Construction and Design of New Hybrid OR and EP Lab: Interview with Niraj Sharma, MD, FACC, FHRS

In this feature interview, EP Lab Digest talks with Dr. Niraj Sharma about the new hybrid operating (OR) suite and electrophysiology (EP) lab at Eastside Medical Center. Dr. Sharma is the Director of Cardiac Electrophysiology at Eastside Medical Center, located in Snellville, Georgia.

How did the new hybrid OR suite and EP lab come about? 

We started this project about a year and a half ago. It was spurred by the fact that our atrial fibrillation volumes were increasing, but a significant number of our patients in Snellville and surrounding areas had to travel up to 20 miles away to other hospitals in the region for treatment. It was a need that we knew existed, but we had to quantify it. Seeing the demographics and the potential growth for the future is what motivated the hospital system to invest in this space. 

Was there an existing EP lab space at Eastside before? 

There was previously a very basic program in place — we performed more simple EP procedures in the lab, and they were quite sporadic. So, there was a non-existent program, and the lab that came up was a fresh start. 

What is the size of the new hybrid operating suite and EP lab? How many rooms are included?

It’s a pretty large space, measuring about 1,253 square feet. The hybrid lab and EP lab are part of a shared space.  

When did the new hybrid OR suite and EP lab open? How long did it take to build?

We opened the space on April 9th of this year. There was an existing OR space, so some of the infrastructure such as anesthesia, the gas line, and electrical wiring, and outlets were already there. However, we expanded outward to make room for the EP lab. Therefore, from the time we received the certificate of need from the state to completion, the construction time was approximately 7 months. 

Tell us more about the creation and construction of the hybrid OR suite and EP lab. What design features and elements were added to the space? 

A lot! After determining how much space we had to work with, we started with the biggest ticket item: the fluoroscopy unit. We chose to install a biplane system that would give off the least amount of radiation. Then we decided on a mapping system that would be appropriate for our needs. During construction, we ensured there wasn’t any electrical interference or noise with our mapping and recording systems. Next, we focused on lighting, choosing high-resolution display units in both the control room and lab. There was also audio/video recording and data storage (onsite and remote) to consider. Another aspect was to choose how many cabinets we would have, including storage space within the control room. It was a long process — I could probably talk about each element for a half hour!  

Who was involved in the process to build the lab?

First, our physicians had a meeting to come up with a unified list of things that everyone wanted. We then went to administration and there were additional meetings. Next, we met with our hospital’s biomedical engineering team. Then the process was outsourced to a national architectural firm, which did EP lab design. 

What specific equipment or technologies were added to the new EP lab?

As a brand-new lab, we wanted to include all state-of-the-art equipment. Intracardiac echo is one of the new technologies incorporated into this lab, as well as video integration of different assets going into the EP lab. Our mapping system, ICE, recording system, fluoro, and anesthesia inputs are all fed into a data storage unit, which records everything and is placed into different outputs. For example, I recently performed a case that we would later be presenting to our community physicians. There were 9 inputs on a large screen, and all that data was recorded continuously throughout the procedure. After the case ended, I was able to review everything that was done from beginning to end, as well as remove data that was not necessary for presentation purposes. We also have the capacity to record audio, which is helpful for teleconferencing to an audience during broadcast ablation cases.  

How many procedures have been performed since opening? Approximately how many procedures are performed each week? 

Since opening the brand new EP lab in April of this year, we have now performed about 30-35 ablations. We plan on performing all types of device implants as well as an array of ablation procedures. 

How many EP lab staff are there currently?

Right now, we have four dedicated EP staff members, two of which have extensive EP experience, and we are undergoing recruitment to hire the most experienced and qualified staff who are specifically trained for EP. 

What were your biggest challenges in creating this new space?

Once the decision was made to proceed with the EP lab, everything was mostly smooth and straightforward. I had experience in this because I was involved in establishing two other labs at another hospital four years ago. Once you receive clearance from administration and have a budget in place, the process does not take very long, because you know everything that is required. 

What does the new space mean for the staff at Eastside Medical Center?

Having EP physicians and staff, as well as the awareness that goes with it, was a big boost to Eastside’s healthcare system and knowledge base. Treatment can now be offered in house rather than sending our patients a significant distance away. 

Is there anything else you’d like to add?

I think the number of EP labs being created in the future is going to increase significantly. The EP market continues to grow, and more labs will be built further away from urban centers. EPs are often crammed into spaces with limited capacity, but ablations keep increasing. At some point, medical societies will have to come up with some sort of policy statement about labs being created outside the urban setting, what types of requirements are needed, and what types of backups should be in place.