GI Suite Development

Whether a new gastroenterology (GI) suite is built from scratch or undergoes an extensive upgrade, the options are many. New, high-tech equipment and computerized patient records can be costly in terms of money, but lucrative in terms of results. However, the process of building a new GI suite is not without its pitfalls. Following guidelines from both manufacturers and nurses who have “been there” can dramatically improve the ease of the development.

“Green” Facilities Some facilities are focusing less on high-tech and more on the environment. The Hackensack University Medical Center in New Jersey recently opened one of the country’s first environmentally responsible and sustainable healthcare facilities. The Gabrellian Women’s and Children’s Pavilion includes:

• an organic menu designed by a world-renowned chef
• insulation made from blue jeans
• fashionable “green” linens and robes, as well as non-toxic toys
• eucalyptus wood finishes

The hospital recognized how crucial environment design was to creating a “total healing environment,” which affected factors as disparate as the air handling system and the pillowcases.

The Manufacturer’s Point of View

“With the population aging and more procedures being done in the endoscopy department, it has become imperative that a facility take advantage of the latest technology to improve patient care and improve efficiency,” says Harold Koltnow, senior product manager for Skybooms, Skytron. “A great advance in equipping endoscopy suites is the use of ceiling-mounted booms for delivery of utilities, equipment management, and space management.”

He adds, “Utilities such as medical gases, vacuum, electrical service, and video cables can be brought to the patient without the hazard of cords and hoses on the floor. The endoscopy equipment, video and physiological monitors, electrosurgical generator, computers and keyboards can all be placed onto the boom, eliminating moveable carts. This not only makes a more efficient way of managing the equipment but also is a safer environment to work in.

“Another advance is the flat screen monitor, which allows the overall size and weight of the monitors to be smaller and more mobile without reducing actual viewing size for the physician and medical team. With a single mount in the ceiling, the Skyboom can offer a tandem mount, with one arm set with a carrier for the endoscopy equipment and another arm set for the flat screen monitor. The endoscopist can look directly ahead and view the procedure. It is a simple task to move the monitor to a desired location by means of a sterilizable handle or by the assisting nurse. An optional surgical light can be added to the mount.”

Bryant Broder, ACSP, is a senior product manager for Skytron as well. Lighting, he says, is also an important consideration. One of the newest offerings, he says, is a video and data communications system, SkyVision. “This can be used to route images throughout the GI suite and to video conference, for consultation on-campus and off-campus to physicians’ offices. SkyVision has the capability of capturing any image from any source connected into the system — not only the video source. They could connect in a data source if they were using ultrasound or a CT scan, or if they wanted to record the patient monitoring system.”

When setting up a suite, design factors are critical. “Ceiling height is a big consideration,” Broder adds. “Having a ten-foot ceiling in a room gives you multiple options with equipment management and lighting both.”

If the ceiling is shorter, it can cause problems for taller staff members. “I like to keep the lowest hanging object eighty inches up,” he explains. For petite members of the staff, the arms are still accessible despite their greater height, because, when pushed back to a static position or storage position, they are still within the reach of even the shortest staff members.

And room size is also important — “My personal preference is to have a room that is not smaller than 400 sq feet. That’s to allow for adequate storage, and maneuvering the patient,” he adds. Certain equipment arrangements may work more efficiently; for example, the center tandem mount system is advocated by Skytron, because, Broder says, “the center tandem mount system tends to provide the most coverage from shoulder to shoulder of the staff’s needs and the patient’s needs.”

Brian Olson, manager, OR planning and design for Berchtold Corp., agrees that a ceiling-mounted equipment boom and flat panel monitor arms, along with a good equipment layout for the room, are key. Over the last year, Berchtold has refined its room design recommendations for GI, and notes that customers with new GI projects are frequently requesting boom technology.

Manufacturers are hardly resting on their laurels even after the advent of such beneficial technology; they continue to research new means of meeting customers’ needs. “One of the things we’re going to be looking at this year is radiofrequency identification (RFID) of products, not only in the surgical suite but with all of our products — being able to track products, equipment, and human assets for facilities so they know where their products are, where their resources are at any given time to provide better coverage within either surgical or procedural venues,” Broder says.

Steve Sanderson, senior business development manager at Olympus America, describes some new equipment that has recently become available. “EndoWorks® 7 is a Web-based information management solution that spans all stages of patient care to increase productivity while reducing costs for healthcare facilities. With browser-based access from any PC or wireless tablet, users can tap into EndoWorks’ full functionality for instant access to comprehensive patient medical information and report data.”

Also, says Jasmin Yigit, EndoSite project manager, “Olympus has introduced the Olympus GI Benchmarking service, which helps to turn operational data into useful information for effective management of any GI facility. Use of the GI-dedicated Benchmarking database allows Olympus clients to not only identify best practices within a specified facility profile, but also to receive a true “apples-to-apples” comparison of their organization with other peer facilities.”

Frank Filiciotto, director of marketing for GI endoscope products at Olympus, offers the Olympus EVIS EXERA™ II 180 series high definition endoscope system, which delivers both high definition (HDTV) and narrow band imaging (NBI) technology.

“At 1080 lines, the HDTV signal from the new CV-180 video processor more than doubles the number of scan lines produced by conventional systems, when used in conjunction with the new high definition GIF-H180 gastroscope or CF-H180A/L colonoscope. The resulting life-like images offer gastroenterologists remarkably clear views of anatomical structures and fine capillaries.”

Adds Marc Shapiro, integration consulting director at Olympus, “Digital hard disk-based recording, archiving, retrieval and editing clinical video and still images, ensures network-centric workflow and eliminates tape-based media physical storage and management. JumpBack mode, variable Speed Playback, Lock Step Editing, image annotation, USB export and dual channel recording (up to 6 inputs) are unique features of the new Olympus n- Stream™ device providing simultaneous multi-modality video recording, whether ultrasound, endoscopic, fluoroscopic, room camera, vital signs or image guided surgery. DICOM compliant gateway options facilitate the importation of the modality work list for populating the patient and case information directly into our DVR/DVD system. Visible light still (endoscopic) images can be acquired and then stored and retrieved directly from the hospitals DICOM compliant PACS database/server. Fluoroscopy/Xray/ CT/MRI images may be retrieved for viewing in the DVR/DVD system via the DICOM compliant PACS system,” he says.

The Nurse’s Point of View

Baylor University Medical Center at Dallas recently opened an expanded GI lab. The lab was designed with patient comfort and convenience in mind; centralized admissions and a relaxing environment create an efficient and pleasant patient visit. Increased privacy and a quiet atmosphere at the lab help maintain confidentiality.

New equipment played a large role in the expansion. “This has allowed us to have rooms dedicated to specialized procedures such as the double balloon endoscopy and endoscopic ultrasound (EUS) with an education pathology area,” says Karey Simmer, RN, MA, director of the GI lab.

Dee Makarewicz, RN, CGRN, is nurse manager of the GI unit at Temple University Health System in Philadelphia. The hospital just recently opened a new digestive disease center, which includes 12 new treatment rooms, five endoscopy rooms, three motility labs, and new patient waiting areas.

The center, which opened Nov. 21, 2005, was modeled after the Cleveland Clinic, with the procedure area incorporated in the area where outpatients are seen in exam rooms during the physician’s office hours. “There is a general waiting room for patients waiting to see the gastroenterologist and then a sub waiting area for patients coming for procedures,” she explains.

This offers “one-stop shopping” for GI patients who don’t have to visit one department to register and then try to find the unit where their procedure is being done. They already are familiar with the area, as that is where they saw the physician at the initial office visit. Another change from the small area to the larger one was the addition of bathrooms — a priority for patients who have taken colonoscopy preps. The department previously had only one bathroom in the actual unit. “Now we have two bathrooms outside the suite, two in the one waiting room, and two in the admission/recovery area of the procedure suite,” says Makarewicz.

The focus with this transition, besides the new, larger GI area, will eventually include an electronic patient record. “Electronic records will make it much easier for everyone to access instead of searching for the chart. We’re still in the process of looking to see which is the best program to suit our needs. We also made the unit a lot more user-friendly for the nurses. We have everything on a boom that can get pushed against the wall when not being used and pulled out toward the patient when needed for the procedure. There are no wires or tubing being strung across the room. The booms house the blood pressure monitor, suction, oxygen, and everything the nurse needs to take care of the patient. There is also a shelf to house a laptop computer for when we get the electronic record,” she adds.

“What I think we’ve done different from other new units is keep a trolley for the scope, video processor and light source,” she continues. “Other units combine everything on one boom so the nurses and physicians are vying for space. We’ve standardized each room, so the nurse or GI tech knows exactly where to turn for each piece of equipment. We also have our central supply department ordering, and stocking the rooms. This frees up the GI nurses and techs to do patient care. Over the last three years, we have worked to allow central supply to do ordering, inventory and stocking. The support departments want to free up the nursing staff.”

Guidelines for Setup

“Input from front-line staff and patients are of utmost importance,” says Simmer. “The original design of our lab changed dramatically once the staff reviewed the plans. Additionally, patient comments and suggestions made regarding the existing design were reviewed and incorporated. It was vital that the medical director, Daniel DeMarco, MD, was kept abreast of proposed changes and had input on every change during development.”

Certain designs work more efficiently, agrees Olson. “We can offer an extra large top shelf on the boom, which is oftentimes used as a scope prep area. The boom’s mounting location in the ceiling is critical,” he points out.

And, says Amanda Bruemmer, EndoSite advisor for Olympus, “Creating a strategic business plan is perhaps the most important guideline to follow when establishing any unit — gathering extensive data on growth, new technology, real estate availability and reimbursement. A business plan should provide an extensive level of detail and risk. A business plan should also be based on a five-year projection.”

Bruemmer adds, “Simultaneously during plan formation, standards for design and construction should be researched. Typically, state and local governments issue construction regulations for items such as parking requirements, ventilation, and emergency power systems — things that could otherwise be overlooked. Once the plan has been approved and standards for design and construction are known, it is important to also perform a detailed space analysis. A unidirectional flow dominates the most efficient units. If a patient is admitted in one area, but discharged through a separate location while maintaining a oneway course throughout the unit, congestion can be reduced. Designing preparation and recovery areas interchangeably allows for greater patient and staff efficiency. For example, more staff and preparation areas are needed in the morning while the opposite is true at the end of the day. Don’t neglect toilets. A commonly accepted formula is one toilet for every threepreparation/ recovery areas. When planning the endoscope cleaning room, design for a dirty-to-clean flow. Allow space on the dirty side for endoscope transport containers and build a separate area for storing patientready endoscopes. Endoscope storage should also encourage even distribution and use of each endoscope.”

“Large wide doors work better than narrow for stretcher entry and egress,” says Jeff Dunkley, manager of OR planning and design for BERCHTOLD Corporation. “I always suggest user group meetings to help design the room to work the best clinically. The users’ input usually helps foresee snags in the design and promotes their ‘buy-in’ after the room is open for use.”

Pitfalls

Certain pitfalls are associated with the suite development process. However, this can be combatted with input, says Simmer. “It is essential not to stop with input at the original design, but continue seeking it throughout the entire process. I worked with an outstanding group of architects, engineers and construction staff that encouraged me, Dr. DeMarco, and the staff to walk through the floor plan in the very beginning — when the cement was poured.”

“If we are brought into the process too late (e.g., after construction documents are already prepared), then the customer may be stuck with a layout and design that we do not recommend to ensure a successful outcome. Change orders can be very expensive to a hospital. If we are included early on, we can ensure that they will not be necessary,” Olson adds.

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