operating rooms (ORs) promise to deliver multiple benefits. The ability to shift from a diagnostic or interventional procedure to a surgical one may trim procedure and recovery times. The rooms open the door to novel transcatheter therapies, and help organizations support subspecialist surgeons and interventionalists. Given these pluses, it’s no surprise that the hybrid OR market is booming and is expected to see an average growth rate of 15 percent annually through 2016, according to Millennium Research Group. However, hybrid ORs represent a hefty investment and require meticulous planning.

Construction of a hybrid room is not for the faint-of-heart, evidenced by price tags ranging from $3.5 million to $5 million, according to Ashley Ford, research consultant for The Advisory Board, Technology Insights, in Washington, D.C. Some hybrid construction projects top the $5 million mark. St. Joseph Hospital (SJH) Heart and Vascular Center in Orange, Calif., opened its $5.5 million room in 2010 after a four-year planning process.

The jaw-dropping price tag is far from the only pain point associated with a hybrid suite. Success hinges on previously unseen levels of collaboration among an array of specialists in interventional radiology; cardiac, vascular and neurovascular surgery and cardiac catheterization. Buried in among decisions about high-value imaging and display systems are mundane details, such as types of electrical outlets and equipment carts. However, the most significant challenge is not identifying, purchasing and installing equipment, says Renee Mazeroll, RN, MSN, executive director of the Heart and Vascular Center at SJH. The bigger question is, “How do you operationalize the room so that it is efficient [and profitable],” she says.

Many hybrid suites have not realized the high utilization they expected, with usage of the room peaking at a mere three to four times a week. In contrast, the hybrid suite at SJH is booked solid and averages 2.5 patients per day. The center’s hybrid volume is approximately two-thirds vascular and one-third cardiac procedures.

While utilization can be measured, other metrics are more complex. University of Virginia Health System (UVA) in Charlottesville, has not measured return on investment for its hybrid room, which opened in January 2011. “The room gives capacity for the program. It is not going to bring patients in by itself. It is a link in the chain of handling new directions in cardiac surgery,” says Scott Lim, MD, co-director the UVA Cardiac Valve Center.

Catholic Health in Buffalo, N.Y., applies a different spin to its pro forma. The health system launched a pair of hybrid ORs at Mercy Hospital in June 2011 and plans to open three more across its system by the end of 2012. “It made sense from an economic standpoint. We were at capacity and unable to accommodate all of the surgeons and interventionalists who wanted to work here. It’s easier to justify a multi-purpose room than a single-purpose room,” says John S. Sperrazza, CNMT, vice president of imaging services at Catholic Health.  

Expense Line Item Estimated Cost
Angiography System (Single-plane, Base Model) $1,500,000
Demolition, Miscellaneous Construction $500,000
Cost for Space 1 $400,000
Heart/Lung Machine $250,000
HVAC $250,000
General Equipment 2 $200,000
Integrated Booms $175,000
Lead Shielding $100,000
Ceiling Reinforcement $75,000
Angiography Equipment/Software $50,000
Medical Gasses $50,000
Radiolucent Tables $50,000
Plumbing $10,000
Cabinets/Room Storage $7,500
Total Cost $3,617,500
1- Assumes 800 square foot room, cost of $500 per square foot
2- Anesthesia equipment, lights, electrical units, etc.
Source: The Advisory Board, Technology Insights

The OR: Dissected

The hybrid OR includes a dizzying assortment of infrastructure, with the imaging equipment serving as the centerpiece.

At SJH, Mazeroll and colleagues aimed for a universal room to support maximum use. Six years ago, when the plan was conceived, Mazeroll estimated relatively weak demand for the suite. Initial interest stemmed from the need to support the pediatric and adult congenital heart program with percutaneous valves. However, volume was very low. At the same time, Mazeroll was