News - March 2019
Pressure on the NHS has never been greater, and with more patients and the expectation of shorter treatment times, the challenge is on for trusts to carry out more operations.
Often this means upgrading current theatres or building completely-new surgical facilities.
But developing these from scratch using traditional construction methods is hugely costly, time consuming, and disruptive.
So a new generation of facilities is increasingly being commissioned – utilising offsite construction methods.
Alan Wilson of ModuleCo said modular solutions had become key to meeting the demand.
“NHS trusts operate in a volatile environment where government funding is uncertain in the long term, yet the demand for acute services increases year on year,” he said.
“A key component in any acute hospital is the operating theatre and we find that trusts are using modular theatres for a number of reasons, including to enable continuous operation during site-wide rebuilds, or for the provision of specialist surgical services.
A quick turnaround
“Off-site construction techniques such as modular build have developed enormously in the last 10 years and, most commonly, modular theatres can also be used as permanent facilities, provided in rapid time-scales and with funding options available including hire.”
Key benefits compared to traditional construction methods are that overall programme times are reduced by more than 50% and time on site is cut by half, reducing on-site disruption and environmental impact and enhancing site safety.
And assembly is carried out in a clean, controlled, factory environment that guarantees a superior build quality.
“Process-driven factory construction methodology enables programme and budget certainty, so, critically, trusts know what they will pay and when they will be operational,” said Wilson.
“Flexibility is assured through designs that allow for future expansion by increasing the building footprint or providing additional storeys.”
ModuleCo recently handed over a modular operating theatre to Bedford Hospital.
The facility sits on a podium directly above the main entrance, which enables it to feed directly into the main theatres at first-floor level.
“This was a challenge in itself, but due to it being a modular solution, we were able to install it while maintaining minimal disruption to the main entrance,” said Wilson.
The company also delivered two orthopaedic theatres to the Royal Berkshire Hospital in just 24 weeks and these enabled the trust to carry out an additional 2,800 operations every year.
“It is reasons like this that make this approach increasingly popular,” said Wilson
“The use of modular theatres is routinely enabling trusts to respond to capacity demands and estates redevelopment in an agile and efficient way and with no compromise on quality, aesthetics or permanence.”
MTX has been designing and building modular operating theatres since the 1980s and these can seen in use up and down the country.
Recently the team worked with Wrexham Maelor Hospital to design a bespoke two-storey operating facility made up of 31 modules and providing 751sq m of space.
It comprises two operating theatres, an endoscope procedure room with admission room, two recovery wards, an anaesthetic room, a nurse base, a staff Room, scrub-up and prep rooms, staff shower rooms, toilets, a waiting area, changing rooms and endoscopy cleaning and drying rooms. The top floor houses two plantrooms; one serving the endoscope and recovery areas and the other serving the operating theatres.
The company has also provided a new orthopaedic theatre at Guy’s Hospital in London.
An example of the flexibility of modular construction methods, the latter was built onto a transfer deck at first-floor level adjacent to the existing theatre department and was craned in out of hours to avoid disruption.
And it’s not just modular operating theatres that are being specified. The additional flexibility of mobile solutions is also proving popular.
Vanguard has responded to this demand with both a standard theatre offering and a more-advanced laminar flow solution and claims uptake has soared since 2000.
A spokesman said: “Mobile operating theatre facilities can offer a significant increase in capacity during downtime for theatre refurbishment or during periods of high patient demand.
“They give hospitals a reliable, safe answer to capacity pressures across a range of specialities and procedure types.”
Standard mobile operating theatre facilities offer HEPA-filtered environmental air that conforms to Grade C EUGMP, with up to 30 air changes per hour passing over the patient.
Vanguard’s solutions also include an anaesthetic room, scrub area, two-bed first-stage recovery area, integrated medical gas banks, changing rooms, and utility areas.
And installation takes just three to four hours, another major plus point for hospitals that need to maintain services round the clock.
The more-recently-launched laminar-flow option is widely used across the NHS for specialist procedures including hip replacements, knee replacements and joint revisions.
They conform to Grade A EUGMP, with up to 600 air changes per hour.
One organisation utilising this approach to service enhancement is University Hospitals of Morecombe Bay NHS Foundation Trust which has installed a mobile laminar flow operating theatre from Vanguard at Westmorland General Hospital in Kendal.
Connected to the main hospital by a corridor and ramps to provide a seamless patient journey, the unit is expected to be on site for 24 weeks while refurbishment work is carried out on site.
And Northern Lincolnshire and Goole NHS Foundation Trust commissioned a unit to help it increase capacity by an estimated 120 procedures a month in preparation for winter pressures.
Best in class
It is for these more-short-term uses that mobile facilities are increasingly being used as opposed to the longer-term modular option.
At the launch of the laminar-flow solution during the 2018 Healthcare Estates show in Manchester last October, the Institute of Healthcare Engineering & Estate Management’s new president, Ian Hinitt, said of the impact of modular and mobile operating theatres: “These are deployed all over the UK, and in fact, across the globe. They add capacity and they assist in emergency situations as well as in planned refurbishments.
“And they are not just impressive from the outside – inside they feature all those things clinicians and others have asked for. There is increased space, refined scrub areas, best-in-class lighting, and surgeons’ panels. There are also enhanced software capabilities and they work seamlessly with existing infrastructures and systems, making them ideal for healthcare environments.”