The Hybrid OR

by Yumi Clevenger

DPR’s Gerry DeWulf’s latest blog post to Healthcare Building Ideas discusses the fast-emerging trend toward the development and demand of Hybrid ORs.

Based on our experience at Banner Health at Good Samaritan Hospital, Gerry shares a couple of things for owners to think about as they consider hybrid ORs for their facilities. Read Gerry's "Hybrid ORs--The Magic Kingdom" post on Healthcare Building Idea's blog.

Any renovation in the OR department is complex – but the Hybrid OR just raises the game to a higher level. So, in addition to his blog post, Gerry has the following advice for project teams when it comes to Hybrid ORs:

  • Typically Hybrid OR’s are being added on, or built next to, existing ORs. There will be more demolition noise, more cores to drill in the slabs, and more structure to be drilled and bolted. Get to know the department staff around you, respect their concerns, start planning early, and share your schedule for the work well in advance. Tell them how you will mitigate the impact to them – and keep your promise. Prepare for lots of off-hours work and ICRA that gets put in place every evening and removed prior to start of business in the morning. Remember that some departments, like ER, never close and you may get very limited access during very brief time periods.
  • For structural requirements, demanding tolerances of today’s new imaging and angiography equipment require stiffer structural supports than in the past. This can be a major disruption the departments located beneath your new Hybrid OR room, and dollars and time in your construction budget and schedule. Try to reinforce/stiffen what you have.
  • For Cooling/HVAC requirements, there are two areas of concern:
    1) The OR room itself will probably require a larger volume of air than that of the previous function in that location. Make certain that existing air-handlers have the fan capacity, humidity control, and cooling coils to handle the additional load.
    2) Cooling load in the equipment room that houses all the computers and UPS systems that support the communications, controls and operation of the new equipment. The most common solution is a CRAC (Computer Room Air Conditioner) unit that requires house-generated chilled water supply and return.
  • Power, control, data, and display wiring is everywhere. Ceiling space is already full of HVAC ductwork, medical gas piping and electrical conduit, which now may need to be relocated. This can be a budget and/or schedule concern if not identified early in the design process. Find the accurate as-built drawing or get your head above the ceiling and get BIM coordination started during the design.
  • Look for opportunities to re-route existing utilities out of the footprint of the new Hybrid OR. You will need every inch of space possible for new ductwork, med-gas piping, boom and light supports, and conduit. The best time to have the most budget impact is early in the design process.
  • Once the project is complete, staff will fight tooth and nail to keep you out of their new OR, now and in the future. Create your “as-built” drawings or updated BIM model as you go and make certain everything is documented before you close up the ceiling. Good record drawings also means that future projects will not require design teams to access the space – a great benefit to the client!