Operating rooms have evolved tremendously with innovations in technology and the vast amount of data available today. Hospitals continue to design rooms with a focus on greater functionality and improved patient comfort. A concept that is shaping OR design of the present and future for hospital staff is the integrated operating room, also referred to as a digital operating room.
OR Integration connects technology, information and personnel throughout the hospital to create a purpose-built system that reduces the dependency on mobile equipment. With the use of advanced audio-visual technology such as multi-image touchscreen displays, and real-time monitoring systems, staff within the OR have limitless access to patient information archives and resources. This establishes smarter interconnectivity between the outside world to improve clinical outcomes and lessen the amount of traffic moving in and out of the sterile operating environment.
With an integrated OR, personnel have fewer reasons to leave the operating theatre due to direct connectivity with other hospital equipment and information systems through an interface with the OR. This connection means an integrated OR can be more quickly and easily prepared for each scheduled procedure. Additionally, direct access to high-resolution imaging equipment like X-ray, CT, MRI, and other diagnostic equipment means patients do not have to be moved during surgery when imaging is required. Which, as a result, creates the opportunity for more minimally invasive surgeries.
One of the greatest benefits of OR Integration extends beyond the operating room as OR Integration connects and supports teams, processes and information to improve operative workflow. For example, OR Integration allows in-OR teams to share surgical video and images with remote specialists for consultation, with classrooms of students for teaching applications, and real-time peer collaboration with another surgeon at a different location for procedure guidance. After a procedure, a clinician can easily show high-definition images of the procedure on a tablet during a post-operative consultation with the patient and family. Conveniently, OR Integration ensures that these images and video are automatically associated with the patient record for accurate documentation of every procedure.
Due to the emergence of advanced diagnostic and imaging technology, the operating room (also known as the operation theater) has become increasingly congested and complex with a multitude of OR devices and monitors.1 In addition to booms, surgical tables, surgical lighting, and room lighting positioned throughout the OR, multiple surgical displays, communication system monitors, camera systems, recording devices, and medical printers are all quickly becoming associated with a modern OR.
An OR Integration System is designed to simplify and streamline the OR by consolidating data, access to video, and controls for all of these devices at a central command station, allowing the surgical staff to perform many of their tasks efficiently without needing to move around the OR. OR Integration also commonly involves suspending monitors and imaging modalities within the OR, removing trip-hazards caused by cabling and allowing for easy access and visibility to surgical video.
The OR is a demanding environment that requires focus, efficiency, communication and expertise. Without OR Integration, surgical teams must navigate around the operating room to perform a variety of tasks. These tasks include checking a computer for patient information, writing this information on a white board, moving to the wall to control OR lighting, stepping into the surgical field to display or change the video they are viewing, and more. The movement and time required to complete these tasks slows a procedure down and can detract attention from where it is needed most: on the patient.
OR Integration Systems consolidate and organize all patient data for the surgical staff during a procedure, minimizing congestion and streamlining information across multiple platforms.1 Through OR Integration, the surgical staff has centralized access to the controls and information they need – to view patient information, control room or surgical lighting, display images during surgery, and more – all from a centralized control panel. OR Integration provides the OR Staff with increased productivity, safety, and efficiency to keep focus on delivering patient care.
OR Integration technology is available in a range of systems and prices, supporting low-complexity Operating Rooms to high-volume, complex ORs. The simplest of OR Integration Systems promote simple visualization of a few devices on a few displays within the OR, while more complex systems may automate video routing, image capture, and equipment control. OR Integration Systems suited for high-complexity ORs build on these capabilities, adding the ability to connect and control many devices, collaborate in real-time using videoconferencing or streaming, and support advanced visualization in 4K ultra-high definition.
Just as OR Integration Systems offer different features to support each Operating Room's needs, these systems also vary in size and design to support a variety of environments. From small box-style systems that can fit on the OR desktop, to larger systems that fit inside the wall or even outside the OR, OR Integration Systems take a variety of forms depending on the needs of the Operating Room.
OR Integration should be centered around the current and future goals of the hospital, such as increasing OR revenue, efficiency, safety, patient satisfaction or educational initiatives. Such goals cascade to how the in-OR staff should perform their tasks, and how OR Integration can support success. For example, a teaching institution may prioritize communication from the OR, and require OR Integration to not only support communication and collaboration between integrated ORs, but also the transmission of video and audio from these ORs to neighboring classrooms or conference rooms.
The OR Integration System's ease-of-use is integral to ensuring that the investment supports a profitable, efficient OR. If an OR Integration System is complex, cluttered, confusing, or difficult to navigate, staff may stop using it or only use small portions of its functionality. A well-designed system is not one-size-fits all, but customized to its users' needs for the performance of their unique workflow and clinical tasks, and positions equipment out of the way of OR traffic.
Planning for compatibility is also key when evaluating OR Integration solutions. Integration provides a technical infrastructure in the OR that allows different types of medical devices, cameras, music devices, environmental systems, and lighting to work together seamlessly and harmoniously. The Integrated OR often offers compatibility with current as well as future technologies, which enables the hospital to easily introduce new devices, like endoscopes or imaging equipment, to existing integrated ORs.
The design of an Integrated OR reflects the types of procedures performed in the room, the medical devices that will be used, where surgical video must be viewed, available space, and the need for durability. The integration vendor works closely with the hospital to design an OR that supports their unique demands and supports an efficient and safe OR.
OR Integration allows the hospital to ideally locate equipment in the OR. For example, cart-based devices can be placed at the wall if desired, connected to the integration system to allow the clinical team to view the device's video throughout the OR. Similarly, endoscopic towers can be located on the equipment boom in the OR, keeping the floor and neighboring areas clear of associated cabling. Displays are often mounted within an Integrated OR, on walls or light arms instead of on rolling carts, to allow easy visibility to surgical video from anywhere in the OR.
When designing an Integrated OR, floor space is maximized to allow the staff to navigate the OR effectively as well as to accommodate the equipment that is needed for each case. The OR Integration System is selected and located to be least obtrusive to the staff – and may be located under on or under a desk, in the wall or even outside the wall depending on hospital preference.
Regardless of the procedures performed, the OR is one of the most harsh and difficult environments for electronics and cabling – particularly those routinely handled and plugged/unplugged. Components of an OR Integration System are therefore often designed to withstand the rigors of the operating room environment. This includes the ability to weather regular cleaning, rough handling, and impact. Some of the components most prone to damage, such as surgical displays and video cables within the surgical field, are reinforced to ensure longevity.
Today's integrated ORs demand connectivity to data, systems and individuals beyond the OR. When planning for an integrated OR, the integration vendor and hospital must consider the bandwidth availability and network configuration requirements necessary for a seamless exchange between the OR and remote locations. Signal transmission compatibility also has a big impact on whether both locations can share media files or videoconference in real-time.
Compared to less-detailed images or videos, today's high-resolution media files are generally larger and require more data storage. To ensure that adequate storage is available, planning for an integrated OR includes defining media storage requirements. If desired, authorized OR staff may choose to access or share their media from their hospital PC or mobile device. If online access is not desired, staff may default to printing images or transporting media on a CD or USB drive.
The protection of a patient's information is paramount, and thus any images, video or data that contains patient information must be protected. When sharing video from the OR during a teaching event, for example, any patient information and identifying features should be hidden from the students' view. The design of the OR integration system and the way it is deployed within the hospital's network infrastructure can help ensure information security.
For more information on OR Integration for the modern operating room, read our article about how COVID-19 Changed the Operating Room.