Facilities Planning for New Hospital Construction – The Technology Perspective

1. Facilities Planning for New Hospital Construction –The Technology Perspective CESO Conference, Thursday, October 30, 2003

2. Today’s Presentation 9:30 – 10:00 Facilities Development – Planning, Design & Construction – Nick Joosten 10:00 – 10:30 Planning Imaging Facilities – Murray Rice 10:30 – 10:50 Coffee Break 10:50 – 11:20 Cardiac Telemetry & Networking Issues – John Leung 11:20 – 11:50 TGH Operating Rooms 11:50 – 12:15 Roundtable Discussion

3. Project Background Toronto General Hospital – Project 2003 • Initiated in 1998 • Funded through $300M Bond Issue • New Imaging, OR and Patient Care Floors • Architectural showpiece • Flexibility for the future

7. Facilities DevelopmentPlanning, Design & Construction Nick Joosten, Project Manager

8. Project Management Prospective • Our ‘goals’ • Leadership • Managing expectations • Keeping the drive • Key construction points • Lessons Learned • Schedule & Budget

9. Our Goals • Build something that never has been done before • Account for the future • Manage the multiple dynamics of the team • Acquire 13.5 million of advance technology equipment & managing over 10 million in construction • Help transition the Team from the 60’s to 2000’s Managing to due all the above ON TIME & ON BUDGET

10. Leadership • Understanding the Operating Teams (End User) Needs & Operation • Working with multiple stake holders • Deciphering the Construction language • Deciphering the Operational language • Instilling Confidence

11. Managing Expectations “Framework” of the Project • Consultants Design v.s Users Needs • Equipment Planning & Deliverables • Vendor demonstrations • Fast Track OR • Furniture & Move Plan • BUDGET

12. Keeping the Drive • Construction site walks • Open communications with staff • Moving from the 60’s to 2000 & beyond • Fundraising tours • Fun facts…

13. Sample Motivation

14. Key Construction Points Some of Many • Vendor participation • Micro infrastructure details • Changes & “Change Orders”

15. Lessons Learned • Have Vendors Participate Early • Deciphering Architectural Elevations • Equipment Luxury v.s Practicality • Avoid the “budget juggle”

16. Planning Imaging Facilities Murray Rice, Manager, Medical Engineering

17. Imaging Equipment Facilities • Planning Steps • Team • Key Milestones in Time Line • Conflicts in Time Line • Detail Design Examples • Administrative Coordination Issues • Key Points

18. Planning Steps • Functional Plan – Requirements of area with consideration of # of staff, # of patients, # of procedures, etc. Happens years in advance of actual building. • Initial Design – Work flow, where the walls are • Detailed Design – Positioning of everything in the room, power requirements, etc. This is what the contractors build from. • Construction • Installation and Moving In

19. Team – Who, When, and the Right Time • Functional Plan – Clinical Team and Planners, Medical Engineering confirms technical details • Initial Design – Building Planners, Clinical Team, Medical Engineering, Infection Control, Hospital Support Groups • Detail Design – Above and Equipment Vendors • Construction – Everyone should monitor construction, involve vendors, clinical, and technical teams • Installation – Above and Hospital IS • Commissioning

20. Key Milestones in Timeline • Functional Plan – Size and number of Rooms • Initial Design – Shape of rooms, Equipment proximity (e.g. MRI) • Detail Design – Initially a generic design, but before finally built need Equipment Selection, need Complete detailed equipment list • Detailed Technical Planning - Three Examples (Radiography Room, Interventional Room, MRI) • Construction – Need Ministry of Health X-Ray Inspection Service Site Plan Approval for X-ray systems before constructing x-ray rooms

21. Conflicts in Time Line • Technology Development/Changes (e.g. digital radiography) versus Construction Time Line • Equipment Procurement Process versus Construction Time Line

22. Radiography Room • Drawing of Room

23. Interventional Room • Operating Room Environment • X-Ray System • Contrast Injector • Ultrasound Machine • Patient Monitoring • Mounted on X-Ray table, or monitor on boom? • Slave/Remote Monitors • Anaesthetic Equipment • CCTV

24. MRI • Weight and Access Route for Bore, Open Magnet (Slab on Grade) • Magnetic Field – Effect on Surrounding Area (Magnetic Shielding?) • EMI – Effect on MRI (RF Shielding), and effect of MRI on Surrounding area • Noise and Vibration

25. Administrative Issues • Budgeting (Who pays for what) • Capital • Construction Changes • Information Systems • Tracking Changes to Plans • Clinical Team, Technical Team, Project Manager, Architect, Consulting Engineers, Construction Manager, Contractor • Decision Makers

26. Key Points • Need thorough understanding of process • Take the time to capture as many details as possible at the detailed design stage. Making changes later is possible, but hard. • Challenge of thinking of Plan versus Reality • Vendor Involvement is key • Medical Engineering acts as conduit for different groups as we are positioned to understand the whole process

27. Cardiac Telemetry & Networking Issues John Leung, Manager, Medical Engineering

28. Cardiac Telemetry Project • Two floors – West wing 4th and 5th • Total 76 telemetry channels • Philips WMTS band telemetry system • Coverage Area – Patient rooms, hallways, Elevator lobby and Patient Court • Project go-live June 19th and June 28th

29. Telemetry System • 4th floor – 36 channels, central monitoring and 6 satellite nursing station, 6 telemon monitors • 5th floor – 40 channels, central monitoring, 3 satellite nursing stations, 6 telemon monitors • Future – stepdown unit with 6 Intellivue • Future – HL7 inbound interface

30. Equipment Selection Process • Consult Clinical User on Wish list • Conduct Work Flow Analysis • Specification & RFP • Vendor Fair • Interface Assessment • Negotiation

31. Timeline • May-June 2002 Consultation, Setup Team • July 2002 Develop Specification & Work Flow Analysis • August 2002 Issue RFP • September 2002 Vendor Fair • Oct-Nov 2002 RFP Response Review & Interface Discussion, Negotiation • Jan 2003 Finalize Equipment List

32. Timeline • Feb-Mar 2003 Issue PO • Apr-May 2003 SARS, Plan User Training • Jun 2003 Delivery and Checkout • July 2003 Go-Live

33. Networking Issues • Ensure Adequate Network Drops Oper. Room - 22 drops Bed with Monitor - 3 drops Bed w/o Monitor – 1 drop • Network Topology – Stand Alone vs. Integrated

34. Networking Issues • Network Security NT Based Central monitors Switch Room Equipment Room Gateway/Web Server • Network Support

35. Lessons Learned • Large projects with long lead-time Equipment budget anomalies User forgets what/why equip is needed • Usability is important, should be part of selection process • Plan extra network drops • Identify who does what Blocking for Monitor mounts Patient Court Antenna

36. TGH Operating RoomsOR Imaging and Communication System Tony Easty, Director, Medical Engineering

37. The Bottom Line for these technological advances in OR Imaging and Communication is …. Clinical - better , safer, and more efficient care for patients at UHN (TGH,TWH,PMH) and from MSH, HSC, and all of Ontario and beyond - capture and storage of ALL records Education - outstanding tools for undergraduate, postgrad, fellowship, CPD, allied, and public education Research - unprecedented opportunity for research in outcomes, innovation, educational models ...

38. TGH Operating Rooms - July 2003 The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

40. TGH Operating Rooms - July 2003 The 2003 OR The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

41. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

42. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) - lights, table, wider doors The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

43. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) - lights, table, wider doors - nursing station control centre The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

44. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) - lights, table, wider doors - nursing station control centre - generous anesthesia space The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

45. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) - lights, table, wider doors - nursing station control centre - generous anesthesia space - equipment on booms, compact The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

46. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) - lights, table, wider doors - nursing station control centre - generous anesthesia space - equipment on booms, compact - technology built in, intuitive The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

47. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) - lights, table, wider doors - nursing station control centre - generous anesthesia space - equipment on booms, compact - technology built in, intuitive - sterile configuration, corridors The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

48. TGH Operating Rooms - July 2003 The 2003 OR - bigger box (550+ sq.ft.) - lights, table, wider doors - nursing station control centre - generous anesthesia space - equipment on booms, compact - technology built in, intuitive - sterile configuration, corridors - image capture, communication The 1950 OR - a small box (~400sq.ft.) - lights, table, 3 doors - ergonomically poor for nurses - cramped space for anesthesia - equipment, additional technology on floor (clutter, hard to clean) - nothing built in - sterile environment compromised - no image capture, communication

49. Imaging Technology in ORs – A very recent innovation When our design process started in 1997, integrating this technology into ORs was unheard of. We seized the opportunity to incorporate the very latest advances “on the fly” during our design and construction process, causing significant trauma to out design and construction team. Because this wasn’t part of the original scope, it was outside the project budget. We had to fundraise directly for this system. By opening day, we managed to fund and install 11 of 19 rooms.

50. WIRED – OCT 2002