European Journal of Radiology, 16 (1992) lo-12 0 1992 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. 0720-048X/92/$05.00
10
EURRAD
00370
An imaging department for the 90s: 3 years experience M.A. Romeo, P. Skrtich and J. Alexander Department of Radiology, Hamilton Civic Hospitals, Hamilton, Ont., Canada
Key words: Radiology and radiologists, design facilities
Introduction At ISPRAD V, Florence 1988, we proposed a unique design for a modern imaging department in a paper titled ‘A Functional Radiology Model for the 1990s’. Within months of this presentation we were to occupy our new department and are now prepared to discuss our experience functioning within this model. Our design was formulated on two integrated concepts which include limiting patient flow to the perimeter of the department and on the grouping of examination rooms of compatible function around a common control area. These groupings we refer to as ‘pods’. The pods surround an inner core which provides optimal access to reception, booking, film library and reporting areas. Throughout the planning process we focused on design features which would improve statI efficiency and reduce duplication of equipment and operating resources. The design was to accommodate growth, adapt changing referral patterns and provide the flexibility to effectively incorporate new technologies. Our experience can best be described in the context of department location and major design features. Discussion Department location and access All diagnostic service departments are located in close proximity on the main floor of the hospital. Patients enter on this level and are easily directed between departments. We currently provide reception and Correspondence to:Dr M.A. Romeo, Department of Radiology, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, Ontario, L8L 2X2, Canada.
record handling for Nuclear Medicine and propose to provide the co-ordination and integration of in-hospital patient flow for all departments providing diagnostic services. A dedicated radiographic suite is located within Emergency but adjacent to the main imaging department providing backup and support with optimal access to more sophisticated equipment. This facility also services the fracture room area which requires that high volumes of patients be examined within a short period of time. Actual examination times are brief and radiographic facilities should be positioned to keep patient handling times to a minimum. Patientperimeter concept The design requires that patients be directed or transported around the perimeter of the department to waiting areas located adjacent to examination rooms. Multiple waiting areas have allowed us to provide some degree of privacy for our patients. Technologists appreciate direct access to their patients while volunteer and support staff assist in the management of patients within these areas. Originally we had been concerned about difficulties associated with decentralized patient waiting areas. We have installed an inexpensive television surveillance system which effectively monitors patients waiting in these areas from the trafhc control station. Decentralized waiting areas provide space suitable for expansion and reconstruction without losing the integrity of the basic design. Functional grouping of examination rooms (pods) This configuration consolidates expensive operational resources such as lead protective devices positioning aids and communication equipment including computer terminals. It provides direct access to auto-
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CORRIDOR
Fig. 1.
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CORRIDOR
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12
matic film handling equipment located in the general radiographic area and the emergency suite. We have recently replaced 3 dedicated cameras in the CT/Angie pod with a multiplexed laser system connected to a processor. The design facilitates incorporating this technology and we plant to install a second system in the Procedural/Ultrasound Pod. Eliminating the need to handle film has had a dramatic impact on productivity. The spacious common control areas facilitate quality control and supervision. Stti are working together in an environment conducive to co-operation and support. Productivity has increased as stti tend to remain in their assigned work areas instead of migrating to the stti lounge between examinations. Centralized reporting areas
Most radiographic examinations are reported in the general reporting area located as an extension of the film library. The two procedural Pods each have incorporated dedicated reporting areas. This arrangement provides effective management of patient files and direct access to assigned radiologists for supervision, consultation, and teaching. While efficient with our existing operation, these areas are ideally situated for adaptation to work stations required for digital imaging networking systems. Central core
Forming the nucleus of the department, the film library is directly adjacent to the main reporting area and is easily accessed by all pods. The optimal location and the inclusion of a fIm tracking module in our computerized information system have significantly increased our ability to efficiently manage patient records. These concepts could be applied to any size of department or expansion program. One variation of this design would group the cross-sectional modalities including CT and ultrasound with a high volume of out of hospital patients to the front of the department adjacent to the main waiting area. The fluoroscopic units utilized for longer procedures could then be grouped as one functional unit. Our department was designed to service a 430 bed
teaching hospital with tertiary care responsibilities in cardiovascular sciences, neurosciences, major trauma and burns. Our bed capacity and commitment to tertiary programs have remained unchanged since our plans were finalized, but we have experienced a dramatic 33 y0 increase in referrals from 70 000 to 93 000 examinations per year. The increases were most significant in CT, Ultrasound, Interventional and Angiographic procedures. We have been able to adapt to shifting referral patterns and to accommodate the increases with existing equipment and only a minimal increase in staff.
Conclusion
We remain totally committed to our model as originally proposed. Our experience attests to the inherent efficiency and flexibility of the ‘Patient Perimeter’ and ‘Pod’ concepts. As we plan for the future we are comfortable that we have room for growth in most areas, but could easily accommodate reconstruction without disrupting the integrity of the basic design required. Based on our experiences after 3 years we would make the following recommendations: Consider the importance of the physical location of your department relative to patient access and to other hospital departments. Maximize staff efficiency by providing direct access to patients, automated film handling equipment and operating supplies. Provide all staff access to effective communication systems including two-way hands free intercoms and computers. Plan for the future, provide the ability to expand and to adapt to changing technologies. Consider the acquisition of universal rather than dedicated fluoroscopic units. The flexibility of these systems would reduce the total number of units required, ensure optimum equipment utilization and reduce associated maintenance costs. Involve all sta.fTin the planning process. The input of users is invaluable and ownership of the project will ensure its ultimate success.
10
EURRAD
00370
An imaging department for the 90s: 3 years experience M.A. Romeo, P. Skrtich and J. Alexander Department of Radiology, Hamilton Civic Hospitals, Hamilton, Ont., Canada
Key words: Radiology and radiologists, design facilities
Introduction At ISPRAD V, Florence 1988, we proposed a unique design for a modern imaging department in a paper titled ‘A Functional Radiology Model for the 1990s’. Within months of this presentation we were to occupy our new department and are now prepared to discuss our experience functioning within this model. Our design was formulated on two integrated concepts which include limiting patient flow to the perimeter of the department and on the grouping of examination rooms of compatible function around a common control area. These groupings we refer to as ‘pods’. The pods surround an inner core which provides optimal access to reception, booking, film library and reporting areas. Throughout the planning process we focused on design features which would improve statI efficiency and reduce duplication of equipment and operating resources. The design was to accommodate growth, adapt changing referral patterns and provide the flexibility to effectively incorporate new technologies. Our experience can best be described in the context of department location and major design features. Discussion Department location and access All diagnostic service departments are located in close proximity on the main floor of the hospital. Patients enter on this level and are easily directed between departments. We currently provide reception and Correspondence to:Dr M.A. Romeo, Department of Radiology, Hamilton Civic Hospitals, 237 Barton St E, Hamilton, Ontario, L8L 2X2, Canada.
record handling for Nuclear Medicine and propose to provide the co-ordination and integration of in-hospital patient flow for all departments providing diagnostic services. A dedicated radiographic suite is located within Emergency but adjacent to the main imaging department providing backup and support with optimal access to more sophisticated equipment. This facility also services the fracture room area which requires that high volumes of patients be examined within a short period of time. Actual examination times are brief and radiographic facilities should be positioned to keep patient handling times to a minimum. Patientperimeter concept The design requires that patients be directed or transported around the perimeter of the department to waiting areas located adjacent to examination rooms. Multiple waiting areas have allowed us to provide some degree of privacy for our patients. Technologists appreciate direct access to their patients while volunteer and support staff assist in the management of patients within these areas. Originally we had been concerned about difficulties associated with decentralized patient waiting areas. We have installed an inexpensive television surveillance system which effectively monitors patients waiting in these areas from the trafhc control station. Decentralized waiting areas provide space suitable for expansion and reconstruction without losing the integrity of the basic design. Functional grouping of examination rooms (pods) This configuration consolidates expensive operational resources such as lead protective devices positioning aids and communication equipment including computer terminals. It provides direct access to auto-
/
CARD I OLODV
NVCL EAR
Ln
,,
STAFF
C0AR!00R
CORRIDOR
Fig. 1.
CORRlOoR
CORRIDOR
STAFF
12
matic film handling equipment located in the general radiographic area and the emergency suite. We have recently replaced 3 dedicated cameras in the CT/Angie pod with a multiplexed laser system connected to a processor. The design facilitates incorporating this technology and we plant to install a second system in the Procedural/Ultrasound Pod. Eliminating the need to handle film has had a dramatic impact on productivity. The spacious common control areas facilitate quality control and supervision. Stti are working together in an environment conducive to co-operation and support. Productivity has increased as stti tend to remain in their assigned work areas instead of migrating to the stti lounge between examinations. Centralized reporting areas
Most radiographic examinations are reported in the general reporting area located as an extension of the film library. The two procedural Pods each have incorporated dedicated reporting areas. This arrangement provides effective management of patient files and direct access to assigned radiologists for supervision, consultation, and teaching. While efficient with our existing operation, these areas are ideally situated for adaptation to work stations required for digital imaging networking systems. Central core
Forming the nucleus of the department, the film library is directly adjacent to the main reporting area and is easily accessed by all pods. The optimal location and the inclusion of a fIm tracking module in our computerized information system have significantly increased our ability to efficiently manage patient records. These concepts could be applied to any size of department or expansion program. One variation of this design would group the cross-sectional modalities including CT and ultrasound with a high volume of out of hospital patients to the front of the department adjacent to the main waiting area. The fluoroscopic units utilized for longer procedures could then be grouped as one functional unit. Our department was designed to service a 430 bed
teaching hospital with tertiary care responsibilities in cardiovascular sciences, neurosciences, major trauma and burns. Our bed capacity and commitment to tertiary programs have remained unchanged since our plans were finalized, but we have experienced a dramatic 33 y0 increase in referrals from 70 000 to 93 000 examinations per year. The increases were most significant in CT, Ultrasound, Interventional and Angiographic procedures. We have been able to adapt to shifting referral patterns and to accommodate the increases with existing equipment and only a minimal increase in staff.
Conclusion
We remain totally committed to our model as originally proposed. Our experience attests to the inherent efficiency and flexibility of the ‘Patient Perimeter’ and ‘Pod’ concepts. As we plan for the future we are comfortable that we have room for growth in most areas, but could easily accommodate reconstruction without disrupting the integrity of the basic design required. Based on our experiences after 3 years we would make the following recommendations: Consider the importance of the physical location of your department relative to patient access and to other hospital departments. Maximize staff efficiency by providing direct access to patients, automated film handling equipment and operating supplies. Provide all staff access to effective communication systems including two-way hands free intercoms and computers. Plan for the future, provide the ability to expand and to adapt to changing technologies. Consider the acquisition of universal rather than dedicated fluoroscopic units. The flexibility of these systems would reduce the total number of units required, ensure optimum equipment utilization and reduce associated maintenance costs. Involve all sta.fTin the planning process. The input of users is invaluable and ownership of the project will ensure its ultimate success.
