By Julie Eisele
On a Tuesday afternoon at William Beaumont Hospital in Royal Oak, MI, John Doe's open heart surgery
was proceeding as expected. He was breathing with the help of a ventilator. The pulse oximeter clip on his finger showed normal oxygen levels. A blood pressure cuff squeezed Doe's right arm at set intervals. His heart was no longer beating, resting as a heart-lung machine did the heart's work, while surgeons toiled to repair a damaged valve.
But the situation changed quickly. The anesthesia machine malfunctioned. The operating room lights dimmed. The power failed. The heart-lung machine clicked off, then chugged back on 10 seconds later as an emergency generator kicked in. Then the fire alarm blared.
Every move was caught on digital video for later critique of staff actions and reactions. Linked with an advanced AV system that records temperature, heart rate, respiration, and blood pressure, the simulated patient can be programmed to confound those working on him, giving medical professionals a chance to navigate tricky scenarios in a realistic way without jeopardizing a patient. The AV system is connected not only to the mock patient, but also to video production services and to building systems (such as lighting and the fire alarm functions).
This is a typical training scenario at the Marcia and Eugene Applebaum Surgical Learning Center, located in Beaumont Hospital, a large care center in suburban Detroit where more than 54,000 surgeries are performed each year. The 5,500-square-foot center includes three main areas: two mock ORs - one for simulated patient training, another for training on the da Vinci Surgical System, which uses robotic technology to perform operations; a bioskills learning area; and a 50-seat classroom. Reception and conference areas are contained within a light-filled glass greenhouse. A $2.5 million gift from the Applebaums made the learning center a reality when it opened in the hospital's South Tower, a recently completed eight-floor project that added more than 650,000 square feet.
Creating Harmless Disasters
The bold move to meld AV function, technology, and architecture is part of the hospital's commitment to change from patient-based training to simulated training. "The vision is to shift the learning curve for surgical techniques and procedures out of the operating room to the extent it can be done effectively," says Charles J. Shanley, MD, senior vice president and chairman of the department of surgical services at Beaumont. He is also the learning center's executive director. Shanley cites a 2000 report by the Institute of Medicine, "To Err is Human," in which the authors suggest that simulation should be used more liberally to improve patient safety and facilitate training and education.
Officials at Beaumont - which ranks first nationally in inpatient admissions and has the second-highest volume in the country for surgeries - took that advice seriously and folded the recommendation into the hospital's expansion plan.
A Critical Operation
Planning and completing the facility were carried out like a delicate but swift surgery. Design and construction timelines were clipped by about half the typical schedule; the amount of space available was limited; and the project included many technical requests that had to be smoothly combined by the design-construction, architectural-engineering, and hospital team members. The team had a budget just under $1 million ($922,408).
"We had to install the AV technology as an overlay to the building systems, medical systems, and simulation systems, and make all these systems work together. The user knew what they wanted and we took it, like a box of parts, and put it together," says Archie Lytle IV, PE, CTS, the center's AV designer and director of technology at Barton Malow Co., Southfield, MI. Barton Malow was the design-builder and construction manager. The project team included Barton Malow; its in-house AV division, BMC Technology Services; Harley Ellis Devereaux, a planning, architectural, and engineering firm, also in Southfield; and hospital representatives.
Aside from the typical architectural challenges of budget, space, and time constraints, Rick Hall, AIA, project architect, says the need to blend technology and architecture was an exceptional feature. As principal of the healthcare studio division at Harley Ellis Devereaux, Hall has extensive hospital experience. But this project was more like a hospital-broadcast studio combination. "This space had many specialized technical needs, especially AV needs. It was like creating a set for a TV show, yet the ORs had to have the fit and feel of real ORs," he says.
Linking the AV system to various building functions was new to the team. "That was one of the biggest challenges. There are very few similar facilities across the country," says project director Jennifer Macks, PE, of Barton Malow. Beaumont officials toured several major simulation facilities in North America, but none were as sophisticated as the facility they envisioned.
The fixtures chosen - such as backlit wall panels, procedure tables in the bioskills area, and finishes in the conferencing area - were higher-end compared with most hospital projects. "The space has a bit of dramatic flare, which you don't normally find in high-tech medical facilities," notes Hall.
The theatrical setting called for clean and uncluttered lines, meaning technology had to be hidden where possible. This was achieved by built-in, pull-down wall racks that enabled quick access to equipment when needed and easy storage when not. Other options included equipment that was easily retracted and stored, such as Draper projection screens. Customized storage units by Middle Atlantic Cabinets were placed around the perimeter of the room, concealed to create a seamless appearance. Building and AV systems navigate through the learning area using an exposed steel strut ceiling; everything above the strut was black or painted black to recede, giving off an ultramodern atmosphere. "We wanted this to look very high-tech. It was difficult because there were many specialized features," Hall notes.
A system by Creston Electronics controls and orchestrates the various building and AV systems and components. Normally, when a surgical suite is constructed, the electrical, surgical, and surgical video systems stand alone. This control system interrupted and integrated these functions through a master AV controller, along with alarm systems, lighting functions, and "patient" vital statistics functions that allow users to create emergency scenarios in the OR "much like a flight simulator that pilots use," says Hall.
Treatment episodes in both ORs are captured to a Telestream Video Digitization MAP Create & Review system, routed through Sierra audio and video switches that use multiple SONY PTZ Evid cameras. Sessions can be broadcast to observers in the adjacent bioskills learning area, where training stations are linked to the ORs via LG 17-inch LCD monitors. Screens are placed strategically to avoid congestion, angled above workstations in the ORs and in the bioskills area on Peerless wall-arm units. The technology is programmed so that any of the bioskills learning stations can become a broadcast presentation area.
Separated from the ORs by a glass wall, the bioskills learning area contains a tissue lab and 10 individual stations for training on suturing and surgical procedures; up to 60 students can practice skills individually or in a group. Users may view and interact with doctors locally and worldwide. Multiple Marconi Video Conferencing Units (VMC5400) allow videoconferencing, and a Telestream Digitization System residing on several Dell servers enables eight simultaneous channel playback options.
The nearby classroom and the center's conference room are also equipped with the Marconi Video Conferencing and Telestream Digitization technology. This enables a large group to participate in interactive training.
Though the project was fast-tracked, every decision was approached carefully. For example, the facility needed high-intensity lighting. But would that interfere with video filming procedures in the learning center? "Because we needed high-intensity lighting, we had to choose interior products carefully. Chips of interior products - such as countertops - were flown in and tested for reflectivity. We had to make sure we didn't have lighting hot spots," says Macks. Accordingly, the team selected light-colored interior finishes to avoid lighting feedback while filming.
Fitting all the components into the allotted space was also difficult. "We had to shoehorn things in," says Lytle. In the ORs and in the bioskills learning area, cameras were placed out of the way by blending them into the walls. Audio-Technica Omnidirectional ceiling microphones and JBL full-range ceiling speakers help meet communication needs without infringing on workspace. Some Telex wireless microphones and intercoms were networked with the system as well.
Because of the space crunch, planners were unable to devote one room to placement of equipment. Instead, the technology was dispersed throughout the facility. Audio, visual, and data connections were concealed within wall panels.
A Healthy Outcome
Since it opened in May 2006, the center has become a hub of activity for medical professionals and students and a model for other medical learning centers. In fact, Beaumont is one of just 10 institutions in the United States that has met the American College of Surgeons (ACS) Accreditation of Education Institutes, designated as a Level I ACS Accredited Education Institute. "This recognition, I believe, speaks volumes," says Shanley.
Want to learn more about this project? Watch the webinar on September 5. Go to http://www.architechmag.com/webinars/avawards to register today. This event is free.
PRODUCT LIST: WILLIAM BEAUMONT HOSPITAL SURGICAL LEARNING CENTER
Audio-Technica ES933WC ceiling microphone
Chief Pro-U wall mount, RPA series projector mount
Crestron AV2 and Pro2 control systems, RF STX-1700CXP 6" two-way wireless panel, TPS300L and TPS
4500V 6" wired panels w/video
Crown CH1 amplifier
DataVideo TLM-404 quad monitor, SE800AV AV switcher
Dell Laptop Latitude D810, Power Edge 2850 Server, Power Edge 4210 Server Cabinet
Draper Electric screen, electric projector lift
Eiki LC-X60L 4000 ANSI XGA projector
Elmo HV-5100XG document presenter
Extron VSC500 60-476-01 scan converter
JBL Control 25T ceiling speakers, Control 26CT ceiling speakers
Kramer PIP-200 picture-in-picture inserter, VP-703SC scan converter
LG RU17LZ50C 17" LCD monitor, VMC5400
Marconi Video Conferencing Unit
Marshall V-LCD15 15" monitor, VR43P triple monitor, VR44P quad monitor
Middle Atlantic MRK44-26AXS rack cabinet
NEC 4010BK 40" LCD monitor
Panasonic AG-VP310 DVD/VCR combo unit, DMRT6070 DVD recorder w/hard drive
Peerless WMJ018 wall-arm assembly
Rane ECA2 echo canceller module, ECM82e matrix audio mixer
Raritan DKX416 KVM switch
Sharp XG-PH50X 4000 ANSI XGA projector
Shure MX692/C UHF boundary microphone, SLX14/84 UHF microphone, SLX24/SM58 UHF handheld microphone, UHF receiver UC4
Sierra 1212VS 12x12 audio/video router, 3232V5S 32x32 RGBHV & audio router, 3232VS 32x32 audio/video router, 88V5S 8x8 RGBHV & audio router
SMART PR-series SMART board display overlay
Sony EVID70 PTZ camera, FWD50PX1B 50" plasma w/speakers, PFM42X1-B 42" plasma w/speakers
Telestream Video Digitization MAP Capture and Review
Telex UHF BTR700 wireless system, PH-88 headset/mic, SS-1002P desktop intercom station, TR700 wireless
Videotek ADA-16 audio distribution amplifier
Laerdahl SimMan 380004 Patient Simulator