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Inside information

A room dedicated to ultrasound or endoscopy — or both — requires thoughtful layout and certain fixtures to ensure efficiency.

Inside information
A multipurpose room accommodates endoscopy and ultrasound patients. The cabinet in the back corner is used to store scopes.

Some diagnostic and treatment procedures once found only in specialist facilities are turning up in a wider range of practices because of greater equipment options and higher standards of care. In the last issue of Today’s Veterinary Business, I discussed planning a dedicated dental procedures space. This month, I will cover how to design rooms for ultrasound, endoscopy and multipurpose use.

Ultrasound

The first consideration is the type and size of the ultrasound unit. Placement relative to the exam surface and the practitioner will set the minimum size for the room.

A right-handed or left-handed layout can be chosen if space is limited. Ideally, you want a room that can accommodate right and left since not all practitioners hold the probe in the same hand. If the room will be your primary space for ultrasound procedures and you are left-handed, that should be the default layout.

An ultrasound-only room usually needs minimal storage space. Some supplies and positioning aids can be kept on open shelves.

Here are other considerations:

  • A tight but functional layout can be done in an 8-by-8-foot room. Ten by 10 or 10 by 12 is large enough for almost any single station layout.
  • Having a workstation for data input is helpful and could be used for image interpretation. However, if your practice has lots of ultrasound patients, another reading station might be needed to avoid bottlenecks.
  • The exam surface can take one of several forms depending on your budget and the types of scans. A variable-height table is preferred. A mobile table allows for patient rotation and easier access to the scan site. For this reason, a mobile lift gurney might be a good choice.
  • Some practitioners prefer an echocardiogram-type raised surface with access ports that allow scanning from below.
  • Darkening of the space should be available so that the scan screen can be easily viewed. Exterior windows should be avoided. Interior windows should be kept to a minimum to reduce lighting spilling in from adjacent areas. Some light spill can be controlled by shades, blinds or shutters, but these options are not perfect and will increase maintenance needs.
  • Interior light from the ultrasound unit is often enough for ambient needs. I recommend installing dimmable fixtures to give you a wider range of lighting choices. Today, most commercial fixtures are LED based and come with dimmer switches. An exam light usually is not needed.
  • Most ultrasound units use standard 110-volt electrical outlets. Having outlets on each wall will allow for more layout options.
  • The room should be capable of oxygen and anesthesia gas venting and disposal. If your hospital has a central system, gas and vacuum drops can be added to either the head wall or ceiling.
  • Ultrasound does not have plumbing needs other than hand and equipment washing, so a standard hand sink inside or near the room is sufficient.
  • Ultrasound typically does not produce odors, so exhaust equipment is not needed. The door to the room often will be closed and the room occupied by one to three people plus the patient, so ventilation and air conditioning should be based on comfort.
  • As long as the ultrasound room is reasonably accessible, it can be relegated to a quieter, more remote area of the hospital.

Endoscopy

Because of the nature of endoscopy, the room arrangement does not have to be as flexible as with ultrasound because the veterinary team almost always is working at the end of the patient. A peninsula arrangement of wall counters and cabinets, with the exam table projecting from it, works best in most instances.

A compact endoscopy room.

When setting up an endoscopy room, weigh these factors:

  • It can be done in a 10-by-10-foot space, though 10 by 12 allows for better circulation and equipment storage.
  • While ultrasound is a relatively mess-less procedure, endoscopy is often the opposite. A collection table can be used, but a wet tub table is preferred. One advantage of the longer tub table is that washing of the fiber bundle can be done with minimal bending, helping to prevent broken fibers.
  • A hand wash sink inside the room is preferred.
  • Someplace is needed to hang and store scopes and fiberoptic bundles. The solution is usually tall, vented cabinets against a wall and with scope hooks. Hanging is preferred over coiled storage so that the fiber bundle doesn’t develop a curve memory. The cabinets can be purchased from commercial suppliers or fabricated by a casework shop. Eight inches deep by 24 inches wide is sufficient for up to three scopes.
  • As with ultrasound, having a data-input workstation in the room is helpful along with ample countertop space and the aforementioned cabinetry. A 10-foot-wide room with cabinets and countertops along one wall and a wet table in the center will allow sufficient space for almost any situation.
  • Endoscopy rooms need to be bright enough for the prep and cleanup work but allow for darkening during the actual scoping. Dimmable ceiling LED fixtures work well.
  • Just as with ultrasound, an oxygen supply and anesthesia gas venting are needed. Again, wall or ceiling drops from a central system can be used, depending on the type of anesthesia machine.
  • Endoscopy is often an odor-producing procedure, so a separate exhaust fan should be installed and operated by either a manual on/off or timer switch. The fan grill should be located as close to the end of the exam table as possible.
  • Endoscopy in most cases does not need to be performed near a treatment room. As long as the endoscopy room is reasonably accessible to staff and can accommodate a gurney, it can be farther away.

Multipurpose Rooms

Veterinary hospitals often cannot accommodate separate rooms for each special procedure, so having one room for everything is common. Also, because the cost of construction generally is rising faster than the inflation rate, I try to design as much utility into a given space as possible.

A simple strategy is to take the worst-case requirements for each procedure and bundle them in a single space. The issue becomes one of caseload and scheduling. As the practice grows and the staff sees the value in adding modalities, conflicts and bottlenecks can occur.

To be as efficient with space as possible and still allow for maximum caseload, I might propose:

  • Building a single dual-table room rather than separate rooms. When my firm does this, we allow for soft room separations using light-blocking curtains on ceiling tracks.
  • Using portable ultrasound equipment when a dual table setup is not possible. Ultrasound can be done in other rooms, such as those used for exams and X-rays, as long as a table is present and the room can be darkened.
  • Dedicating space outside the room for pre- and post-procedure activities. Endoscopes can be washed elsewhere. Images can be read and results documented in an office equipped for it. Animals can be induced and recover in treatment or pre-op. The goal is to free the space as quickly as possible.

In the next installment, I will cover alternative medicine and rehabilitation spaces.

Constructive Criticism columnist Paul Gladysz is the principal architect at BDA Architecture. The Albuquerque, New Mexico, firm specializes in the planning, design and construction of animal care facilities.

ultrasound

A mobile lift gurney serves as an exam surface for ultrasound procedures.

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