Modular ambulatory surgical units
The provision of elective healthcare is increasingly migrating towards the outpatient ambulatory surgical setting, with the most recent addition being that of minimally invasive spine surgery. The advances in techniques and technologies over the last decade have propelled the treatment of spinal disorders into the 21st century, with their muscle sparring approaches and minimal blood loss profiles. Due in large part to these factors the majority of spine care can now be safely performed in an outpatient setting, with the patient able to be discharged home the same day.
Within the US these outpatient spine procedures are carried out in ambulatory surgical centers that are generally constructed on site using the typical materials of construction such as cement, metal and brick. The energy footprint that is created in the construction is significant and of even more concern is the energy requirements that are required to run the facilities. In essence these outpatient facilities, although vastly more efficient than hospitals, are still considered sub-optimal in terms of their ‘green’ credentials and continue to use resources in arguably an inefficient manner.
One of the pressing concerns of the 21st century is the issue of fossil fuel energy and in particular its deleterious effect on the environment. In addition there is a finite amount of the material and at some point the planet’s resources will become exhausted. The arena of renewable energy has been gathering momentum over the last decade, as the scientific communities realize the short energy timeline on which man currently exists. These issues are without question entirely applicable to the healthcare sector, which is probably one of the most wasteful from an energy standpoint. To address this problem requires the conceptualization of energy efficient healthcare units that are able to provide the same quality of healthcare as provided by the traditionally constructed ambulatory surgical units. In addition to make this venture a viable business requires that the market be global, and in this consideration it also necessitates that the units be configured in such a way as to enable their placement off the energy grid and capable of being self-sustaining.
An ambulatory surgical unit has a distinct energy profile which depends on the nature of the surgical equipment being utilized in the facility. Certain elements of the surgical suite require greater amounts of energy such as the radiological C arm and the surgical lighting. On all units manufactured in the US there is back up generator that starts if there is a power failure and these units are vast consumers of energy. Interestingly the more efficient the surgical team and the quicker they can safely perform the cases the better is the energy profile of the center.
A US patent has been filed regarding the design of the modular surgical units and development is under way to produce the first prototype. The key component of the design is simplicity and a focus on removing energy redundancies from the system. Prior to the filing of the patent an extensive energy analysis of a one room surgical center in NJ was performed and parts of the grid were identified as being wasteful and clinically unhelpful. It was surprising to note the complete lack of energy thermostats throughout the building which in and of themselves would contribute to at least a 5% saving of total energy expenditure. However one of the most critical aspects of the design that contributed to the poor energy profile of the building was the use of poorly insulated brick and concrete. In addition there were no devices installed to extract the heat from the anesthetic gases emitted through the building ducts. These additions are cheap and if appropriately placed can lead to at least a 2% reduction in the EP.
To design a unit that was light, functional, mobile and able to be placed off the grid in remote parts of the world meant thinking outside of the healthcare construction ‘box’ and in this case it started with an analysis of the work of the British architect Norman Foster whose pioneering work on the use of lightweight solar infused building blocks, first successfully employed in the development of buildings constructed in the gulf region. Foster had worked out a way to have the functional units of a variety of buildings manufactured cheaply off-site and then transported to the assembly location. The financial savings compared to the shipment of concrete blocks and their construction was of factor of ten. Similarly the modular surgical units will be constructed from patented solar panels whose internal construction is already configured to include the plumbing and electrical requirements for an ambulatory surgical center. The solar panels will contain high grade solar energy transducers that have been calculated to create enough energy to sustain a particular number of surgical cases in a 24 hour period and most relevantly in off grid regions. This unique characteristic of the patented units will allow the delivery of modern healthcare to parts of the world that are currently lagging on the WHO list of health indices.
The component of medical training will be achieved through the incorporation of video conferencing facilities which have become extremely affordable, and in addition to the use of advanced imaging goggles the exchange of real time surgical detail with experienced surgeons in other parts of the world will ensure the maintenance of quality care.
The healthcare sector is undergoing a revolution that is technologically based and it seems that at last the parochialism of the ‘profession’ of medicine is being forced to bow out.