Hybrid ORs pair imaging with the sterility & surgical capabilities of a traditional OR

Luann Culbreth, MEd, MBA, RT, FACHE

The term “hybrid” operating room entered clinical vernacular about 10­–15 years ago, according to Luann Culbreth, MEd, MBA, RT, FACHE, former Director of Radiology & Cardiovascular Services on the Clinical Operations team at HealthTrust. Hybrid operating rooms blend a clean environment with an interventional radiology suite, enabling a surgical team to perform highly advanced open procedures that also require imaging.

“Some of the first iterations of these rooms were really just an interventional room in a surgery suite on a different floor,” shares Culbreth. There has been tremendous progress over the last decade in both technology and room design.

Early adopters

Missi Johnson

Heart Hospital of Austin was a pioneer in this space, being the first in Austin, Texas, to open a hybrid OR in 2007. Heart Hospital became part of HCA Healthcare in November 2010 after being acquired by St. David’s HealthCare. “We had two hybrid ORs prior to the merger and acquisition [M&A]. We now have a third hybrid OR, all with state-of-the- art imaging and interventional tools,” says Missi Johnson, Director of Surgical Services at Heart Hospital of Austin, a campus of St. David’s Medical Center.

Rising demand

The early pioneers and driving forces behind hybrid ORs can be attributed to cardiovascular surgeries, particularly vascular procedures, and rapid growth in technological advancements. Additionally, hybrid ORs are now being used for providing treatment in thoracic, neurological and orthopedic diseases.

A report published by Allied Market Research in 2020 indicates that the global hybrid OR industry is projected to reach $1.8 billion by 2026—a compound annual growth rate of 11.7% from 2019 to 2026.

Product Mix

Products that may be included in a hybrid OR include:

Intraoperative Diagnostic Systems

  • Magnetic Resonance Imaging (MRI)
  • Computed Tomography (CT)
  • Ultrasound
  • Angiography systems
  • Other imaging systems

Operating Room Fixtures

  • Operating tables that meet the expectations of both surgeons and interventionalists
  • Operating room lights
  • Surgical booms
  • Systems for monitoring, communications & the control room

Stakeholder feedback

Experts agree that when designing a hybrid OR suite, the most important component is meeting with your key stakeholders (e.g., surgeons, nurses, OR managers) to understand what your organization needs before setting out to design it. Find out what goals they hope to achieve with the addition of an advanced surgical room, as well as the type of hardware, software and workflows they currently use and what is needed to support interdisciplinary use of the new rooms. You’ll want to interview the appropriate specialists, such as vascular and neuro specialists, cardiac surgeons and interventionalists (e.g., cardiologists, interventional radiologists, electrophysiologists, neuroradiologists).

Space & design considerations

Room location and size are important. While a traditional OR is about 700 square feet, industry resources suggest 1,200 square feet as preferable when designing a hybrid OR to accommodate imaging equipment as well as a control room where the procedures are monitored. Hybrid ORs must also allow for the possibility of converting to an open procedure, so they need to be large enough to accommodate both the staff and equipment for two separate clinical teams.

“Enough physical space is key,” shares Johnson. “There are large monitors, surgical lights and the c-arm that all compete for ceiling space because they are all mounted on ceiling tracks. You have to move all these pieces to different locations and positions depending on the procedure. If you don’t have enough physical space in the room, the booms can collide, which can cause equipment damage. It can also be a challenge to get everything in the right position.”

Versatility is also important in design, Johnson explains. “One of our three hybrid ORs also has integrated electrophysiology equipment, so if EP needs an overflow room, we have that capability. Two of the three hybrid OR rooms can also be used for cath lab cases.”

Assistance abounds

“The good news is,” Culbreth shares, “if you’re looking to build a hybrid OR, you’re not on your own. While not every IDN [integrated delivery network] has the resources for an in-house team to advise on the particulars, the majority of suppliers in this space are more than willing to consult with your stakeholder team on the design and configuration.” Culbreth recommends talking to all contracted suppliers in this space. “If there are four suppliers with this expertise, I’d talk to all four and find the best fit for your organization,” she adds.

The majority of the big players in imaging have progressed to marry their equipment with the setup of OR equipment from the larger companies. After consulting with supplier partners, most facilities will standardize to a supplier of choice for their hybrid rooms, Culbreth explains.

HealthTrust is currently reviewing contracts in this space. Watch the Response newsletter for updates on the Interventional & Angiography, Equipment & Accessories category, or contact AVP of Clinical Operations Jennel Lengle for information at jennel.lengle@healthtrustpg.com.


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