Adding a new CT, MRI, or other modality can improve an imaging department’s diagnostic capabilities, providing faster and higher-quality readings. Health care reimbursement changes also may demand the addition of one
particular modality or another. But what if there simply is not enough room?
Four key space solutions can help radiology administrators and health care executives add new imaging technology without enlarging existing departments: centralizing functions, removing nonessential areas, sharing control space, and selecting appropriate technology.
Combining support spaces in a convenient, central location within a department can free up substantial space for an additional modality. These “softer” spaces include gowned-waiting areas, patient holding bays, and radiology reading rooms. Depending on an existing department’s original design, these kinds of spaces can be grouped together, creating more efficient use of the department’s overall space.
|Figure 1. Plan drawing represents the centralized gowned-waiting area implemented at Advocate Christ Medical Center, Oak Lawn, Ill.
In many departments, the MRI, CT, and general radiography areas each will have its own gowned-waiting space for holding one or two patients at a time. In centralizing the gown-waiting function for a larger group of patients (see Figures 1 and 2), efficiencies can be gained in both space utilization and staffing. By centralizing patients into a single gowned- waiting area, the ratio of square feet per patient can be reduced by spreading the area for circulation over a larger number of patients.
Though a centralized gown-waiting area still will need to be divided for male and female patients, the overall space can be reduced. The required clearances to meet disability codes also will be more efficient when combined in the single larger space because of the sharing of the required clear floor areas.
For the staff, having a single location to hold patients rather than distributing them throughout the department can also gain efficiencies.
A second type of space to consider centralizing is the inpatient holding bay. When inpatients are first brought on stretchers or wheelchairs to an imaging department, they often are held for a period of time in a holding bay, because of room availability. For each modality, there may be one or two holding bays, with overflow sometimes waiting in hallways. If inpatient-holding bays are spread throughout the department, there may be two or three bays per modality in order to account for peak times of services. By centralizing these functions (see Figure 3), the overall number of bays can be reduced by sharing the additional peak time bays. This can account for a reduction of up to four to six bays based on the size of the department.
|Figure 2. Plan drawing illustrates a centralized gowned-holding area implemented at the smaller Advocate Medical Campus Southwest, Tinley Park, Ill.
In addition to saving space, the single-location holding area can be very beneficial for nursing staff in dealing with a large in-patient volume. The number of nurses required to observe and assist patients may be reduced to one or two in charge of the centralized holding area.
Radiology reading rooms are a third type of space to consider centralizing. When various modalities’ reading rooms are gathered together into one location, library, storage, and support space can be shared. This approach is particularly effective with film-based reading rooms. In a single centralized room, three or four radiologists can comfortably read film at the same time in an open space.
With digital reading, divided space is required for viewing the monitors. In creating a common space (see Figure 4, page 48), radiologists can be grouped in a grid pattern, with six to eight small rooms on either side of a central support area. The central area can provide space for informal meetings, storage, and library space.
Further supporting this option is the growing trend toward web-based reading by radiologists in a variety of off-site locations, reducing the number of radiologists who may be in the central reading room at the same time.
The increasing possibilities for radiologists and physicians to study imaging results at locations outside the department also make it possible to reduce the space usually taken by offices and conference rooms. This approach is most effective with digital reading, where new web-based technology allows radiologists to conduct readings from their home computers.
|Figure 3. A plan drawing of a centralized holding area designed to reduce the overall number of bays at Advocate Christ Medical Center, Oak Lawn, Ill.
The size and space for offices can be reduced drastically, allowing room for additional modalities. The use of conference rooms, too, can be reconsidered. A single conference room can fulfill multidepartment needs through tighter scheduling, thereby reducing the number of required rooms.
Control Space, Technology
As imaging technology develops, it is becoming smaller in size, which offers greater space flexibility. With CT, MRI, and other modalities requiring less space, they can be grouped together more easily. Further space reduction can be gained in placing support and control areas in positions for sharing between rooms.
Eliminating redundancies between support and control space also strengthens staff efficiency. Rather than placing the imaging rooms sporadically throughout the department(s), it can be beneficial to group the modalities and their support space so that technicians can walk quickly from one room to another (see Figure 5).
The newest and most cutting-edge imaging technology, while attractive, may not always be the most appropriate for a department’s specific patient needs. MRI technology, for example, is expanding rapidly. A room housing the higher tesla models must contain the greater magnetic field, which requires more space. While a large academic hospital may need a high field-strength magnet for conducting research, a community hospital most likely can fully serve its patients with a less powerful MRI in a smaller space.
|Figure 4. A plan drawing of a centralized reading area.
Except for the high-powered MRIs, most other new imaging technology is decreasing in size. Ultrasound manufacturers are rapidly developing new mobile, handheld equipment, further reducing space needs. Knowing the department’s patient profile and needs will help determine the proper imaging equipment. Administrators and department chairmen who stay informed about the newest technology can make the most appropriate equipment decisions.
Selecting imaging equipment as early as possible in the design phase greatly facilitates the overall design and construction process. When modalities have not been selected, designers must plan according to the worst-case scenariodesigning the biggest room, just in case. The same piece of equipment produced by different manufacturers also may require different sized rooms. Mechanical and electrical support placement, too, is based on a specific piece of imaging equipment. When the technology is chosen early, all exact dimensions can be determined from the start.
Above and Beyond
Beyond these measures for space saving, a hospital imaging department could consider moving its outpatient volume to a nearby medical office building. Space would be freed in the hospital location for new modalities for inpatients. In the office building, construction would be less costly because standards and code requirements are less stringent for office space than for hospitals. To help staff load, the new outpatient area might be able to joint-venture with a nearby physicians group.
|Figure 5 is a drawing of a centralized control area that consolidated operations of multiple CT rooms at Advocate Christ Medical Center in Oak Lawn, Ill.
When administrators and imaging department heads are faced with adding a new modality, the space crunch can be daunting. However, clear solutions for maximizing space may be at hand.
David Redemske, project designer with HDR, Chicago, can be reached at (773) 380-7900 or [email protected].