Surgical Services Department

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Surgery

Department

Graphic Standards

Programming and Schematic Design

June 1999

lc



Surgery Departmen

Surgery Department 2

Table of Contents

Table of Contents

Function 3

Staff 5

Advantages of Movable Modular Casework 6

Functional Areas 7

Control Station 7

Pre-Operative Holding 8

Scrub Area 8Operating Room 9

Cystoscopy 10

Substerile 11

Clean Core 12

Post-Anesthesia Care Unit

(PACU/Recovery Room) 13

Equipment Storage 14

Clean/Sterile Storage 15

Clean Workroom 16

Soiled Utility 17

Anesthesia Supply/Workroom 18

Satellite Lab 19

Satellite Pharmacy 20

Staff Lounge/Locker Room 21

Administrative Office 22

Functional Program 23

Bubble Diagram 24

Block Diagram 25

Preliminary Plan 26

Schematic Plan 27

Future Trends 28



Surgery Departmen


Function

Function

The surgery department of a general

hospital is that area responsible for the

surgical procedures, or operations,

performed on hospital inpatients and/orambulatory outpatients. The ambulatory

surgery services may be in another

location within the hospital or in a

freestanding facility.

Because surgical procedures are

performed under the strictest sterile

techniques and infection control

concepts, the design of the department

and the flow of patients, staff, and

supplies must be rigidly controlled. Thesurgery department includes a required

number of operating rooms, pre- and

post-anesthesia areas, technical support

functions, equipment and supply areas,

and administrative staff space.

Traffic Flow

The layout of the operating room

suite may be a single corridor plan

with operating rooms and supportservices opening off the same

corridor.

Today the more commonly used

design combines a clean core with

peripheral corridors, sometimes

called the “racetrack” design.

Either type of plan will typically have

three basic zones of traffic flow.

Unrestricted Areas

The unrestricted area allows visitors or staff

attired in street clothing to enter the surgerydepartment. Their movement is limited to the

locker rooms, staff lounge, and from the

main entrance to the control station.

Semi-Restricted Areas

These areas are within the department and

beyond the control station, requiring

personnel to be attired in scrub suits or

dresses, shoe covers, and hair covers.

Restricted Areas

The most restricted areas of the department

are the operating rooms, the clean core, and

the scrub areas. A face mask must be worn in

these areas in addition to the scrub suit and

hair and shoe covers.

CLEAN CORE/PERIPHERAL CORRIDORSINGLE CORRIDOR



Surgery Departmen


Function

Flow of Patients

Patients are brought to the surgery

department on stretchers from the patient

units. After notification of the control

station staff, patients are moved to a pre-operative holding area to wait for the

available operating room. Medications

and/or intravenous fluids may be

administered while patients are in the

pre-operative holding area.

Surgery procedures are scheduled for

predetermined times in specific rooms

with a minimal amount of turnaround

time between cases for cleaning and case

preparation.

Patients will then be moved to the

designated operating room, the

anesthesia administered, and the surgical

procedure performed.

Following surgery, patients are moved to

the post-anesthesia care unit where they

remain until responding and awake, and

are then returned to the patient unit.

The method of choice for the delivery of

surgical supplies and instruments is the

case cart system. Rather than instruments

and supplies for each operative casebeing housed in casework and compiled

in the operating room, the sterile

processing department will assemble the

appropriate supplies and send them to

surgery as a specific case cart. This case

cart is stocked with all of the materials,

instruments, and supplies necessary for a

single designated surgical procedure,

with a cart prepared in advance for all

daily scheduled surgery cases. Thus the

turnaround times between cases can bekept to a minimum. Case carts are also

supplied and kept ready for the most

frequently performed emergency cases.

In the clean core/peripheral corridor type

of plan, there is dual access to the

operating rooms with the clean supplies

and case carts flowing from the clean

central core into the operating room and

the dirty supplies and contaminated case

carts moving into the peripheral corridorto the decontamination area. This type of

flow provides the best opportunity for

infection control, preventing the clean

and dirty supplies from crossing paths.

Flow of Supplies

Traditionally, surgery departments stored

supplies and instruments in casework

cabinets within the operating rooms, in

corridors, and in clean supply rooms.Supplies were then collected from

multiple areas and carried to the

appropriate operating room before each

surgical case. In some cases, supplies

were stored in rooms dedicated to a

specific type of surgical case.

This system has proven to be time

consuming and inefficient. Turnaround

time, or the time between the close of

one surgical case and the beginning of

the next case, is critical in the productive

utilization and revenue generation of the

operating rooms.

Because the surgery department is the

primary user of sterile equipment and

supplies in the hospital, sterile processing

departments are now being located either

adjacent to or in a direct line above or

below the surgery department. Today, the

supplies and instruments for surgery are

centralized, reprocessed, and distributed

from the sterile processing department,

eliminating the costly duplication of

reprocessing equipment and reducing

both inventory and labor costs by

utilizing movable modular casework and

carts.



Surgery Departmen


Staff

Administrative Staff

Manager of Post-Anesthesia Care Unit

The manager of the post-anesthesia

care unit (PACU) is a registered nurse

(RN) with administrative responsibili-

ties for the PACU. This person may

be a major decision maker or

influential in equipment and facility

decisions as they relate to this unit.

Manager of Ambulatory Surgery

This may be the operating roomsupervisor or a separate RN manager

who reports to the administrator of

ambulatory services. Frequently, this

person supervises a patient holding

and recovery area separate from the

main surgery department and is

responsible for department staff and

budgets.

Anesthesia Supervisor

The anesthesia supervisor makesdecisions on supplies, budgets, and

equipment purchases frequently in

conjunction with the chief of

anesthesiology. This person may be a

nurse anesthetist or technician.

OR Materials Manager

This position, many times found in

larger and/or teaching hospitals, may

report to the director of surgical

services, the director of sterileprocessing, or the director of materials

management. This person is

responsible for ordering supplies and,

sometimes, instruments and

equipment.

Staff

Surgery departments typically have two lines of authority – physicians and nurses –

and an administrative staff.

Operating Room Staff

OR Supervisor

An operating room supervisor or director of

surgical services is usually an RN with extensive

operating room experience and may have an

advanced degree in nursing, management, or

business. This position will be in charge of

nursing; responsible for such business aspects of

the department as budgets, inventory, scheduling,

and staffing; and responsible for balancing the

needs of administration, physicians, operating

room staff, and patients.

Head Nurse/Clinical Nurse Manager

This person usually is a registered nurse (RN)

with or without an advanced degree; works with

one or more specialty services, such as

cardiovascular; and is influential in decisions

regarding supplies, equipment, policies, and

procedures for that specialty area.

Circulating Nurse

This is a registered nurse (RN) who coordinatesactivity in the operating room for a particular

surgical procedure, opens supplies for the scrub

nurse, assists with moving the patient, applies

dressings, etc.

Scrub Nurse/Instrument Nurse

This registered nurse (RN) or surgical technician

maintains the sterile operating field, and

organizes and passes sterile instruments and

supplies to the surgeon.

Surgical Technician

Typically, this technician has completed a one-

year program in preparation for working in a

surgery department and is familiar with

instruments, surgical procedures, and sterile

techniques.

Physician Staff

Chief of Surgery

The chief of surgery (an MD or

DO) will oversee the physicians, the

surgical procedures, and/or the

administration of anesthesia, as well

as make recommendations

concerning the medical aspects of

the department.

Chief of Services

The chief of services is an MD whooversees a specialty service such as

orthopedics.

Chief of Anesthesiology

The chief of anesthesiology (an MD

or DO) is the administrative head of

the anesthesia department and

supervises the anesthesiologists,

nurse anesthetists, and anesthesia

technicians. This position manages

anesthesiology supplies, equipment,and procedures.



Surgery Departmen


Advantages of Movable Modular Casework

Advantages of Movable Modular Casework

Surgical departments may differ somewhat in square footage, method of operation, and staffing

based on the size of the hospital, type of hospital, and scope of patient services, but each will

have certain functional areas in common. The following pages describe the advantages of

movable modular casework, give a brief description of the functional areas of the surgery

department, and provide typical plan views of movable modular casework applications.

Financial Advantages

The initial cost of movable modular

casework is competitive with fixed

casework or millwork. However,

the life cycle cost of movable

modular casework is far less than

fixed casework because of

· Longer product life.

· Minimal maintenance cost.

· Continual reuse of the

components for new or differen

functions.

· Ability to install and

reconfigure with little

downtime.

· Accelerated depreciation rate,

especially important to “for-

profit” organizations.

For preliminary budget purposes,

movable modular casework for a

surgery department has an average

price in the range of $248 to $372

per linear foot.

This range will be affected by the

density of overhead and under-

counter storage components and the

type of support structure used

(wall-mounted versus panels).

Movable Modular Casework

Movable modular casework offers the

following major advantages and

differences when compared with fixed

casework or millwork:

· All movable modular casework

components can be easily rearranged

or reused by the end user, allowing

ongoing changes with new technology

and accommodate major procedural

changes as well as hour-to-hour

variations in activities.

· Movable modular casework

components have been specifically

designed to meet the functional

requirements of surgery departments.

· Components are sanitizable, and

every configuration can be

disassembled to easily clean parts.

· Movable modular components canquickly and easily be relocated to the

opposite wall in an operating room

when a specific procedure requires

that the operating table be turned

around.

· A movable system accommodates the

increasing need to plan the majority

of operating rooms generically, rather

than dedicating them to a specific

procedure. Being able to move

procedure-specific supplies into ageneric operating room simplifies

scheduling and increases the

productivity of the department.

· Additional components can be added

at any time.

Materials Handling Components

Movable modular materials handling

components can be especially useful for

supporting effective and efficient delivery,

storage, use, and removal of the supplies used

in the surgery department.

Components can be rearranged to suit any

needed configuration as static storage, either

wall-hung or freestanding.

The quick-delivery capability allows

specialized supplies to be stored in a central

location and transported to an operating room

on demand. Each component can become

mobile by combining it with a wheeled

component and used for transport as well as

storage.

Specific components appropriate for use in the

surgery department include

· Case carts.· L carts.

· Crash carts.

· Specialty procedure carts.

· Lockers.

· Supply carts.

· Process tables.

· Extra-deep modular shelving.

Modular Furniture Systems

· Panel systems for administrative areasoffer the use of less space, the flexibility

to make changes easily, and increased

worker productivity.

· The system provides cantilevered work

surfaces and efficiently arranged

workstations.



Surgery Departmen


Control Station

Plan View of a Control Station

A control station will range in size from

200 to 400 square feet.

20 linear feet work surface

72 linear feet overhead storage

224 filing inches

330 square feet

Movable Modular Casework and Furniture Systems Applications

A control station can be planned using freestanding frame and/or panel systems with

movable modular casework components and generally will require

Functional Areas

Control Station

The control station is primarily a clerical

area located in a position to control

traffic into the surgery department.Similar to a nurses station, it is the

communications center of the surgery

department. A control station may be

configured in a variety of shapes and

sizes depending on the size of the

department and the number of operating

rooms.

A control station tends to differ from a

nurses station in that less people

generally work out of this area, andusually there are no patient monitors

located here.

Surgeries are scheduled; patient charges,

records, and administrative functions are

maintained; and intra- and inter-

departmental communications are

channeled through the control station.

Space should be provided for requisi-

tioned items to be delivered or picked upby other departments.

· Marker board for posting daily

surgery schedule.

· Acoustical tiles to reduce noise in the

area.

· Computer support components.

· File drawers.

· Work tools and form trays to help

organize the large volume of paper

and forms.



Surgery Departmen


Pre-Operative Holding, Scrub Area

Plan View of a Pre-Operative Holding

Area

A pre-operative holding area will range

in size from 300 to 700 square feet.



2 L carts

1 procedure cart

475 square feet

Pre-Operative Holding

Patients arriving for surgical operations

are held in this area until the appropriate

operating room is ready. This area may

also be called pre-anesthesia as patientsmay be given medications or intravenous

fluids under close observation of the

nursing staff.

Movable Modular Casework Applications

A pre-operative holding area can be planned using movable modular casework and

may require

· Small workstation for

filling out forms and

paperwork.

· Locker to hold patient care

supplies.

· L cart, procedure/supply

cart, or rail-hung C frame

storage unit placed near

each stretcher.


· Extra-deep modular

shelving units.

· Sink unit.

· Med prep/storage.

Scrub Area

Scrub areas are placed strategically

outside operating rooms. If the surgical

suite is designed with the clean core/

peripheral corridor plan, the scrub sinks

are best located in the peripheral

corridor.

Surgical scrub sinks are generallyceramic or stainless steel with foot or

knee controls. It is helpful to place

shelves above the sink to hold scrub

brushes and masks.

Plan View of a Scrub Area


(2 feet per sink)

50 square feet


Depending on the design of the scrub

area, scrub brushes and masks can be

housed in modular shelving hung on rail,

on wall strips above the sinks, or in rail-

hung C frame storage units with drawers

beside the sinks.



Surgery Departmen


Operating Room

Plan View of an Operating Room

An operating room will range in size

from 400 to 600 square feet.



1 locker for anesthesia supplies

Operating Room

An operating room is the area where

surgical procedures are performed under

strict sterile techniques.

Operating rooms may be dedicated to

specific procedures such as cardiovascu-

lar, neurological, orthopedic, or

ophthalmic procedures. Special supplies

and equipment are moved in and out as

needed.

Operating rooms may also be generic and

used for many different procedures

which will maximize the use of the space.

Operating rooms should have positive

pressure ventilation systems, with

controlled temperature and humidity, to

prevent corridor air from entering.

The general layout of the OR should

place the work surface for the circulating

nurse near the entrance door and the

movable modular casework on the wall at

the foot end of the table depending on the

head orientation of the patient.

Little or no built-in casework should be

used in the operating room for

sanitization purposes and because

· Built-in casework inhibits change.

· It is difficult to sanitize.

· It increases construction costs due to

the need for soffits and recesses.

· It increases the floor space needed.

Rather than using wall strips, horizon-tally mounted rail with rail-hung

components are appropriate for hanging

work surfaces for documenting or

charting. Rail-hung shelves or CST units

are suitable for overhead storage.


An operating room can be planned using movable modular casework components.

Movable modular casework can be relocated to the opposite wall when a specific

procedure requires that the operating table be turned around.

3 lockers for backup supplies

1 L cart

1 anesthesia cart

case carts as required

528 square feet

L carts or procedure/supply carts used for

· Anesthesia supplies and equipment.

· Suction and cautery equipment.

· Monitoring equipment.

· Prep and dressing.

· Anesthesia carts.

Stainless steel case carts which can also

be used as a back table.

Lockers used for

· General supply storage.

· Backup supplies.


Process tables used as

· Administrative/computer workstation

· Back table for instruments.



Surgery Departmen


Cystoscopy

Plan View of a Cystoscopy Room

A cystoscopy room will range in size




2 bulk supply carts

1 L cart

287 square feet

Cystoscopy

Because of the nature of the procedures,

this should be a separate procedural

room that may or may not open off the

clean core.

While similar to an operating room, it

differs in some aspects. It will include a

sink and may include a flushing floor

drain. The room requires space for a

large quantity of irrigating fluids and a

large supply of catheters.

This room needs to be lead lined and

should be adjacent to an x-ray control

room.


A cystoscopy room can be planned using movable modular casework components and

may require

· Bulk supply carts for medical/

surgical supplies.

· L carts for prep supplies or special

procedures.

· Bulk supply carts or lockers with

wire shelves for storing fluids.

· Cantilevered work surfaces.

· Cantilevered sink units or sink base

cabinets.

· Extra-deep modular shelving units.

NOTE: Anytime components are hung

from the wall, care must be taken not to

compromise the lead lining.



Surgery Departmen


Substerile

Plan View of a Substerile Room

A substerile room will range in size from




1 locker for supplies

162 square feet

Substerile

Substerile rooms are workrooms, usually

located between two operating rooms.

They most frequently contain the “flash”

sterilizer and the blanket/solutionwarmer, as well as storage of clean

supplies and equipment.


A substerile room can be planned using

movable modular casework components

and may require

· Heavy-duty work surface at stand-up

height.

· Modular shelving units and flipper

units, if closure is desired.

· Lockers to hold supplies.

· L carts or procedure/supply carts.

· Process tables.

· Casework sink unit.



Surgery Departmen


Clean Core

In a double-corridor plan, clean and

sterile supplies are stored in the clean

core, a large internal corridor adjacent to

and opening into all operating rooms.

This area is accessible only to those in

surgical attire.

The area may allow for freestanding or

built-in sterilizers, blood refrigerator, and

freestanding or table-top warming

cabinets.


A clean core can be planned using movable modular casework components and may

require

Plan View of a Clean Core

A clean core will range in size from

150 to 200 square feet per operating

room.


2 lockers per operating room

1 case cart per operating room

1125 square feet

Clean Core

· Small workstation for paperwork

with work surface, overhead storage,

undershelf lighting, and drawers.

· Lockers for holding supplies or as

specialty carts.

· Case carts.

· Procedure/supply carts.

· Bulk supply carts.

· Regular and extra-deep modular

shelving units.



Surgery Departmen



Plan View of a Post-Anesthesia Care Unit

A post-anesthesia care unit will range in size from 100 to 350 square feet per bed.


(PACU/Recovery Room)

This area is usually adjacent to the

operating room and generally near the

critical care units. Patients are brought to

this area after surgery to recover from

anesthesia and regain stable vital signs.

After patients are stable, they are

transferred to a patient unit or, in the case

of outpatient surgery, patients are moved

to secondary recovery before being

discharged.

The space is usually in an open area with

patients separated by cubicle curtains or

modular panels. Those patients who need

to be isolated are kept in a separate

isolation recovery room.

The layout of this space generally

includes a medical headwall for each

patient stretcher, a nurses control station

with physicians’ dictation space, a

medication preparation area, an area for

supplies and equipment, and hand-

washing sinks.


Movable modular casework components appropriate for use in the post-anesthesia

care unit include

· Nurses control station.

· L carts or rail-hung C frame storage

units with drawers for supplies for

each patient.

· Lockers for linen and medical

supplies.

· Cantilevered sink units.

· Dictation area.

lockers as required

L carts as required

procedure carts as required

bulk supply carts as required

2772 square feet



40 filing inches

1 C frame storage unit per bed



Surgery Departmen


Equipment Storage

Plan View of an Equipment Storage Room

An equipment storage room will range in

size from 150 to 400 square feet.


32 linear feet storage

1 locker

220 square feet


An equipment storage area can be

planned using movable modular

casework components and may require

· Extra-deep modular shelving units

and/or lockers with shelves to keep

smaller items off the floor.


· Wire carts.

Equipment Storage

There is a large amount of equipment

that needs to be stored for use in the

operating rooms and a variety of ways

of storing this equipment. Peripheralcorridor alcoves or single-corridor

alcoves can be planned for stretcher

storage, a single large room for general

equipment storage, and/or specific

smaller rooms for specialty equipment

storage such as orthopedic, cardiac

surgery, etc.

Much of this equipment must be

accessible to electrical outlets to

maintain battery charges.

In addition to needing floor space for

housing large equipment, overhead

shelving can be used so equipment can

be placed underneath for maximum use

of space.



Surgery Departmen


Clean/Sterile Storage

Clean/Sterile Storage

Clean/sterile storage areas differ in each

surgery department depending on how

supplies are distributed to the department

and the layout of the department:

· Supplies may be sent to this area on

a replenishment and/or exchange

system from general stores and/or

sterile processing.

· Case carts may be partially or

entirely assembled in this area, or

case carts may be sent to this area

from sterile processing.


A clean/sterile storage area can be planned using movable modular casework

components and may require

Plan View of a Clean/Sterile Storage Area

A clean/sterile storage area will range in size


lockers or wire carts as required

bulk supply or wire carts as required

279 square feet

· Process tables to stage supplies for

packing case carts (if assembled

here).

· Regular and extra-deep modular

shelving units.

· Lockers to store clean/sterile supplies

or to be used as case carts.


· Stainless steel case carts.

· Space for wire carts to hold sterile

linen, bulky supplies, and instrument

trays.



Surgery Departmen


Clean Workroom

Plan View of a Clean Workroom

A clean workroom will range in




1 L cart

133 square feet

Clean Workroom

This area is used for assembling,

wrapping, and sterilizing specialty and/or

delicate instruments that are kept within

the department.

If central supply does not support the

reprocessing function for surgery, this

space will need to be large enough to

accommodate the necessary assembly

and sterilization functions.


A clean workroom can be planned using movable modular casework components

and may require

· Cantilevered work surfaces for

assembling instrument sets.

· Large process tables for wrapping

instrument sets.

· Modular shelving units, L carts, and

lockers for supply storage.

· Cantilevered sink unit.

· Wire carts for staging assembled

trays.



Surgery Departmen


Soiled Utility

Used linens, instrument sets, and

equipment are placed in soiled utility

immediately after surgery. This room

may hold case carts, lockers, wire carts,trash containers, and soiled linen that

have been used in the operating rooms

until they are returned to central supply.

If the surgery department processes its

own instrument sets, this room may

function as the decontamination area and

must be large enough to accommodate

washing and decontaminating equipment.

Surgery departments processing their

own instruments may also require

stainless steel sinks (with double and

triple bowls) and a counter for washing

instruments and utensils.


A soiled utility room can be planned

using movable modular casework

components and may require

· Process tables or heavy-duty work

surfaces for receiving soiled items.

· Modular shelving units and/or

lockers with shelves to hold cleaning

supplies.

· Horizontal rail to hold lockers

awaiting return to central supply.


Plan View of a Soiled Utility Room

A soiled utility room will range in size




1 locker for supplies

case carts

220 square feet

Soiled Utility



Surgery Departmen


Anesthesia Supply/Workroom

Plan View of an Anesthesia Supply/Workroom

An anesthesia supply/workroom will range in size from 250 to 500 square feet.


Anesthesia will have a workroom with an

area for washing equipment and

maintaining/testing anesthesia machines.

Sometimes a second room or area is

provided to hold anesthesia supplies.

Anesthesia supply carts are generally

replenished from this room, and at the

end of the day, these carts may be parked

and secured here.

The anesthesia supply room may require

· Lockers and modular shelving units

for supply storage.

· Locked drawers and cassettes for

medication storage.

· Bulk supply carts.





328 filing inches

5 lockers

bulk supply carts as required

470 square feet

The anesthesia workroom may require

· Work surfaces or process tables to

receive and clean equipment.

· Small administrative area with work

surface, seating, file storage,

tackboards, space for computer,

overhead storage for manuals and

binders.



The anesthesia workroom and supply room can be planned using movable modular

casework components.



Surgery Departmen


Satellite Lab

Plan View of a Satellite Lab

A satellite lab will range in size from




1 locker (optional)

332 square feet


A satellite lab can be planned using

movable modular casework components

and may require

· Heavy-duty work surfaces and/or

process tables for automated

instruments.

· Wall strips, modules, or support

panels to hold work surfaces and

overhead storage.

· Tackboards.

· File storage.

· Flipper units, C frames, lockers, and

L carts for storage.


Satellite Lab

The surgery department may have a

satellite lab for STAT testing of tissues

and for creating and reading frozen

section slides.



Surgery Departmen


Satellite Pharmacy

Satellite Pharmacy

A satellite pharmacy may exist in the

surgery department. This decentralization

of the pharmacy function allows for more

rapid response to the needs of the patient.

The space will vary in size but will

usually contain a small drug picking area,

sink, refrigerator, computer, printer, label

printer, and controlled substance storage.

Some satellite pharmacy areas may have

a small laminar flow hood.

The satellite pharmacy is staffed,

stocked, and serviced by the primary

pharmacy department.

Modular carts are appropriate for the

transfer of medications to the satellite

pharmacy.


The same movable modular casework components used in the main pharmacy are

appropriate for the satellite pharmacy, allowing for continual flexibility and change in

the space and may include

Plan View of a Satellite Pharmacy

A satellite pharmacy will range in size


18 linear feet work surface28 linear feet overhead storage

80 drug bins average

1 locker

1 medication cart

140 square feet

· Medication locker or transfer cart.

· Double-locking drawers for storing

controlled substances.




· Dispensing rail.



Surgery Departmen


Staff Lounge/Locker Room

Plan View of a Staff Lounge/Locker

Room

A staff lounge/locker room will range in




2 lockers

175 square feet


A staff lounge is used primarily for

coffee breaks, snacks, and as a place for

staff to rest from the pressures of patient

care. Space should be provided for arefrigerator, microwave oven, and large

coffee maker.

Staff locker rooms, usually adjacent to

the staff lounge, are provided for male

and female staff to change from street

clothing into surgery attire. Clothing

lockers, toilet facilities, and showers are

provided.

Movable Modular Casework and Furniture Systems Applications

This environment should be easily cleaned and offer a warm, enjoyable atmosphere.

Staff lounges may require

· Wall strips with work surface and

overhead storage or heavy-duty

storage work surface with C frame

and drawers for a coffee maker and

supplies.

· Tables and seating.

· Tackboards for displaying

information.

· Lockers or wire carts for surgical

attire – dresses, suits, caps, shoe

covers.

· Base cabinets for storage.



Surgery Departmen


Plan View of an Administrative Office



20 filing inches

100 square feet

Administrative Office

Movable Modular Casework and

Furniture Systems Applications

These areas may be furnished with

modular furniture systems and seating.These offices may need


· Tool bar with accessories for paper

handling.

· Work surfaces with keyboard

drawers or trays to accommodate

computers and printers.

· Overhead storage, flipper units,

display shelves, and marker boardsfor displaying information.

· Task lights and personal lights.

· Freestanding, under-work surface, or

wall-attached drawers and files.

Administrative Office

Each surgery department will have

unique requirements for its administra-

tive areas. Generally the following

positions will require an administrativeoffice:

· Operating room supervisor.

· Director of surgery.

· Director of anesthesiology.

· Chief surgical residents.

· Clinical nurse managers.

· Operating room materials manager.



Surgery Departmen


Functional Program

Functional Program

Number Department Area Square Feet

Movable Modular Casework

Control Station

Pre-Operative Holding Area

Scrub Areas @________ sq. ft.

Operating Rooms @________ sq. ft.

Orthopedic Operating Room

Orthopedic Equipment Storage Room

Cystoscopy Room

Substerile Room

Clean Core


Primary Recovery

Secondary Recovery

Isolation Recovery

Patient Toilet

Medication Area

Clean Holding Room

Soiled Utility Room

Equipment Storage Room

Clean/Sterile Storage Area

Clean Workroom

Soiled Utility Room


Satellite Lab

Satellite Pharmacy

Staff Toilets @________ sq. ft.

Janitor’s Closet

Subtotal

Modular Furniture Systems


Administrative Offices @________ sq. ft.

Subtotal

TOTAL NET SQUARE FEET

Net-to-Gross Conversion Factor X

TOTAL GROSS SQUARE FEET



Surgery Departmen


Bubble Diagram

Bubble Diagram

The bubble diagram of the surgery

department demonstrates typical

departmental relationships and

interaction between areas. Necessaryadjacencies within the department

become clear.

SUBSTERILE

CONTROL

STAFFLOUNGE/

LOCKERS

SOILED

HOLDING

CLEAN

WORKROOM

CLEAN

HOLDING

CLEAN CORE

OPERATING

ROOM

PERIPHERAL

CORRIDOR

PRE-OP

HOLDING

SECONDARYRECOVERY

PACU

ANESTHESIA

SCRUB



Surgery Departmen


Block Diagram

Block Diagram

The block diagram demonstrates the adjacencies and relative sizes for the areas within

a typical surgery department. Evaluation of the work flow and materials flow from the

bubble diagram has determined this initial general layout.

The size of each area is determined by combining the typical movable modular

casework plans for each identified function. Traffic patterns are developed, and an

overview of the general work process can be evaluated.

CYSTOSCOPY

SECONDARY

RECOVERY

PRIMARY

RECOVERY

CLEAN CORE



Surgery Departmen


Preliminary Plan

Preliminary Plan

The preliminary plan clarifies the surgery

department space requirements by

showing the location of all the fixed

walls and open areas and identifiesentrances, exits, and exact traffic

patterns.

SECONDARY

RECOVERY

PRIMARY

RECOVERY



Surgery Departmen


Schematic Plan

Schematic Plan

The schematic plan shows all of the

specific movable modular casework,

modular furniture systems, and materials

handling components appropriate for atypical surgery department.

SECONDARY

RECOVERY

PRIMARY

RECOVERY



Surgery Departmen


Future Trends

Future Trends

Facilities

Because of the increase of outpatient

surgeries, the number of off-site surgical

outpatient facilities has grown over thepast ten years. Currently, however,

hospitals are constructing more on-site

outpatient surgical suites than

freestanding surgery centers. This trend

is due to surgeons’ preference for using a

hospital setting with its backup resources

and equipment rather than a remote

location and patient preferences for a

hospital setting. The percentage of

outpatient surgical procedures will

continue to rise.

Surgery departments require constant

renovation to keep pace with new

technologies, practices, and equipment.

Layout

New technology and new procedures will

continue to impact the need for larger

operating rooms to accommodate thenecessary equipment. These larger

operating rooms will still need to remain

flexible in function as well as being able

to adapt to continual change.

Space must be provided for the storage

of the constant influx of new equipment

used in surgical procedures.

Future surgery departments must

continue to fine tune sterile storage andmaterials handling procedures and

planning to provide the most cost-

effective systems, including space

allocations for case cart and exchange

cart systems.

The disposal of waste materials from the

surgery department will have an impact

on future planning. There is an emerging

trend for surgery departments to return to

reusable supplies, particularly operatingroom linen and instruments, because of

the rising costs of medical-waste

disposal. This will affect not only waste

removal, but the clean storage areas of

the surgery department, and the delivery

system of the central sterilizing

department.

The nursing care emphasis on “patient-

focused” care will promote changes in

planning to allow greater patient privacy

and comfort within the surgery

department.

Procedures and Services

There will be new and increasing

numbers of procedures for the regulation

of waste products from the operatingrooms, of which approximately fifteen

percent is infectious.

Implementation and expansion of

information systems will be seen

throughout the hospital with computer

capabilities and technology becoming

standard equipment in each operating

room. The increased use of computer

systems will be accompanied by the use

of bar code technology for a variety of applications.

Innovations in medical technology will

continue to have a profound effect on the

types and variety of surgical procedures

performed.

Advances in technology will center

around cardiac surgery, organ

transplants, and new laser and

endoscopic procedures.



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Surgical Services Department

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