Hybrid Biplane Operating Room

With the intent to maintain state-of-the-art Neurosurgery capabilities, Harborview Medical Center determined the need for a new Neurosurgical Bi-plane Operating Theater. A feasibility report identified the location of the new Bi-plane operating room (BPOR), to be best within the existing operating room suites. Ultimately, it was decided the new BPOR would replace an existing operating room. This came with significant challenges, as the location is in the middle of a busy surgical department that needs to remain operational during construction. This, coupled with a higher demand on systems infrastructure required careful planning from all parties involved.

Among numerous infrastructure, P2S Inc. assessed the existing surgical air delivery systems and identified design methodology to avoid full replacement. This determined an ability to use existing air handlers for the remodel as long as the team could free up the necessary capacity. We subsequently underwent a campaign to decrease existing duct leakage, remove non-essential rooms, and re-balance the existing operating rooms. This methodology paved the road to solve key challenges. It provided the necessary surgical air delivery system capacity, and the ability to maintain existing operating rooms “live” throughout the construction. Our methodology avoided costly upgrades and replacements, which provided benefits to schedule and phasing. As an added bonus, our mechanical designs reestablished correct air pressure relationships within the department and enhanced energy performance.

As one of the scope exercises for this project, P2S evaluated different types of surgical air delivery systems. An integrated ceiling was our solution used in the operating room over the surgical table. The pre-manufactured modular system integrates the finish ceiling, lights, booms, diffusers, and gasses. All of this was built off-site and shipped ready. The result was a ‘plug and play’ type system that provided rapid installation. Although the material costs of this system were greater than that of conventional built-up construction, the benefits to the schedule, and quality of the installation were substantial. Harborview received a very good quality product, and the whole team benefited from the rapid installation and ease of testing and balancing.

Planning a construction project within a functioning surgical suite presents numerous unique challenges. In addition to the normal design and engineering for new construction, there are challenges with accessibility, infection control, and maintaining functional utilities. These obstacles are best dealt with in a collaborative team environment with all the parties involved.

P2S participated in many planning exercises not only with design partners, but with the hospital project managers, surgical staff, facilities staff, construction crew, and equipment vendors. This full-team approach to information gathering, enabled a thorough perspective of the project constraints, and led to the successful outcome.

Because of the need to maintain ‘live’ utilities to adjacent surgical suites, we met with our installers and the facilities crew in-the-field to identify the actual points of demolition and new connections. We identified key points for piping systems like water, waste, steam, condensate, medical air, oxygen, vacuum, nitrogen, nitrous oxide, and waste anesthetizing vacuum. We installed new isolation valves at many locations of these systems to make it easy during the construction process.

The addition of new isolation valves enabled new piping systems to be worked on and tested while being isolated from the rest of the ‘live’ system. This made it convenient for medical gas piping to be installed, cleaned, tested, and certified. Immediately after the certification, they were ‘live’ with the remainder of the facility so operations could continue, as normal.

Harborview Medical Center is a publicly owned critical-access hospital. It is the only level 1 trauma center hospital in the state of Washington and has served the public for over a century. The new Biplane neurosurgery suite is an example of maintaining performance and excellent care even within the constraints of aging infrastructure.

Our team identified ways to serve the new construction with the existing systems, while making improvements to mechanical systems within the whole department. We gained spare capacity in the air delivery systems by eliminating leaky ductwork, re-distributing, and re-balancing the existing surgical department in order to make it more efficient. This retuning effort saved time and money, while simultaneously providing value beyond the initial scope boundaries.

Saving on time and labor costs without sacrificing on quality is a constant driving force for construction and this project is no exception to that fact. The complexity of the operating room’s integrated ceiling system could have been a daunting task for builders, but our decision to use pre-manufactured systems proved to be the right choice. The ceiling area in this type of surgical suite can become exceedingly congested with multiple systems like hygienic air delivery, equipment booms, lighting, medical gases, and guide rails for the imaging equipment.

It is costly to custom-build all the parts and pieces, and get it correct. Utilizing the pre-manufactured system enhanced construction flow, efficiency, and cleanliness. Although it was an initial investment, it allowed builders to avoid the challenges of a custom-built solution and is a prime example of achieving a high-quality product for not much more in overall construction costs.

Incorporating the healthcare specialists and staff who are the end users of the space into the design process was critical in the functionality and success of the space. A surgical suite of this caliber allows Harborview to provide state-of-the-art neurological surgical procedures to the Pacific Northwest.

P2S reduced waste, time, and demolition costs by retuning and reusing existing air delivery systems. These efforts also increased the overall efficiency of the mechanical systems. Additionally, we took consideration of the high air exchange rates required for surgical rooms of this nature. These high rates must be present during a surgery, but can potentially be ramped down otherwise. As part of our design for operating room controls, we set up automated modes for the space when the space is occupied and non-occupied. A local display allows the surgical staff to monitor the room mode, and will also produce an alarm if the room is occupied but not in the correct air exchange mode. These features provide energy efficiency by allowing the air delivery systems to ramp down when necessary, but also maintain safety and hygiene as a high priority.

There was an intense level of effort for planning at the outset of this project. Because of the project delivery method, Progressive Design-Build, a large team was assembled to consistently meet and collaborate. This planning was not without a commitment for time and cost. However, this planning enabled a thorough understanding of the owner’s needs and the project constraints. The project was successful as a direct result of that shared understanding and collaboration.

This project produced a high-quality product that met the owner’s requirements, and was completed on time and under budget. P2S was able to contribute to this by bringing solutions like retuning and reusing existing air delivery systems, detailing phased construction methods, and designing an integrated ceiling system.

Photos courtesy of Ankrom Moisan.