facilities planning for new hospital construction – the technology perspective ceso conference,...

Facilities Planning for New Hospital Facilities Planning for New Hospital Construction –Construction –

The Technology PerspectiveThe Technology Perspective

CESO Conference, Thursday, October 30, 2003

Today’s PresentationToday’s Presentation9:30 – 10:00 Facilities Development – Planning, Design &

Construction – Nick Joosten

10:00 – 10:30 Planning Imaging Facilities – Murray Rice

10:30 – 10:50 Coffee Break

10:50 – 11:20 Cardiac Telemetry & Networking Issues – John Leung

11:20 – 11:50 TGH Operating Rooms

11:50 – 12:15 Roundtable Discussion

Project BackgroundProject 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

Facilities DevelopmentFacilities DevelopmentPlanning, Design & ConstructionPlanning, Design & Construction

Nick Joosten, Project ManagerNick Joosten, Project Manager

Project Management ProspectiveProject Management Prospective

• Our ‘goals’

• Leadership

• Managing expectations

• Keeping the drive

• Key construction points

• Lessons Learned

• Schedule & Budget

Our GoalsOur 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 60’s to 2000’s

Managing to due all the above

ON TIME & ON BUDGET

LeadershipLeadership

• Understanding the Operating Teams (End User) Needs & Operation

• Working with multiple stake holders

• Deciphering the Construction language

• Deciphering the Operational language

• Instilling Confidence

Managing ExpectationsManaging Expectations

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

Keeping the DriveKeeping the Drive

• Construction site walks

• Open communications with staff

• Moving from the 60’s to 2000 & beyond

• Fundraising tours

• Fun facts…

Sample MotivationSample Motivation

Key Construction PointsKey Construction Points

Some of Many

• Vendor participation

• Micro infrastructure details

• Changes & “Change Orders”

Lessons Learned Lessons Learned

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

Planning Imaging FacilitiesPlanning Imaging Facilities

Murray Rice, Manager, Medical Engineering

Imaging Equipment FacilitiesImaging Equipment Facilities

• Planning Steps

• Team

• Key Milestones in Time Line

• Conflicts in Time Line

• Detail Design Examples

• Administrative Coordination Issues

• Key Points

Planning StepsPlanning 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

Team – Who, When, and the Right TimeTeam – 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

Key Milestones in TimelineKey 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

Conflicts in Time LineConflicts in Time Line

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

• Equipment Procurement Process versus Construction Time Line

Radiography RoomRadiography Room

• Drawing of Room

Interventional RoomInterventional 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

MRIMRI

• 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

Administrative IssuesAdministrative 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

Key PointsKey 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

Cardiac Telemetry & Networking IssuesCardiac Telemetry & Networking Issues

John Leung, Manager, Medical Engineering

Cardiac Telemetry ProjectCardiac 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

Telemetry System 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

Equipment Selection ProcessEquipment Selection Process

• Consult Clinical User on Wish list

• Conduct Work Flow Analysis

• Specification & RFP

• Vendor Fair

• Interface Assessment

• Negotiation

TimelineTimeline

• 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

TimelineTimeline

• Feb-Mar 2003 Issue PO

• Apr-May 2003 SARS, Plan User Training

• Jun 2003 Delivery and Checkout

• July 2003 Go-Live

Networking IssuesNetworking 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

Networking IssuesNetworking Issues

• Network Security

NT Based Central monitors

Switch Room

Equipment Room

Gateway/Web Server

• Network Support

Lessons LearnedLessons 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

TGH Operating RoomsTGH Operating RoomsOR Imaging and Communication SystemOR Imaging and Communication System

Tony Easty, Director, Medical Engineering

The The Bottom LineBottom Line for these technological advances for these technological advances in OR Imaging and Communication is ….in OR Imaging and Communication is ….

ClinicalClinical - 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

EducationEducation - outstanding tools for undergraduate, postgrad, fellowship, CPD, allied, and public education

ResearchResearch - unprecedented opportunity for research in outcomes, innovation, educational models ...

TGH Operating Rooms - July 2003TGH Operating Rooms - July 2003

The 1950 ORThe 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


The 2003 ORThe 2003 ORThe 1950 ORThe 1950 OR




- bigger box (550+ sq.ft.)





- bigger box (550+ sq.ft.)- lights, table, wider doors





- bigger box (550+ sq.ft.)- lights, table, wider doors- nursing station control centre





- bigger box (550+ sq.ft.)- lights, table, wider doors- nursing station control centre- generous anesthesia space





- bigger box (550+ sq.ft.)- lights, table, wider doors- nursing station control centre- generous anesthesia space- equipment on booms, compact






- technology built in, intuitive






- technology built in, intuitive- sterile configuration, corridors






- technology built in, intuitive- sterile configuration, corridors- image capture, communication



Imaging Technology in ORs – Imaging Technology in ORs – A very recent innovation 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 wasn’t 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.

WIRED – OCT 2002

Imaging Technology in ORs – Imaging Technology in ORs – What are the advantages? 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.

The New ORs

MSICU

CVICU

CCU

Dialysis

Principles of OR designPrinciples of OR design

• Patient/worker access and flowPatient/worker access and flow• sterility protectionsterility protection• communication issuescommunication issues• ergonomic work spaces for nurses, anesthetists ergonomic work spaces for nurses, anesthetists

and surgeonsand 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

corridor

corridor

corridor

Sterilecore

Sterilecore

CVICU

PACU

Light choiceand

placement

Boom choiceand

placement

Lightsand

Boomsand

LCD monitors

OR Imaging task forceOR Imaging task force

• SurgeonsSurgeons• Biomedical EngineersBiomedical Engineers• NursesNurses• RadiologistsRadiologists• IT StaffIT Staff• AnaesthetistsAnaesthetists• PlannersPlanners• Respiratory TherapistsRespiratory Therapists

Elevation toward sterile corridor

Elevation toward main corridor

OR Imaging/TelecommunicationsOR Imaging/Telecommunications• cameras for open surgery, MIS


• LCD monitors


• LCD monitors

• PACS system in each OR


• LCD monitors


• pathology, radiology, endoscopic images


• LCD monitors


• pathology, radiology, endoscopic images

• image capture/storage systems in each OR for records, teaching and research

OR Imaging/TelecommunicationsOR 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

OR Imaging/TelecommunicationsOR 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 controlCentral control

So what?So what?

The The Bottom LineBottom Line for these technological advances in OR for these technological advances in OR Imaging and Communication is ….Imaging and Communication is ….

ClinicalClinical - 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

EducationEducation - outstanding tools for undergraduate, postgrad, fellowship, CPD, allied, and public education

ResearchResearch - unprecedented opportunity for research in outcomes, innovation, educational models ...

facilities planning for new hospital construction – the technology perspective ceso conference,...

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