Surgery Department. Graphic Standards Programming and Schematic Design. June 1999

Surgery Department Graphic Standards Programming and Schematic Design June 1999

Table of Contents Table of Contents Function 3 Staff 5 Advantages of Movable Modular Casework 6 Functional Areas 7 Control Station 7 Pre-Operative Holding 8 Scrub Area 8 Operating Room 9 Cystoscopy 10 Substerile 11 Clean Core 12 Post-Anesthesia Care Unit (PACU/Recovery Room) 13 Equipment Storage 14 Clean/Sterile Storage 15 Clean Workroom 16 Soiled Utility 17 Anesthesia Supply/Workroom 18 Satellite Lab 19 Satellite Pharmacy 20 Staff Lounge/Locker Room 21 Administrative Office 22 Functional Program 23 Bubble Diagram 24 Block Diagram 25 Preliminary Plan 26 Schematic Plan 27 Future Trends 28 Surgery Department 2

Function Function The surgery department of a general hospital is that area responsible for the surgical procedures, or operations, performed on hospital inpatients and/or ambulatory outpatients. The ambulatory surgery services may be in another location within the hospital or in a freestanding facility. Because surgical procedures are performed under the strictest sterile techniques and infection control concepts, the design of the department and the flow of patients, staff, and supplies must be rigidly controlled. The surgery department includes a required number of operating rooms, pre- and post-anesthesia areas, technical support functions, equipment and supply areas, and administrative staff space. Traffic Flow The layout of the operating room suite may be a single corridor plan with operating rooms and support services opening off the same corridor. Today the more commonly used design combines a clean core with peripheral corridors, sometimes called the racetrack design. Either type of plan will typically have three basic zones of traffic flow. Unrestricted Areas The unrestricted area allows visitors or staff attired in street clothing to enter the surgery department. Their movement is limited to the locker rooms, staff lounge, and from the main entrance to the control station. Semi-Restricted Areas These areas are within the department and beyond the control station, requiring personnel to be attired in scrub suits or dresses, shoe covers, and hair covers. Restricted Areas The most restricted areas of the department are the operating rooms, the clean core, and the scrub areas. A face mask must be worn in these areas in addition to the scrub suit and hair and shoe covers. SINGLE CORRIDOR CLEAN CORE/PERIPHERAL CORRIDOR Surgery Department 3

Function Flow of Patients Patients are brought to the surgery department on stretchers from the patient units. After notification of the control station staff, patients are moved to a preoperative holding area to wait for the available operating room. Medications and/or intravenous fluids may be administered while patients are in the pre-operative holding area. Surgery procedures are scheduled for predetermined times in specific rooms with a minimal amount of turnaround time between cases for cleaning and case preparation. Patients will then be moved to the designated operating room, the anesthesia administered, and the surgical procedure performed. Following surgery, patients are moved to the post-anesthesia care unit where they remain until responding and awake, and are then returned to the patient unit. Flow of Supplies Traditionally, surgery departments stored supplies and instruments in casework cabinets within the operating rooms, in corridors, and in clean supply rooms. Supplies were then collected from multiple areas and carried to the appropriate operating room before each surgical case. In some cases, supplies were stored in rooms dedicated to a specific type of surgical case. This system has proven to be time consuming and inefficient. Turnaround time, or the time between the close of one surgical case and the beginning of the next case, is critical in the productive utilization and revenue generation of the operating rooms. Because the surgery department is the primary user of sterile equipment and supplies in the hospital, sterile processing departments are now being located either adjacent to or in a direct line above or below the surgery department. Today, the supplies and instruments for surgery are centralized, reprocessed, and distributed from the sterile processing department, eliminating the costly duplication of reprocessing equipment and reducing both inventory and labor costs by utilizing movable modular casework and carts. The method of choice for the delivery of surgical supplies and instruments is the case cart system. Rather than instruments and supplies for each operative case being housed in casework and compiled in the operating room, the sterile processing department will assemble the appropriate supplies and send them to surgery as a specific case cart. This case cart is stocked with all of the materials, instruments, and supplies necessary for a single designated surgical procedure, with a cart prepared in advance for all daily scheduled surgery cases. Thus the turnaround times between cases can be kept to a minimum. Case carts are also supplied and kept ready for the most frequently performed emergency cases. In the clean core/peripheral corridor type of plan, there is dual access to the operating rooms with the clean supplies and case carts flowing from the clean central core into the operating room and the dirty supplies and contaminated case carts moving into the peripheral corridor to the decontamination area. This type of flow provides the best opportunity for infection control, preventing the clean and dirty supplies from crossing paths. Surgery Department 4

Staff Staff Surgery departments typically have two lines of authority physicians and nurses and an administrative staff. Physician Staff Chief of Surgery The chief of surgery (an MD or DO) will oversee the physicians, the surgical procedures, and/or the administration of anesthesia, as well as make recommendations concerning the medical aspects of the department. Chief of Services The chief of services is an MD who oversees a specialty service such as orthopedics. Chief of Anesthesiology The chief of anesthesiology (an MD or DO) is the administrative head of the anesthesia department and supervises the anesthesiologists, nurse anesthetists, and anesthesia technicians. This position manages anesthesiology supplies, equipment, and procedures. Operating Room Staff OR Supervisor An operating room supervisor or director of surgical services is usually an RN with extensive operating room experience and may have an advanced degree in nursing, management, or business. This position will be in charge of nursing; responsible for such business aspects of the department as budgets, inventory, scheduling, and staffing; and responsible for balancing the needs of administration, physicians, operating room staff, and patients. Head Nurse/Clinical Nurse Manager This person usually is a registered nurse (RN) with or without an advanced degree; works with one or more specialty services, such as cardiovascular; and is influential in decisions regarding supplies, equipment, policies, and procedures for that specialty area. Circulating Nurse This is a registered nurse (RN) who coordinates activity in the operating room for a particular surgical procedure, opens supplies for the scrub nurse, assists with moving the patient, applies dressings, etc. Scrub Nurse/Instrument Nurse This registered nurse (RN) or surgical technician maintains the sterile operating field, and organizes and passes sterile instruments and supplies to the surgeon. Surgical Technician Typically, this technician has completed a oneyear program in preparation for working in a surgery department and is familiar with instruments, surgical procedures, and sterile techniques. Administrative Staff Manager of Post-Anesthesia Care Unit The manager of the post-anesthesia care unit (PACU) is a registered nurse (RN) with administrative responsibilities for the PACU. This person may be a major decision maker or influential in equipment and facility decisions as they relate to this unit. Manager of Ambulatory Surgery This may be the operating room supervisor or a separate RN manager who reports to the administrator of ambulatory services. Frequently, this person supervises a patient holding and recovery area separate from the main surgery department and is responsible for department staff and budgets. Anesthesia Supervisor The anesthesia supervisor makes decisions on supplies, budgets, and equipment purchases frequently in conjunction with the chief of anesthesiology. This person may be a nurse anesthetist or technician. OR Materials Manager This position, many times found in larger and/or teaching hospitals, may report to the director of surgical services, the director of sterile processing, or the director of materials management. This person is responsible for ordering supplies and, sometimes, instruments and equipment. Surgery Department 5

Advantages of Movable Modular Casework Advantages of Movable Modular Casework Surgical departments may differ somewhat in square footage, method of operation, and staffing based on the size of the hospital, type of hospital, and scope of patient services, but each will have certain functional areas in common. The following pages describe the advantages of movable modular casework, give a brief description of the functional areas of the surgery department, and provide typical plan views of movable modular casework applications. Movable Modular Casework Movable modular casework offers the following major advantages and differences when compared with fixed casework or millwork: All movable modular casework components can be easily rearranged or reused by the end user, allowing ongoing changes with new technology and accommodate major procedural changes as well as hour-to-hour variations in activities. Movable modular casework components have been specifically designed to meet the functional requirements of surgery departments. Components are sanitizable, and every configuration can be disassembled to easily clean parts. Movable modular components can quickly and easily be relocated to the opposite wall in an operating room when a specific procedure requires that the operating table be turned around. A movable system accommodates the increasing need to plan the majority of operating rooms generically, rather than dedicating them to a specific procedure. Being able to move procedure-specific supplies into a generic operating room simplifies scheduling and increases the productivity of the department. Additional components can be added at any time. Materials Handling Components Movable modular materials handling components can be especially useful for supporting effective and efficient delivery, storage, use, and removal of the supplies used in the surgery department. Components can be rearranged to suit any needed configuration as static storage, either wall-hung or freestanding. The quick-delivery capability allows specialized supplies to be stored in a central location and transported to an operating room on demand. Each component can become mobile by combining it with a wheeled component and used for transport as well as storage. Specific components appropriate for use in the surgery department include Case carts. L carts. Crash carts. Specialty procedure carts. Lockers. Supply carts. Process tables. Extra-deep modular shelving. Modular Furniture Systems Panel systems for administrative areas offer the use of less space, the flexibility to make changes easily, and increased worker productivity. The system provides cantilevered work surfaces and efficiently arranged workstations. Financial Advantages The initial cost of movable modular casework is competitive with fixed casework or millwork. However, the life cycle cost of movable modular casework is far less than fixed casework because of Longer product life. Minimal maintenance cost. Continual reuse of the components for new or different functions. Ability to install and reconfigure with little downtime. Accelerated depreciation rate, especially important to forprofit organizations. For preliminary budget purposes, movable modular casework for a surgery department has an average price in the range of $248 to $372 per linear foot. This range will be affected by the density of overhead and undercounter storage components and the type of support structure used (wall-mounted versus panels). Surgery Department 6

Control Station Functional Areas Control Station The control station is primarily a clerical area located in a position to control traffic into the surgery department. Similar to a nurses station, it is the communications center of the surgery department. A control station may be configured in a variety of shapes and sizes depending on the size of the department and the number of operating rooms. Movable Modular Casework and Furniture Systems Applications A control station can be planned using freestanding frame and/or panel systems with movable modular casework components and generally will require Computer support components. File drawers. Work tools and form trays to help organize the large volume of paper and forms. Marker board for posting daily surgery schedule. Acoustical tiles to reduce noise in the area. A control station tends to differ from a nurses station in that less people generally work out of this area, and usually there are no patient monitors located here. Surgeries are scheduled; patient charges, records, and administrative functions are maintained; and intra- and interdepartmental communications are channeled through the control station. Space should be provided for requisitioned items to be delivered or picked up by other departments. Plan View of a Control Station A control station will range in size from 200 to 400 square feet. 20 linear feet work surface 72 linear feet overhead storage 224 filing inches 330 square feet Surgery Department 7

Pre-Operative Holding, Scrub Area Pre-Operative Holding Patients arriving for surgical operations are held in this area until the appropriate operating room is ready. This area may also be called pre-anesthesia as patients may be given medications or intravenous fluids under close observation of the nursing staff. Movable Modular Casework Applications A pre-operative holding area can be planned using movable modular casework and may require Small workstation for filling out forms and paperwork. Locker to hold patient care supplies. Plan View of a Pre-Operative Holding Area A pre-operative holding area will range in size from 300 to 700 square feet. 6 linear feet work surface 10 linear feet overhead storage 2 L carts 1 procedure cart 475 square feet L cart, procedure/supply cart, or rail-hung C frame storage unit placed near each stretcher. Specialty procedure carts. Extra-deep modular shelving units. Sink unit. Med prep/storage. Scrub Area Scrub areas are placed strategically outside operating rooms. If the surgical suite is designed with the clean core/ peripheral corridor plan, the scrub sinks are best located in the peripheral corridor. Surgical scrub sinks are generally ceramic or stainless steel with foot or knee controls. It is helpful to place shelves above the sink to hold scrub brushes and masks. Movable Modular Casework Applications Depending on the design of the scrub area, scrub brushes and masks can be housed in modular shelving hung on rail, on wall strips above the sinks, or in railhung C frame storage units with drawers beside the sinks. Plan View of a Scrub Area 8 linear feet overhead storage (2 feet per sink) 50 square feet Surgery Department 8

Operating Room Operating Room An operating room is the area where surgical procedures are performed under strict sterile techniques. Operating rooms may be dedicated to specific procedures such as cardiovascular, neurological, orthopedic, or ophthalmic procedures. Special supplies and equipment are moved in and out as needed. Operating rooms may also be generic and used for many different procedures which will maximize the use of the space. Operating rooms should have positive pressure ventilation systems, with controlled temperature and humidity, to prevent corridor air from entering. Movable Modular Casework Applications An operating room can be planned using movable modular casework components. Movable modular casework can be relocated to the opposite wall when a specific procedure requires that the operating table be turned around. L carts or procedure/supply carts used for Anesthesia supplies and equipment. Suction and cautery equipment. Monitoring equipment. Prep and dressing. Anesthesia carts. Stainless steel case carts which can also be used as a back table. Lockers used for General supply storage. Backup supplies. Specialty procedure carts. Process tables used as Administrative/computer workstations. Back table for instruments. The general layout of the OR should place the work surface for the circulating nurse near the entrance door and the movable modular casework on the wall at the foot end of the table depending on the head orientation of the patient. Little or no built-in casework should be used in the operating room for sanitization purposes and because Built-in casework inhibits change. It is difficult to sanitize. It increases construction costs due to the need for soffits and recesses. It increases the floor space needed. Rather than using wall strips, horizontally mounted rail with rail-hung components are appropriate for hanging work surfaces for documenting or charting. Rail-hung shelves or CST units are suitable for overhead storage. Plan View of an Operating Room An operating room will range in size from 400 to 600 square feet. 4 linear feet work surface 4 linear feet overhead storage 1 locker for anesthesia supplies 3 lockers for backup supplies 1 L cart 1 anesthesia cart case carts as required 528 square feet Surgery Department 9

Cystoscopy Cystoscopy Because of the nature of the procedures, this should be a separate procedural room that may or may not open off the clean core. While similar to an operating room, it differs in some aspects. It will include a sink and may include a flushing floor drain. The room requires space for a large quantity of irrigating fluids and a large supply of catheters. This room needs to be lead lined and should be adjacent to an x-ray control room. Movable Modular Casework Applications A cystoscopy room can be planned using movable modular casework components and may require Bulk supply carts for medical/ surgical supplies. L carts for prep supplies or special procedures. Bulk supply carts or lockers with wire shelves for storing fluids. Cantilevered work surfaces. Cantilevered sink units or sink base cabinets. Extra-deep modular shelving units. NOTE: Anytime components are hung from the wall, care must be taken not to compromise the lead lining. Plan View of a Cystoscopy Room A cystoscopy room will range in size from 250 to 400 square feet. 4 linear feet work surface 4 linear feet overhead storage 2 bulk supply carts 1 L cart 287 square feet Surgery Department 10

Substerile Substerile Substerile rooms are workrooms, usually located between two operating rooms. They most frequently contain the flash sterilizer and the blanket/solution warmer, as well as storage of clean supplies and equipment. Movable Modular Casework Applications A substerile room can be planned using movable modular casework components and may require Heavy-duty work surface at stand-up height. Modular shelving units and flipper units, if closure is desired. Lockers to hold supplies. L carts or procedure/supply carts. Process tables. Casework sink unit. Plan View of a Substerile Room A substerile room will range in size from 75 to 200 square feet. 8 linear feet work surface 8 linear feet overhead storage 1 locker for supplies 162 square feet Surgery Department 11

Clean Core Clean Core In a double-corridor plan, clean and sterile supplies are stored in the clean core, a large internal corridor adjacent to and opening into all operating rooms. This area is accessible only to those in surgical attire. The area may allow for freestanding or built-in sterilizers, blood refrigerator, and freestanding or table-top warming cabinets. Movable Modular Casework Applications A clean core can be planned using movable modular casework components and may require Small workstation for paperwork Procedure/supply carts. with work surface, overhead storage, undershelf lighting, and drawers. Bulk supply carts. Lockers for holding supplies or as specialty carts. Case carts. Regular and extra-deep modular shelving units. Plan View of a Clean Core A clean core will range in size from 150 to 200 square feet per operating room. 8 linear feet work surface 2 lockers per operating room 1 case cart per operating room 1125 square feet Surgery Department 12

Post-Anesthesia Care Unit Post-Anesthesia Care Unit (PACU/Recovery Room) This area is usually adjacent to the operating room and generally near the critical care units. Patients are brought to this area after surgery to recover from anesthesia and regain stable vital signs. After patients are stable, they are transferred to a patient unit or, in the case of outpatient surgery, patients are moved to secondary recovery before being discharged. Movable Modular Casework Applications Movable modular casework components appropriate for use in the post-anesthesia care unit include Nurses control station. L carts or rail-hung C frame storage units with drawers for supplies for each patient. Lockers for linen and medical supplies. Cantilevered sink units. Dictation area. The space is usually in an open area with patients separated by cubicle curtains or modular panels. Those patients who need to be isolated are kept in a separate isolation recovery room. The layout of this space generally includes a medical headwall for each patient stretcher, a nurses control station with physicians dictation space, a medication preparation area, an area for supplies and equipment, and handwashing sinks. Plan View of a Post-Anesthesia Care Unit A post-anesthesia care unit will range in size from 100 to 350 square feet per bed. 54 linear feet work surface lockers as required 46 linear feet overhead storage L carts as required 40 filing inches procedure carts as required 1 C frame storage unit per bed bulk supply carts as required 2772 square feet Surgery Department 13

Equipment Storage Equipment Storage There is a large amount of equipment that needs to be stored for use in the operating rooms and a variety of ways of storing this equipment. Peripheral corridor aoves or single-corridor aoves can be planned for stretcher storage, a single large room for general equipment storage, and/or specific smaller rooms for specialty equipment storage such as orthopedic, cardiac surgery, etc. Movable Modular Casework Applications An equipment storage area can be planned using movable modular casework components and may require Extra-deep modular shelving units and/or lockers with shelves to keep smaller items off the floor. Cantilevered work surfaces. Wire carts. Much of this equipment must be accessible to electrical outlets to maintain battery charges. In addition to needing floor space for housing large equipment, overhead shelving can be used so equipment can be placed underneath for maximum use of space. Plan View of an Equipment Storage Room An equipment storage room will range in size from 150 to 400 square feet. 4 linear feet work surface 32 linear feet storage 1 locker 220 square feet Surgery Department 14

Clean/Sterile Storage Clean/Sterile Storage Clean/sterile storage areas differ in each surgery department depending on how supplies are distributed to the department and the layout of the department: Supplies may be sent to this area on a replenishment and/or exchange system from general stores and/or sterile processing. Case carts may be partially or entirely assembled in this area, or case carts may be sent to this area from sterile processing. Movable Modular Casework Applications A clean/sterile storage area can be planned using movable modular casework components and may require Process tables to stage supplies for Specialty procedure carts. packing case carts (if assembled here). Regular and extra-deep modular shelving units. Lockers to store clean/sterile supplies or to be used as case carts. Stainless steel case carts. Space for wire carts to hold sterile linen, bulky supplies, and instrument trays. Plan View of a Clean/Sterile Storage Area A clean/sterile storage area will range in size from 225 to 400 square feet. lockers or wire carts as required bulk supply or wire carts as required 279 square feet Surgery Department 15

Clean Workroom Clean Workroom This area is used for assembling, wrapping, and sterilizing specialty and/or delicate instruments that are kept within the department. If central supply does not support the reprocessing function for surgery, this space will need to be large enough to accommodate the necessary assembly and sterilization functions. Movable Modular Casework Applications A clean workroom can be planned using movable modular casework components and may require Cantilevered work surfaces for assembling instrument sets. Large process tables for wrapping instrument sets. Modular shelving units, L carts, and lockers for supply storage. Cantilevered sink unit. Wire carts for staging assembled trays. Plan View of a Clean Workroom A clean workroom will range in size from 125 to 750 square feet. 12 linear feet work surface 10 linear feet overhead storage 1 L cart 133 square feet Surgery Department 16

Soiled Utility Soiled Utility Used linens, instrument sets, and equipment are placed in soiled utility immediately after surgery. This room may hold case carts, lockers, wire carts, trash containers, and soiled linen that have been used in the operating rooms until they are returned to central supply. If the surgery department processes its own instrument sets, this room may function as the decontamination area and must be large enough to accommodate washing and decontaminating equipment. Surgery departments processing their own instruments may also require stainless steel sinks (with double and triple bowls) and a counter for washing instruments and utensils. Movable Modular Casework Applications A soiled utility room can be planned using movable modular casework components and may require Process tables or heavy-duty work surfaces for receiving soiled items. Modular shelving units and/or lockers with shelves to hold cleaning supplies. Horizontal rail to hold lockers awaiting return to central supply. Cantilevered sink unit. Plan View of a Soiled Utility Room A soiled utility room will range in size from 200 to 400 square feet. 16 linear feet work surface 20 linear feet overhead storage 1 locker for supplies case carts 220 square feet Surgery Department 17

Anesthesia Supply/Workroom Anesthesia Supply/Workroom Anesthesia will have a workroom with an area for washing equipment and maintaining/testing anesthesia machines. Movable Modular Casework Applications The anesthesia workroom and supply room can be planned using movable modular casework components. Sometimes a second room or area is provided to hold anesthesia supplies. Anesthesia supply carts are generally replenished from this room, and at the end of the day, these carts may be parked and secured here. The anesthesia supply room may require Lockers and modular shelving units for supply storage. Locked drawers and cassettes for medication storage. Bulk supply carts. Specialty procedure carts. Extra-deep modular shelving units. The anesthesia workroom may require Work surfaces or process tables to receive and clean equipment. Small administrative area with work surface, seating, file storage, tackboards, space for computer, overhead storage for manuals and binders. Cantilevered sink unit. Plan View of an Anesthesia Supply/Workroom An anesthesia supply/workroom will range in size from 250 to 500 square feet. 16 linear feet work surface 42 linear feet overhead storage 328 filing inches 5 lockers bulk supply carts as required 470 square feet Surgery Department 18

Satellite Lab Satellite Lab The surgery department may have a satellite lab for STAT testing of tissues and for creating and reading frozen section slides. Movable Modular Casework Applications A satellite lab can be planned using movable modular casework components and may require Heavy-duty work surfaces and/or process tables for automated instruments. Wall strips, modules, or support panels to hold work surfaces and overhead storage. Tackboards. File storage. Flipper units, C frames, lockers, and L carts for storage. Cantilevered sink unit. Plan View of a Satellite Lab A satellite lab will range in size from 150 to 400 square feet. 43 linear feet work surface 65 linear feet overhead storage 1 locker (optional) 332 square feet Surgery Department 19

Satellite Pharmacy Satellite Pharmacy A satellite pharmacy may exist in the surgery department. This decentralization of the pharmacy function allows for more rapid response to the needs of the patient. The space will vary in size but will usually contain a small drug picking area, sink, refrigerator, computer, printer, label printer, and controlled substance storage. Some satellite pharmacy areas may have a small laminar flow hood. Movable Modular Casework Applications The same movable modular casework components used in the main pharmacy are appropriate for the satellite pharmacy, allowing for continual flexibility and change in the space and may include Medication locker or transfer cart. Cantilevered work surfaces. Double-locking drawers for storing Extra-deep modular shelving units. controlled substances. Dispensing rail. Cantilevered sink unit. The satellite pharmacy is staffed, stocked, and serviced by the primary pharmacy department. Modular carts are appropriate for the transfer of medications to the satellite pharmacy. Plan View of a Satellite Pharmacy A satellite pharmacy will range in size from 120 to 250 square feet. 18 linear feet work surface 28 linear feet overhead storage 80 drug bins average 1 locker 1 medication cart 140 square feet Surgery Department 20

Staff Lounge/Locker Room Staff Lounge/Locker Room A staff lounge is used primarily for coffee breaks, snacks, and as a place for staff to rest from the pressures of patient care. Space should be provided for a refrigerator, microwave oven, and large coffee maker. Staff locker rooms, usually adjacent to the staff lounge, are provided for male and female staff to change from street clothing into surgery attire. Clothing lockers, toilet facilities, and showers are provided. Movable Modular Casework and Furniture Systems Applications This environment should be easily cleaned and offer a warm, enjoyable atmosphere. Staff lounges may require Wall strips with work surface and overhead storage or heavy-duty storage work surface with C frame and drawers for a coffee maker and supplies. Tables and seating. Tackboards for displaying information. Lockers or wire carts for surgical attire dresses, suits, caps, shoe covers. Base cabinets for storage. Plan View of a Staff Lounge/Locker Room A staff lounge/locker room will range in size from 125 to 250 square feet. 10 linear feet work surface 10 linear feet overhead storage 2 lockers 175 square feet Surgery Department 21

Administrative Office Administrative Office Each surgery department will have unique requirements for its administrative areas. Generally the following positions will require an administrative office: Operating room supervisor. Director of surgery. Director of anesthesiology. Chief surgical residents. Clinical nurse managers. Operating room materials manager. Movable Modular Casework and Furniture Systems Applications These areas may be furnished with modular furniture systems and seating. These offices may need Cantilevered work surfaces. Tool bar with accessories for paper handling. Work surfaces with keyboard drawers or trays to accommodate computers and printers. Overhead storage, flipper units, display shelves, and marker boards for displaying information. Task lights and personal lights. Freestanding, under-work surface, or wall-attached drawers and files. Plan View of an Administrative Office 9 linear feet work surface 12 linear feet overhead storage 20 filing inches 100 square feet Surgery Department 22

Functional Program Functional Program Number Department Area Square Feet Movable Modular Casework Control Station Pre-Operative Holding Area Scrub Areas @ sq. ft. Operating Rooms @ sq. ft. Orthopedic Operating Room Orthopedic Equipment Storage Room Cystoscopy Room Substerile Room Clean Core Post-Anesthesia Care Unit Primary Recovery Secondary Recovery Isolation Recovery Patient Toilet Medication Area Clean Holding Room Soiled Utility Room Equipment Storage Room Clean/Sterile Storage Area Clean Workroom Soiled Utility Room Anesthesia Supply/Workroom Satellite Lab Satellite Pharmacy Staff Toilets @ sq. ft. Janitor s Closet Modular Furniture Systems Staff Lounge/Locker Room Administrative Offices @ sq. ft. Subtotal Subtotal TOTAL NET SQUARE FEET Net-to-Gross Conversion Factor TOTAL GROSS SQUARE FEET X Surgery Department 23

Bubble Diagram Bubble Diagram The bubble diagram of the surgery department demonstrates typical departmental relationships and interaction between areas. Necessary adjacencies within the department become clear. SECONDARY RECOVERY CONTROL PRE-OP HOLDING PACU STAFF LOUNGE/ LOCKERS PERIPHERAL CORRIDOR ANESTHESIA SCRUB SOILED HOLDING OPERATING ROOM CLEAN WORKROOM SUBSTERILE CLEAN CORE CLEAN HOLDING Surgery Department 24

Block Diagram Block Diagram The block diagram demonstrates the adjacencies and relative sizes for the areas within a typical surgery department. Evaluation of the work flow and materials flow from the bubble diagram has determined this initial general layout. The size of each area is determined by combining the typical movable modular casework plans for each identified function. Traffic patterns are developed, and an overview of the general work process can be evaluated. SECONDARY RECOVERY PRIMARY RECOVERY CLEAN CORE CYSTOSCOPY Surgery Department 25

Preliminary Plan Preliminary Plan The preliminary plan clarifies the surgery department space requirements by showing the location of all the fixed walls and open areas and identifies entrances, exits, and exact traffic patterns. SECONDARY RECOVERY PRIMARY RECOVERY Surgery Department 26

Schematic Plan Schematic Plan The schematic plan shows all of the specific movable modular casework, modular furniture systems, and materials handling components appropriate for a typical surgery department. SECONDARY RECOVERY PRIMARY RECOVERY Surgery Department 27

Future Trends Future Trends Facilities Because of the increase of outpatient surgeries, the number of off-site surgical outpatient facilities has grown over the past ten years. Currently, however, hospitals are constructing more on-site outpatient surgical suites than freestanding surgery centers. This trend is due to surgeons preference for using a hospital setting with its backup resources and equipment rather than a remote location and patient preferences for a hospital setting. The percentage of outpatient surgical procedures will continue to rise. Surgery departments require constant renovation to keep pace with new technologies, practices, and equipment. Procedures and Services There will be new and increasing numbers of procedures for the regulation of waste products from the operating rooms, of which approximately fifteen percent is infectious. Implementation and expansion of information systems will be seen throughout the hospital with computer capabilities and technology becoming standard equipment in each operating room. The increased use of computer systems will be accompanied by the use of bar code technology for a variety of applications. Innovations in medical technology will continue to have a profound effect on the types and variety of surgical procedures performed. Advances in technology will center around cardiac surgery, organ transplants, and new laser and endoscopic procedures. Layout New technology and new procedures will continue to impact the need for larger operating rooms to accommodate the necessary equipment. These larger operating rooms will still need to remain flexible in function as well as being able to adapt to continual change. Space must be provided for the storage of the constant influx of new equipment used in surgical procedures. Future surgery departments must continue to fine tune sterile storage and materials handling procedures and planning to provide the most costeffective systems, including space allocations for case cart and exchange cart systems. The disposal of waste materials from the surgery department will have an impact on future planning. There is an emerging trend for surgery departments to return to reusable supplies, particularly operating room linen and instruments, because of the rising costs of medical-waste disposal. This will affect not only waste removal, but the clean storage areas of the surgery department, and the delivery system of the central sterilizing department. The nursing care emphasis on patientfocused care will promote changes in planning to allow greater patient privacy and comfort within the surgery department. Surgery Department 28

For the location of the sales facility or dealer near you, visit www.hermanmiller.com/healthcare or call (800) 628 0058. 1999 Herman Miller, Inc., Zeeland, Michigan Z, Y, Action Office, Aeron, Ambi, Arrio, Beirise Collection, Co/Struc, Custom Choices, Eames, Equa 2, Ergon 3, Ethospace, E-Wall, Frottage, Ground Cloth, Harmonics, Hollington, Intersite, Kinemat, Liaison, Meridian, Miare, Mosaic, Newhouse Group, Pellicle, Perspectives, Proper, Pulsar, Rapid Response, Relay, Response Plus, Scooter, Super Room, Systems Bridge, Timepiece, V-Wall, and Wild Card are among the registered trademarks of Herman Miller, Inc. SM Y, Aeron Chair Configuration, Ambassador, Burdick Group, Chadwick, CLT, CoActive, DIAMOND, Flex-Edge, Florence, ID, Iota, Milafin, Myriad, Passage, Potomac, Puzzle, Q, Raleigh, Rapunzel, and Traverse are among the trademarks of Herman Miller, Inc. OASIS is a service mark of Herman Miller, Inc.