Space Quest

Trends and challenges in design of the interventional radiology suite

In little more than 30 years, the practice of interventional radiology (IR) has expanded from angioplasty and stenting to the treatment of many conditions that once required surgery, as well as to new applications such as nonsurgical ablation of tumors, embolization therapy, and catheter-directed thrombolysis. With this expansion has come a demand for new and renovated facilities that efficiently support today’s IR practice.

Here is a look at the trends and challenges in the design of IR facilities.

One of the major challenges facing designers is providing for the adjacencies to support the anesthesiology requirements of many procedures. Often, IR and the Department of Anesthesiology are not located near one another in the hospital; moreover, anesthesiologists are typically in the Department of Surgery for most of the day.

Although a few IR departments have the volume to support a full-time dedicated anesthesiologist, this is generally not the case. Even in surgery departments, the lack of a full-time anesthesiology staff is a barrier to increasing the volume of procedures. One solution is to locate surgery, as well as cardiac catheterization, adjacent to IR to improve efficient utilization of anesthesiologists’ time.

Because the equipment and level of sterility required for IR procedures and cardiac catheterization are almost identical to those of surgery, increasingly these procedure rooms are located adjacent to or within the Department of Surgery. In this way, IR procedure rooms may be able to share perioperative, patient prep and recovery, and family waiting areas to enhance utilization and efficiency.

From Floor to Ceiling

Design of an IR suite poses many logistical and practical challenges. For example, the weight of the equipment requires a structure with adequate load capacity. Newer hospitals can generally accommodate the equipment on the existing floor slab. Renovations to an older building may require a steel plate or other reinforcement to the floor slab to spread the load. If there are clinical spaces directly below, this process could negatively impact their operations. Equipment vendors have responded to this issue by reducing the size and weight of IR equipment to the extent possible.

The ventilation requirements of IR procedure rooms are approaching the same levels required of surgical procedure rooms through the various regulatory agencies. This requires an additional level of air changes, and therefore mechanical equipment if it is not already available.

Similarly, staff and patient movement protocols (restricted vs nonrestricted corridors) are approaching the level of surgery. If the IR suite is independent of those for cardiac catheterization and/or surgery, then it requires numerous redundant functions such as dedicated pre- and post-procedure patient beds based on the number of procedures per day, and average prep and recovery times. A dedicated IR suite also will require support spaces for staff, additional dedicated “restricted” circulation for staff and patients to minimize cross-contamination, and a sterile environment for delivery and storage of equipment and supplies.

Wired and Visible

The myriad of cables between the control room and equipment in procedure rooms necessitates solutions to avoid damage to cables from movement of equipment, as well as the tripping hazard. Therefore, it is advantageous to install these cables above the ceilings. However, this requires adequate floor-to-floor height, which may be inadequate in an older building. Usually, there are ways to overcome this challenge in all but those spaces with an unusually low floor-to-floor height.

Line of sight between the control room and procedure rooms is an important consideration. Layout to achieve proper visualization is impacted by the dimensions of the IR equipment. It is advantageous for the IR department head and staff to visit a completed installation to assess those requirements and potential options including what works, as well as what doesn’t work.

Everything in Its Place

Supply-storage cabinets are often placed within the individual procedure rooms for the physicians’ and staff’s convenience. It may be more efficient and result in better utilization of inventory if storage is located between and shared by at least two procedure rooms. It is also desirable to provide spaces to store stretchers after patients are transferred to procedure tables to avoid leaving these in the corridors; ideally, this is an alcove beside the entry to the procedure room.

Computers and associated devices used to control the IR equipment require a dedicated, air-conditioned room adjacent to the procedure rooms to enable technicians who are calibrating the IR equipment to move back and forth. The planning and design team also must consider the evolution of IR systems and control equipment in the future, providing the department with flexibility in its power and telecommunications infrastructure to meet future requirements.

Calculated Spaces

Designers work with the IR department head and staff to understand and calculate the number and average length of procedures, and associated recovery times. This information is used to calculate not only the optimal number of procedure rooms, but also the ratio between procedure rooms and associated recovery bays. Typically, the ratio is one procedure room to two or four recovery bays. At this point it is also advantageous to consider hours of operation relative to need for procedure rooms.

Other calculations pertain to room dimensions, which are typically based on equipment layout and the size of the control room. In an academic center, there may be more space allotted to the procedure room to enable physicians and students to observe procedures.

Natural Light, Humanistic Interior Design

Often, IR departments are windowless facilities located on the hospital’s basement level. It is desirable to bring natural light into the IR department, as it is in any other type of clinical space. Natural light is appreciated not only by patients, but also by physicians and staff who spend their workdays in this setting. Whenever possible, the planning team should consider locating the department to enable provision of exterior windows—and possibly, views—for the IR suite, including possibly procedure rooms, as well as prep and recovery areas.

It is often an unexpected challenge to convince IR staff of the desirability of exterior windows if they are used to a windowless environment. They may raise issues related to patient privacy, glare on computer screens, or radiation shielding, but these challenges typically can be overcome with thoughtful design.

Similarly, within the limitations imposed by the high-tech nature of IR, creative designers select natural materials, finishes, furnishings, lighting, and colors to create a warm, humanistic space. For example, one can replace many of the typical 2’x4′ fluorescent light fixtures with indirect light fixtures. In one facility, procedure rooms were designed with dome-like indirect lighting fixtures that appeared like backlit sky. Prep and recovery areas are natural locations for murals and indirect lighting.

Construction Challenges

The challenges associated with renovations of existing buildings relate to construction logistics in what is typically a 24/7 environment. Space is required for the construction process itself, as well as for construction staging areas, deliveries, and storage of building materials. Safe vehicular and pedestrian circulation also must be maintained. The process must be scheduled and managed to cause as little disruption as possible to normal hospital operations. In this respect, it is beneficial to involve an experienced health facilities construction manager in the planning process.

Cultural and Administrative Issues

A growing trend is consolidation of programs in IR, cardiac catheterization, and surgery to maximize efficiency—and many facility planners and designers recommend that institutions consider it, if they can overcome cultural and administrative issues.

In fact, the most significant challenges involved in designing a consolidated surgical/IR/cardiac catheterization suite often are not design issues, but cultural issues, including clinical and administrative autonomy potentially evolving into a consolidated clinical and administrative department.

The opportunity in this regard is to eliminate numerous redundancies of three separate departments as well as the related hospital systems that support these three, often distant geographic locations.

The potential exists to convert three separate areas to:

1. one entry/reception/registration/waiting area/family amenities
2. one set of consult rooms
3. one set of staff lockers
4. one staff lounge
5. one system of delivery and cleanup
6. one departmental purchasing coordinator
7. one system of storage and sterile support
8. one infrastructure including necessary system redundancies
9. one departmental softball team
10. and imagine what else

The impact of departmental adjacencies and shared space on administrative policies and procedures must also be considered. In particular, leaders may wish to consider the issue of identification of the appropriate profit centers versus one profit center to allocate revenues from each type of procedure.

Another administrative issue relates to hospital support of IR in the most efficient way through effective utilization of professional and support staff. This is another issue that has design, cultural, and administrative implications.

If a given institution has the strength and willingness to explore these efficiencies of consolidation, it is clear how the overall cost of care may be reduced while the overall quality of care may be enhanced.

When all is said and done, health care leaders may adopt a new vision around interventional procedures and expect their architects to assist in the delivery of an IR facility that enhances the efficiency of their operations and enables them to provide patient- and family-focused medical care. This level of innovation is not based solely on traditional facility development, but a simultaneous analysis and exploration of new directions in operations, hospital systems, and the physical space of the facility.

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Dennis Kaiser, AIA, LEED AP, is a Principal with Perkins + Will. He can be reached in the Boston office at (617) 406-3433 or .