In a report in the Jan 13, 2009 issue of the American Journal of Cardiology, Byrne and his colleagues wrote how an all-purpose cardio hybrid can be used for “every cardiovascular procedure, including traditional cardiac surgery, traditional vascular surgery, endovascular aortic procedures, electrophysiology procedures, or interventional coronary procedures.” They added that there were also financial benefits from the “synergy of teams, cross-training personnel, with overlapping of the OR team with the interventional team.”
Although construction and design costs can vary, it costs between $2.5 million and $3 million to equip an OR-catheterization lab hybrid, according to Edward Hernandez, vice president of Balfour Resource Group, a Nashville-based company that provides healthcare equipment and technology planning services.
“There's some danger of using a formula to say, ‘This type of room costs X,'” Hernandez says, because construction circumstances can have many variables. (He adds that equipment costs for neuro or vascular-specific hybrid ORs can cost from $1.75 million to $3 million to equip.)
Byrne says the space for Vanderbilt's 750-square-foot hybrid opened up when its new children's hospital opened and VUMC's existing pediatric catheterization lab moved to the new facility.
When the Smilow Cancer Hospital at Yale-New Haven (Conn.) opened in October 2009, it freed up space for a new cardio hybrid, says Ross Adam Cole, a principal with BAM Architecture Studio in New York.
“As soon as a hospital builds a new building, a game of musical chairs goes on,” Cole says.
But finding enough space isn't always easy. Byrne says at least one wall was knocked down to create Vanderbilt's hybrid, and Cole says usually 600 to 1,000 square feet is necessary for the surgical space and adjoining control room. “I've never seen anyone do this at 400 square feet,” he says.
David Miller, a principal with Earl Swensson Associates in Nashville, worked on the Vanderbilt hybrid and says the most important people to get feedback from are the project's “champion” at the institution and its equipment planner.
“We usually design these together,” Miller says, adding that most of these projects have the same starting point.
“I've learned over the years to ask the surgeon or the surgical team where they want the patient's head to be,” he explains. “When you get these basics in place, the rest of the equipment goes around that.”