Avoiding the Void: Integrating Cath Lab Equipment Early Facilitates Easier, Quicker Lab Design and Construction

Knowing the exact cath lab equipment to be used allows lab design to be more accurate and construction to proceed more smoothly and quickly. Cath lab equipment needs impact the full spectrum of a lab’s design, including size, electrical and mechanical support, as well as staff placement and flow. Equipment selection greatly influences project costs. The project’s overall budget must allow for an average of $1 million per lab for the equipment alone. An experienced architect who is brought early into the process can counsel the owner on the budget, both for design and construction as well as equipment. Frequently the project begins at an executive level, with a visionary budget established in consultation with a financial team and/or facility programmer. In the latter case, the architect is selected after the budget has already been established, which can limit the design flexibility often needed in complex building arrangements. High-Speed Delivery When a cath lab’s construction needs to be fast-tracked for early delivery, the precise information about specific equipment needs is especially critical. Without equipment specifications from a selected manufacturer, architects must design for the worst-case scenario, requiring that time be taken later to adjust space sizes and support placement. This leads to cases where in order to complete the project on time, the remainder of the building is finished, and a void is left in the areas needing final equipment selection. Once the equipment selection is made, those areas get completed last, but by then the contractor’s crew may be composed of different personnel for later phases of work, requiring a recall of the earlier workers, and thereby disrupting the workflow and lengthening the completion date. With a fast-track schedule for a new or renovated cath lab in an existing facility, early equipment selection eases the construction phasing sequence. In an existing facility, every construction activity has a domino effect, requiring that one department move out so that a space can be finished for another department to move in. Each of the project’s components depends on the successful completion of previous components, which cannot be accomplished without all information necessary for design. Supporting Mechanical Equipment An early determination of the cath lab’s major focus on either diagnostic imaging (catheterization, angiography) or interventional treatment (stent and pacemaker insertions, angioplasty and laser procedures) can help to refine equipment decision-making. The lab’s direction is especially critical to mechanical design. If a lab will be treating patients with more invasive procedures, the room needs to be designed to standards approaching that of an operating room, including increased airflow to maintain a sterile field around the patient. The selection of the cath lab equipment determines design aspects of the mechanical support system, such as the location of supply and return grills, and whether the equipment is ceiling-mounted or floor-mounted. More and more labs are being designed with interdisciplinary personnel involvement. A cath procedure may involve a vascular physician, an interventional radiologist and/or a cardiothoracic surgeon. Therefore these rooms must be flexible and adaptable in their usage. Various manufacturers’ specific equipment for the same type of use also produces different heat outputs. Knowing this kind of specific information in advance helps to determine the volume of air that needs to be provided to the room to sustain a constant temperature. If this information is unknown during early design, the architect must overdesign for the maximum necessary air and provide means to adjust for the corrected amount later. Electrical Considerations While various pieces of equipment have different loads depending on manufacturer and type, what impacts design the most is the variance between each manufacturer’s equipment support pieces. The size or required location of support equipment, such as electrical generators, determines how the overall design must accommodate its inclusion. Some pieces must be placed inside the lab against a wall, while others can be placed inside a closet. Space Concerns The best approach in designing around equipment for a cath lab is to provide a suggested layout to the equipment manufacturer(s) and then let them come back with a preferred arrangement, based upon their specific equipment needs. These plans will give various options for how to position and support equipment within a given space. The architect can present the plans to the owner, solicit input for changes, and work with the manufacturer to produce a final plan. Many lab owners have previously established relationships with equipment vendors and often have formed equipment selection committees to make decisions. Their consulting architects should guide them in touring comparable facilities and encourage interaction with various vendors before making a final selection. Staff Flow Cath lab physicians, nurses and technologists are looking for the most efficient layout that will allow them to circulate without impacting patient procedures. The flow of materials needs to be clear and logical so that clean supplies and soiled materials do not cross paths. One proven basic design concept is to cluster cath labs around a central core, forming a primary staff zone (Figure 1). Patients enter from an outer ring into the labs. Physicians scrub in the core and enter into the lab. Clean supplies enter the lab from the core, and soiled materials exit out after the patient into the outer zone for processing and disposal. A cath lab suite also needs to be placed properly within the hospital to facilitate efficient staff and patient flows. With an already existing hospital, proper positioning of a new cath lab can be difficult. Typically, emergency and radiology rooms already are clustered together in a confined arrangement, preventing the adjacency of a new cath lab suite offering critical interventional care. In designing a new facility, the cath lab suite should ideally be placed next to emergency, so that when chest pain patients arrive, they can be sent immediately into the lab for diagnosis and treatment. Every minute counts when it comes to saving starved heart muscle. You don’t want to be moving these patients long distances through the hospital to get to the cath labs. Experience Helps Selecting an experienced design team is the first step for an owner in following a successful design and construction process. The team can evaluate new and existing parameters and programming issues, and work with the owner on equipment selection and inclusion. Establishing a single point of contact on the owner’s side will also help ease the process. The owner’s representative will be able to consolidate ideas from various individuals important to the project and bring the consensus decisions to the architect. The architect can then move forward, basing the cath lab’s design on the most precise and accurate information possible. Armed with the proper information and team, labs can avoid the equipment (and knowledge) void. Michael Tangney, HDR, can be reached at mtangney@hdrinc.com.

NULL