Medical Construction & Design

MAY-JUN 2018

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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MCDM AG.COM | M AY/ J U N E 2018 | Medical Construction & Design 53 reduced tasks for staff between cases and an overall reduced room turnover time. Strategy #2: Effi cient building communication A typical HVAC control system communicates through a pro- tocol called master slave token passing, or MS/TP, which allows various system control- lers to communicate by passing information from controller to controller in a closed loop. Say one wants to lower the temperature of an operat- ing room. The adjustment is made to the thermostat in the operating room and the re- quest travels through a series of controllers, as many as 60 on a single connection, to the building management system where the change is processed and sent back through the chain to open the damper, thereby lowering the tem- perature. This communication takes time and does cause de- lay to the room recalibration. Reducing the overall number of controllers to no more than 30 in a single loop limits com- munication time to less than 5 seconds, again resulting in an ability to turn each operating room over more quickly and to potentially create addition- al time capacity throughout each scheduled day. Strategy #3: Thermostat location Another strategy involves the location of the thermostat. It is true that the location of the thermostat in the operating room can contribute to throughput and operational effi ciency. For one project, a transient computational fl uid dynamics model of a typical OR with a typical HVAC system and laminar airfl ow (see fi gure 2) was created to evaluate the calibration impacts of diff erent thermostat locations within the OR. The CFD analysis showed the impact of cooling and dehumidifying an operating room from 75 F / 50 percent RH to 65 F / 50 percent RH. The residual heat from the previous surgery can result in a longer cooling delay than one might expect during a transition period. The laminar fl ow creates a fi eld around the surgical patient and team to limit the potential for airborne infec- tions at the surgical site. This carefully controlled airfl ow results in a temperature vari- ant between the center of the operating room and the perimeter walls of that room. Therefore, if the room control thermostat is located within one of those perimeter walls, the surgical site temperature will vary from what is desired. Recalibration of the tem- perature and humidity settings could again create a situation of experienced operating room downtime and/or extended room turnover. Consider a typical thermo- stat location on the wall. The discrepancy in temperature in the room can cause delays to get temperatures to a true and accurate temperature at the surgical site. Placing the temperature sensor in diff erent locations, such as at the return airduct or using wireless sen- sors in the center of the room, can signifi cantly reduce the turnover time and provide a level of accuracy and confi - dence for the surgeon and staff . When designing an operat- ing room, the smallest detail can have a signifi cant impact on a hospital's revenue and outcomes. Many performance optimization concepts are common in surgical depart- ment design like locating supplies and equipment close at hand, minimizing travel distances, pass-through supply and even consolidated proce- dural platforms. All of these design concepts certainly work toward im- proved effi ciency and cost re- duction. An integrated design team thinks more holistically, partnering with space design- ers to create properly designed HVAC systems allowing for additional performance im- provement in operating room utilization. This holistic design approach, when realized, arms healthcare providers with ad- ditional tools to manage cost and increase revenue. 1 What does one minute of operating room time cost?, Journal of Clinical Anesthesia (2010). Cindy Beckham is healthcare studio leader and a principal at SmithGroupJJR's Washington, D.C. offi ce. Rosemary Hwang, E.I.T, LEED AP BD+C, is a mechanical engineer at SmithGroupJJR's Washington, D.C. offi ce. Editor's Note: Kevin Andreone, LEED AP, and Kevin Ricart, mechani- cal engineers at SmithGroupJJR's Washington, D.C. offi ce, contributed to this article. Saving one minute of OR turnover time can have a signifi cant impact on revenue. It is important to note savings is based on eight procedures a day for 250 operating days a year. REVENUE VS. TURNOVER TIME TEMPERATURE VS. TIME This graph shows the change in the temperature readings for different sensor locations when 55 F air is delivered into the space under a laminar fl ow condition.

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