AIA, NCARB, CSI, ICC
Constructive Criticism columnist Paul Gladysz, AIA, NCARB, CSI, ICC, is the principal architect at BDA Architecture. The Albuquerque, New Mexico, firm specializes in the planning, design and construction of animal care facilities. Gladysz has over 35 years experience in design and managing animal care facility projects. He has been involved in more than 300 veterinary designs, including 20 award-winning projects. His areas of special interest include project delivery methods, including design/build and construction management; lighting; acoustical control and new construction materials and methods.Read Articles Written by Paul Gladysz
Veterinary medicine has enjoyed healthy growth for a number of years in the range of services offered. For many general practices and specialty hospitals, income and caseload growth are powered by expanded diagnostic and treatment modalities.
Carving out space for special procedures has become standard in both new and existing clinics. Clients are looking to add dental suites, rooms for ultrasound, endoscopy and laser therapy, and dedicated areas for what was once considered alternative medicine: acupuncture, massage and acupressure.
(A funny story: The firm I work at was programming a large veterinary hospital for a client in Hong Kong. When I asked about alternative medical services, the response was, “What do you mean?” I said, “You know, like acupuncture or acupressure.” The client answered, “Here we just call that medicine.”)
Over the coming months, I’ll cover a variety of procedure spaces. In this issue, I’ll discuss key planning points for dental care, which is by far the fastest-growing service at the majority of my firm’s clients.
Make a Shopping List
Special-procedure spaces generally fall into two types: single purpose and multifunction. Single-purpose rooms are equipment-driven, and dental suites fall into that category.
To design the space, you need to identify necessities. For example:
- Tables are either a plumbed wet tub or a non-plumbed collection style.
- Tub tables can be used for dental cleanings and other wet treatments, so they are more flexible. They are more expensive than collection tables because of the cost of water and waste piping.
- Collection tables can be used for dry treatments and dental cleanings. Most have the added benefit of being height-adjustable.
- Lift wet tables are available, providing the best of both options, but the cost is at the upper end.
- Dental X-ray can be handheld, pole mounted, spider-base mounted or wall mounted, the most common choice. If you go with the last option, placement is key because you must ensure that the reach of the mounting arms will cover the entire area where the animal’s head will rest. An 82-inch reach is about the maximum available. If you don’t have adequate wall space, a mobile pole-mounted unit is the most flexible and can be parked out of the way when not in use. The third option is a hand-held unit, which some practitioners prefer and others don’t care for.
- When choosing a dental machine, focus on function, fit and needed connections. Of course, the first consideration should be functionality: Will it do the things you need to fit your protocols? Next is fit. Where will it live? Some units are fairly small and will sit on a cart in the table’s knee space or be mounted there on a swing arm. Larger, taller units will need a floor parking space.
- Keep in mind that you will need an anesthesia machine. If it’s mounted on a cart, you can quickly run out of floor space. The option is a wall-mounted unit at the other end of the table. You will have the hoses draped across the table or over the animal, but it frees up space. Unless your hospital has central medical air, getting a unit providing an onboard compressor is best.
- Oxygen needs to be supplied at the table. Depending on the kind and location of the anesthesia machine, oxygen can be supplied from a ceiling drop, wall outlet or small tank with the machine.
- Lighting traditionally is supplied by ceiling-mounted fixtures. Today’s brightness-adjustable LED lamps are efficient and cooler. Gaining in popularity are loupe lights. Many practices use both.
- Waste anesthesia gas disposal, or scavenging, is necessary. If you are not using canisters, an active system is recommended. These days, central systems are available for a relatively small investment and can serve not just the dental station but also treatment and surgery areas. There’s no reason not to include this important safety feature.
- A room or ceiling exhaust fan is nice if it can be easily installed. Some procedures generate obnoxious odors, so my firm tries to capture them at the source.
- Ergonomics are very important. Dental procedures can be lengthy, and a busy practice can have them going all day. Height-adjustable stools and tables as well as wrist rests and back support will make for a much better and more productive workspace.
- Dental suites with multiple tables can be leveraged for greater utilization. A single wall-mounted X-ray machine can cover the working ends of both tables if positioned correctly. If that’s not possible, a mobile unit is the next choice. A splitter will allow two anesthesia machines to use a single oxygen drop. When my firm designs for a growing practice, we almost always plan for dual tables even if the second station is installed later.
But Where, Exactly?
Finally, dental areas should be located close to but away from the flow of the treatment room. Team members who perform cleanings need immediate access to doctors, so being remote can be problematic.
The main reason my firm is asked to create dedicated dental space is because using a main treatment table — the way many practices start — is fairly disruptive to the flow within the room. Having a team member seated at the end of a workstation often creates a roadblock for co-workers trying to walk past. If the dental suite is not in an adjacent, separate room, the best place would be an alcove visible from the treatment area.
Client education helps build a dental practice, but a well-thought-out suite sustains the service and maximizes productivity and income.
In coming issues, I’ll cover other specialty uses like ultrasound and endoscopy, acupuncture/massage, physical therapy, hydrotherapy and chemotherapy.
If you have a specific request, please let me know by emailing kniedziela@NAVC.com.
The American Animal Hospital Association’s newly updated “Dental Care Guidelines for Dogs and Cats” is available at http://bit.ly/2DBJvET. The resource is designed to help veterinary professionals identify and treat oral pathology in their patients and improve client education.
“Recommendations are given for general anesthesia, pain management, facilities and equipment necessary for safe and effective delivery of care,” according to AAHA. “To promote the well-being of dogs and cats through decreasing the adverse effects and pain of periodontal disease, these guidelines emphasize the critical role of client education and effective, preventive oral health care.”