Transcript Facilities Development Planning, Design & Construction

Facilities Planning for New Hospital
Construction –
The Technology Perspective
CESO Conference, Thursday, October 30, 2003
Today’s Presentation
9:30 – 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 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 Development
Planning, Design & Construction
Nick Joosten, Project Manager
Project Management Prospective
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Our ‘goals’
Leadership
Managing expectations
Keeping the drive
Key construction points
Lessons Learned
Schedule & Budget
Our Goals
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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
Leadership
• Understanding the
Operating Teams (End User)
Needs & Operation
• Working with multiple
stake holders
• Deciphering the
Construction language
• Deciphering the
Operational language
• Instilling Confidence
Managing Expectations
“Framework” of the Project
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Consultants Design v.s Users Needs
Equipment Planning & Deliverables
Vendor demonstrations
Fast Track OR
Furniture & Move Plan
BUDGET
Keeping the Drive
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Construction site walks
Open communications with staff
Moving from the 60’s to 2000 & beyond
Fundraising tours
Fun facts…
Sample Motivation
Key Construction Points
Some of Many
• Vendor participation
• Micro infrastructure details
• Changes & “Change
Orders”
Lessons Learned
• Have Vendors Participate
Early
• Deciphering Architectural
Elevations
• Equipment Luxury v.s
Practicality
• Avoid the “budget juggle”
Planning Imaging Facilities
Murray Rice, Manager, Medical
Engineering
Imaging Equipment Facilities
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Planning Steps
Team
Key Milestones in Time Line
Conflicts in Time Line
Detail Design Examples
Administrative Coordination Issues
Key Points
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
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
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
Conflicts in Time Line
• Technology Development/Changes (e.g.
digital radiography) versus Construction
Time Line
• Equipment Procurement Process versus
Construction Time Line
Radiography Room
• Drawing of Room
Interventional Room
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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
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
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
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
Cardiac Telemetry & Networking Issues
John Leung, Manager, Medical
Engineering
Cardiac Telemetry Project
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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
• 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 Process
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Consult Clinical User on Wish list
Conduct Work Flow Analysis
Specification & RFP
Vendor Fair
Interface Assessment
Negotiation
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
Timeline
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Feb-Mar 2003 Issue PO
Apr-May 2003 SARS, Plan User Training
Jun 2003 Delivery and Checkout
July 2003 Go-Live
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
Networking Issues
• Network Security
NT Based Central monitors
Switch Room
Equipment Room
Gateway/Web Server
• Network Support
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
TGH Operating Rooms
OR Imaging and Communication System
Tony Easty, Director, Medical Engineering
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 ...
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
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
The 2003 OR
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 OR
- bigger box (550+ sq.ft.)
- 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
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 OR
- bigger box (550+ sq.ft.)
- a small box (~400sq.ft.)
- lights, table, wider doors
- 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
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 OR
- bigger box (550+ sq.ft.)
- a small box (~400sq.ft.)
- lights, table, wider doors
- lights, table, 3 doors
- nursing station control centre
- 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
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 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
- bigger box (550+ sq.ft.)
- lights, table, wider doors
- nursing station control centre
- generous anesthesia space
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 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
- bigger box (550+ sq.ft.)
- lights, table, wider doors
- nursing station control centre
- generous anesthesia space
- equipment on booms, compact
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 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
- bigger box (550+ sq.ft.)
- lights, table, wider doors
- nursing station control centre
- generous anesthesia space
- equipment on booms, compact
- technology built in, intuitive
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 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
- 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
TGH Operating Rooms - July 2003
The 1950 OR
The 2003 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
- 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
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 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 –
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.
Dialysis
M
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U
The New ORs
CVICU
Principles of OR design
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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
c
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Sterile
core
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Sterile
core
c
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P
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CVICU
Light choice
and
placement
Boom choice
and
placement
Lights
and
Booms
and
LCD monitors
OR Imaging task force
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Surgeons
Biomedical Engineers
Nurses
Radiologists
IT Staff
Anaesthetists
Planners
Respiratory Therapists
Elevation toward sterile corridor
Elevation toward main corridor
Elevation toward main corridor
Elevation toward main corridor
OR Imaging/Telecommunications
• cameras for open surgery, MIS
OR Imaging/Telecommunications
• cameras for open surgery, MIS
• LCD monitors
OR Imaging/Telecommunications
• cameras for open surgery, MIS
• LCD monitors
• PACS system in each OR
OR Imaging/Telecommunications
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cameras for open surgery, MIS
LCD monitors
PACS system in each OR
pathology, radiology, endoscopic images
OR Imaging/Telecommunications
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•
•
•
•
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
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
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
So what?
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 ...