How Hybrid ORs Are Enabling the Next Generation of Outpatient Care
Over the past several years, one of the most significant shifts we've seen in ambulatory healthcare has been the rapid growth of cardiovascular ambulatory surgery centers. While orthopedic, ophthalmic, and endoscopy centers have long been common in the outpatient environment, cardiovascular procedures are increasingly following the same path.
At Hardaway|Sziabowski Architects, we've recently completed or designed several cardiovascular ambulatory surgery centers incorporating hybrid operating rooms, in addition to vascular access centers and other similar facilities. That isn't simply a reflection of our practice. It reflects a broader transformation occurring throughout outpatient healthcare.
This is not due to a single breakthrough. It's the convergence of several developments that are fundamentally changing how cardiovascular care is delivered.
More CV Procedures Are Moving Outpatient
Perhaps the biggest catalyst has been the continued migration of cardiovascular procedures from hospitals to ambulatory surgery centers. As CMS has expanded its list of approved outpatient procedures, physicians have gained the opportunity to perform increasingly complex interventions in appropriately equipped ASCs. At the same time, advances in imaging technology, minimally invasive techniques, anesthesia, and postoperative care have made outpatient treatment practical for a growing number of patients.
Patients benefit from receiving care in a more convenient setting. Physicians gain greater control over scheduling, workflow, and the patient experience. Payers benefit from lower costs. It is one of those rare situations where the interests of nearly every stakeholder are aligned.
The Hybrid OR Is an Enabler
One of the technologies making this transition possible is the hybrid operating room. Many people assume a hybrid OR is simply a larger operating room equipped with advanced imaging. In reality, it is much more than that.
A hybrid OR combines the capabilities of a fully functional operating room with fixed interventional imaging, allowing physicians to perform sophisticated image-guided procedures while maintaining the ability to immediately perform open surgery if circumstances require. The result is greater clinical capability, increased procedural flexibility, and the ability to safely perform procedures that only a few years ago would have been considered hospital-based.
Importantly, not every cardiovascular ASC requires a hybrid OR. The decision should be driven by the anticipated procedure mix, physician preferences, long-term practice goals, and projected case volume. A hybrid OR is a strategic investment, not simply a technology purchase.
Designing a Hybrid OR Is Different
From a planning perspective, cardiovascular hybrid ORs are unlike most operating rooms. Unlike a conventional ASC, which is primarily workflow-driven, a hybrid OR is both workflow-driven and equipment-driven. The imaging platform influences nearly every aspect of the room's design.
The selected imaging equipment affects structural design, room dimensions, ceiling coordination, electrical capacity, HVAC systems, shielding requirements, control room layout, equipment rooms, and even the organization of adjacent support spaces.
One lesson we've learned is that the imaging system should not be treated as equipment that gets added later. It should be selected early because it drives many aspects of the room design. Changing imaging platforms late in design often results in redesign, added cost, and schedule delays.
Before You Plan a Hybrid OR...
Before selecting a site or beginning design, consider these questions:
The answers to these questions often determine whether a project proceeds smoothly or requires costly redesign later. In addition, select an experienced design team and vendors who have done it before.
Existing Buildings Present Unique Challenges
Many cardiovascular ASCs are developed within existing medical office buildings. While these projects can be highly successful, they require careful investigation before a lease is signed or design begins.
Questions that should be answered early include:
These are not questions that should be discovered halfway through construction. In our experience, one of the most valuable services an architect can provide is identifying these constraints before significant commitments are made.
Renovating and existing ASC to include a hybrid OR introduces additional challenges. Even a large existing OR may not provide enough space. The hybrid room requires control and equipment rooms which take up additional space that is often not programmed into existing ASC's.
Designing for the Future
Healthcare changes much faster than buildings do. The cardiovascular procedures being performed in outpatient settings today are significantly different from those being performed only a few years ago. That trend is likely to continue.
Rather than designing around today's equipment alone, successful projects create infrastructure that allows the facility to evolve. Additional electrical capacity, structural provisions, coordinated ceiling systems, and thoughtfully planned support spaces can significantly reduce the cost and disruption associated with future technology upgrades.
Good planning is not about predicting the future perfectly. It is about creating flexibility so the building can adapt as medicine continues to evolve.
Looking Ahead
We believe cardiovascular ambulatory surgery centers will continue to be one of the fastest-growing segments of outpatient healthcare. As physicians perform increasingly sophisticated procedures outside the hospital, facilities must evolve to support those advancements safely and efficiently. The hybrid OR is one important part of that evolution, but the larger story is the continued migration of cardiovascular care into the outpatient setting.
For organizations considering a cardiovascular ASC, the most important decisions often occur before design begins. Understanding future clinical goals, selecting the appropriate imaging platform, evaluating existing buildings, and planning for long-term flexibility can have a lasting impact on both operational success and future growth.
The most successful cardiovascular ASCs are not simply designed for the procedures being performed today. They are designed for the practice their physicians aspire to build tomorrow. Thoughtful planning, the right technology, and adaptable infrastructure create facilities that continue to deliver value long after construction is complete.
If HSA can assist in evaluating a potential site, determining whether a hybrid OR is appropriate, or helping you plan a cardiovascular ASC, we'd welcome the opportunity to share what we've learned designing these facilities across the country.