EP0398079A1 - Modular mobile surgery centre - Google Patents

Abstract

The centre has a circular shape provided with a structure having at least one storey which can be radially and concentrically divided. The operating block comprises, on the ground floor, a waiting room (20) and toilets; and, on the first floor, an aseptic corridor (23), an operating unit (22) at the centre of this corridor (23) and a post- operative recovery room (24) outside this aseptic corridor (23). A lift (21) connects the ground floor to the first floor, this lift (21) being accessible from the waiting room (20) on the ground floor and from the aseptic passage (23) on the first floor. <IMAGE>

Description

In various fields of surgery and microsurgery, in particular for surgical procedures requiring only local or regional anesthesia and more particularly for ocular microsurgery, we have been oriented for a few years towards ambulatory surgery.

This technique of ambulatory surgery has been made possible by the development of a comfortable and flexible loco-regional anesthesia technique, the sophistication of microsurgical equipment, particularly sutures, the perfect development of the surgical procedure or for a specific intervention.

This technique of ambulatory surgery is also highly desirable because it allows greater moral comfort, and therefore less stress for the patient who is only separated from his family and his usual environment for a short time. This technique also makes it possible to significantly reduce the cost of a surgical intervention, the duration of hospitalization, the immobilization of hospital premises and the use of hospital services being greatly reduced.

Unfortunately this technique of ambulatory surgery cannot at present be generalized and optimized because, whether it is practiced in a hospital environment or in a practitioner's office, the premises and infrastructures available are unsuitable for the repetitiveness of the procedure. 'surgical procedure.

The present invention attempts to solve this problem by new design of a modular surgical center specially equipped for ambulatory surgery, possibly supplemented by a short-stay hotel and essential ancillary services. The design of this ambulatory surgical center must also include an operating module or unit that meets the specific constraints of ambulatory surgery and can be supplemented by sterilization, consultation, short-stay, and administrative modules. The design of the center is modular and must respond to the possible industrialization of the main elements of its structure.

The subject of the present invention is a modular ambulatory surgical center comprising at least one operating unit meeting the characteristics listed in claim 1.

• La figure 1 est une vue schématique en plan de la distribu­tion des locaux au rez-de-chaussée d'un centre de chirurgie ambulatoire comportant au moins une unité de chirurgie ambulatoire.
• La figure 2 est une vue en plan schématique du premier étage du bâtiment de la figure 1.
• Les figures 3a et 3b illustrent une unité de chirurgie am­bulatoire modulaire du bâtiment illustré aux figures 1 et 2.
• La figure 4 illustre en plan et schématiquement une partie d'une variante du centre hospitalier muni d'une unité chirurgicale ambula­toire.
• La figure 5 est une vue en perspective du module de l'unité de chirurgie ambulatoire du centre illustré à la figure 4.
• La figure 6 illustre un bâtiment d'examen d'un centre hospi­talier conçu avec les mêmes structures que les centres précédents.
• La figure 7 illustre un centre de chirurgie ambulatoire avec un bâtiment d'examen et un bâtiment contenant des unités de chirurgie ambu­latoire.

The attached drawing illustrates schematically and by way of example a particular embodiment of an ambulatory surgical center as well as an operating module of this center.

• Figure 1 is a schematic plan view of the distribution of premises on the ground floor of an ambulatory surgery center comprising at least one ambulatory surgery unit.
• Figure 2 is a schematic plan view of the first floor of the building in Figure 1.
• Figures 3a and 3b illustrate a modular ambulatory surgery unit of the building illustrated in Figures 1 and 2.
• FIG. 4 illustrates in plan and schematically a part of a variant of the hospital center provided with an ambulatory surgical unit.
• FIG. 5 is a perspective view of the module of the ambulatory surgery unit of the center illustrated in FIG. 4.
• Figure 6 illustrates an examination building of a hospital center designed with the same structures as the previous centers.
• Figure 7 illustrates an ambulatory surgery center with an examination building and a building containing ambulatory surgery units.

The ambulatory surgical center according to the present invention is specially designed and produced to optimize the surgical procedures that can be performed on an ambulatory basis by the circulation of patients and hospital staff. On the other hand it is designed in the modular mode so as to present maximum flexibility of realization while using in the most rational way elements or blocks that can be industrialized in their structure and pre-equipped. It is thus possible to respond to specific requests depending on the size of the surgical center and the type of surgery or microsurgery performed there according to the wishes of the users.

The typical ambulatory surgical center according to the present invention consists of a building which may consist of different modules in the form of sectors of a circle and comprising a ground floor and if necessary a first floor.

The ground floor is intended for the circulation and reception of patients, their families and accompanying persons and may for example have a circular modular structure comprising:
- reception rooms
- distribution and patient circulation corridor
- one or more consulting rooms with their adjacent technical unit, in one or more modules.
- a short-stay hotel module.

The first floor, which is accessed by elevators, is in principle reserved for patients and technical staff: carers, surgeons and nurses. It vertically extends the modular structure of the circular ground floor and may for example include:
- one or more operating theater modules served by individual elevators
- changing rooms
- sterilization units registered in a typical modular space,
- rest units for surgeons and post-operative for patients
- conference and administrative premises.

In such a modular and unitary structure, it is possible to create zones of different degree of sterility and paths for patients, hospital staff and equipment which are different and minimize contamination of the sterile zones.

The circular modular concept can be industrialized in its main structural elements as well as for the pre-equipment of the different blocks, units or premises, it results in obvious advantages such as significant savings on the cost of construction although of traditional quality , very short construction and therefore availability times, and this is very important to later allow the distribution to be modified and an additional floor to be installed, which allows the center to be enlarged quickly and at a lower cost.

The ambulatory surgical center can be uni- or multidisciplinary. Indeed, the modularity of the surgical center makes it possible to group surgical units from different disciplines such as ophthalmology, hand surgery, stomatology, paradontology, otorinolaringalogy, radiology, gynecology, medical analyzes, to name only the most important. In general, all surgical or diagnostic disciplines that can be carried out on an outpatient basis or with a short hotel stay, can be considered in such a center with optimal use.

A typical example of an ambulatory surgical center according to the invention may include a building which essentially comprises a metallic structure with a reinforced concrete slab 34 meters in diameter. This slab is seated on a set of foundations made up of continuous or insulated footings.

From the start, the foundations are planned to allow the subsequent construction of 2 or more additional floors.

The earthworks carried out allow the existence of a crawl space in which circulate all the supply or discharge networks.

The modular design of the surgical center is based on the use of a metal framework comprising 15 geometrically identical sectors of a circle.

The planned height of the structure is such that it allows a ceiling height of 2.70 meters while providing a sufficient vacuum between the ceiling and the upper slab for the passage of conditioning ducts and various specific supplies as well as the network extension on upper floors.

The roofing is carried out by a concrete slab resting on the metal structure. This slab is intended to receive the necessary thermal insulation and sealing materials. Lan's pose dull or illuminating can be considered.

The facade consists of a curtain wall and includes a grid of horizontal and vertical profiles in which are included the lighting flush and the light full panels.

The glazing is double, insulating and reflective (light shade or bronze).

The architecture of the facade is enhanced by bands and battlements made of anodized metal elements or pre-painted in the oven. The floor coverings, according to the destinations and the choice of the user, will be treated in tiling on screed, carpet and upholstery.

The internal separations are:
- either in single or double light partitions,
- either heavy elements: cement blocks or reinforced concrete sails.

The electrical installations are carried out in accordance with S.I.A. The whole building is air conditioned (summer / winter). The facilities are grouped together in a boiler room; distributions are carried out by pipes and ducts in crawl space and in the ceiling void.

The heating installation also includes a pit for the fuel tank.

In sterile areas (operating room, clean corridor, airlock, etc.), the air purification will be in accordance with the different classes corresponding to the assignments of the "Clean room" premises.

The building will be equipped with all the essential equipment to comply with safety rules, in particular fire, emergency exits, necessary in this area.

The modularity of the structures in concentric circles allows the assembly and disassembly of partitions according to the varying needs of users without impacting works.

The essential part of the modular ambulatory surgical center is obviously the operating module, its design and its circulation which makes it a standard unit of ambulatory surgical treatment adapted to the most modern techniques and requirements.

Figure 1 schematically illustrates in plan the configuration of the ground floor of an ambulatory surgery center according to the invention. We can clearly see the radial structure divided into sectors. In the example illustrated, this center comprises on the ground floor an entrance 1 giving access to a circular public corridor 2 serving a number of individual living rooms 3, as well as common premises such as cafeteria 4, toilets, changing rooms, examination rooms, administrative premises, etc. This ground floor is therefore for the most part at least public and therefore not sterile.

On the first floor, FIG. 2, this center comprises, still organized along this radial structure, occupying part of the central area one or more operating theaters 5 surrounded by airlocks for the patients and for the treating staff. A clean corridor 6 surrounds the airlocks allowing surgeons and nursing staff to access the various premises on this first floor from a reserved entrance and also reserved cloakrooms. Around this clean corridor 6 are various rooms, patient locker rooms, rest and recovery rooms as well as various administrative rooms. This first floor is thus organized so that the high sterility zones are in the center, the degree of sterility of the premises decreasing from the center to the periphery of the building.

• a. Au réz-ce-chaussée une salle d'attente ambulatoire 7 accessible depuis l'entrée 1 et l'accueil, des sanitaires 8 et un ascenseur 9.
• b. Au premier étage un local de desserte 10 dans lequel débouche l'ascen­seur 9, un vestiaire 11 donnant accès dans le couloir propre 6. Un sas d'entrée 12 au bloc opératoire 5, ainsi qu'un local pour le matériel stérile 14 et un local de préparation du personnel 15 hospitalier don­nant tous deux accès tant au bloc opératoire 5 qu'au couloir stérile 6. Le local de matériel stérile donne également accès à une salle de repos post-opératoire 16 et sert de sas de sortie du bloc opératoire 5. La salle de repos post-opératoire donne accès soit au vestiaire 11 soit au local de desserte 10.

Such an ambulatory surgical center comprises at least one surgical unit occupying a sector A on two floors. A typical example of an ambulatory surgical unit is shown in plan in Figures 1 and 2 and in partial perspective in Figures 3a and 3b. Such a surgical unit includes:

• at. On the ground floor an ambulatory waiting room 7 accessible from entrance 1 and reception, toilets 8 and an elevator 9.
• b. On the first floor a service room 10 into which the elevator 9 opens, a cloakroom 11 giving access to the clean corridor 6. An entrance airlock 12 in the operating theater 5, as well as a room for sterile equipment 14 and a room for the preparation of hospital staff 15 both giving access to both the operating room 5 and the sterile corridor 6. The room for sterile equipment also gives access to a post-operative rest room 16 and serves as an airlock for leaving the operating room 5 The post-operative rest room gives access either to the cloakroom 11 or to the service room 10.

With such a distribution of premises it becomes possible to organize a circulation of patients and hospital staff which is optimal for ambulatory surgery.

The modularity of the various hospital functions makes it possible to properly separate the public part on the ground floor from the technical part, operating room on the upper floor by the elevators.

The patient arrives at entrance 1 and the reception and entry formalities are carried out on the ground floor in non-sterile common rooms. He is then directed to the ambulatory waiting room 7 where he can still stay with family members or accompanying persons. When his turn arrives he goes up to the first floor with the ace censor 9 and will change in cloakroom 11 which is generally equipped with a room for undressing and individual cabinets. In this changing room the patient is equipped with sterile operating clothes. From the cloakroom, it crosses the clean corridor 6, which is also sterile, and enters the airlock 12 with an even greater degree of sterility. There he undergoes a pre-operative preparation, if necessary, then he enters the operating room 5 whose degree of sterility is maximum, where he undergoes the planned ambulatory surgical intervention. Once this is finished, he leaves the operating room via the sterile room 14 and joins the post-operative rest room equipped with rest beds and screens. The patient stays in this rest room for a few hours then, depending on his condition, he goes back through the cloakroom where he gets dressed, then goes down with elevator 9 and finds his family in the waiting room to leave the hospital. If his condition requires it, he is transferred from the post-operative rest room 16 to his bed by the service room 10 and the elevator on the ground floor, then is led by corridor 2 to a room where he passes one night or more if necessary.

The medical staff accesses the first floor by another elevator 17 from corridor 2 on the ground floor then crosses a cloakroom 18 to access the clean corridor 6 from where they can reach the operating theater 5 via the preparation room 15.

It is obvious that several modular units of this type can be incorporated in the same ambulatory surgical center or hospital center.

Figures 4 and 5 illustrate another variant of the ambulatory surgical unit which is more personalized for the patient.

Figure 4 illustrates part of the ground floor of a cen be hospitable, comprising not a common waiting room but individual waiting and preparation rooms.

Once the patient is registered at the reception and all the administrative formalities are completed, he is introduced by an external corridor 19 into a personalized waiting room 20 where there are toilets and a cloakroom. The patient can therefore, in the presence of his family or accompanying person, prepare, undress and put on the operating clothes. When the operating room is free the patient takes the elevator 21 which includes an operating table with adjustable position on which the patient sits. He goes up to the first floor, the operating table is lengthened and introduced into the operating room 22 by crossing the clean corridor 23 through which the hospital staff accesses.

Once the operation is finished, the patient is taken to the mobile operating table through the clean corridor 23 and the elevator 21 to a rest room 24 where the necessary time remains. When his condition allows it he takes the elevator back to the personalized waiting room 20 where he changes, can wash, and is again supported by his family.

In such a configuration, an operating theater 22 can be common to two units.

Here too, the zones of different degrees of sterility are well separated and the flow of patients, hospital staff and equipment is designed to optimize the maintenance of these various degrees of sterility.

FIG. 6 illustrates in plan the distribution of a consultation building which can be included in a hospital center for ambulatory surgery which comprises only one ground floor. This building, always built according to the same triangular modulation comprises an entrance 25 giving access to a reception and a distribution corridor 26. In the center of this corridor 26 are located changing rooms, toilets and other utility rooms while around this corridor are located rooms waiting 27 each giving access to a specialized consultation room, laboratories and possibly a small surgery or treatment room. Administrative premises are located on either side of the entrance.

FIG. 7 illustrates an ambulatory hospital and surgical center comprising a one-storey building on ground B, of the type described with reference to FIGS. 1 to 3, connected by corridors C1, C2 and an intermediate pavilion D to a building E of type of that described with reference to figure 6.

The three buildings B, D and E are all modular, divisible into sectors and are all constructed from the same prefabricated structural elements.

Thanks to the modular design by sectors developed, constructions can be made that exactly meet the needs and desires of users and which, as we have seen above, are particularly well designed for ambulatory surgery.

Indeed, this design and this realization of a modular surgical center makes it possible to effectively separate the zones of different degrees of sterility and to limit as much as possible the passage of people, patients, practitioners etc, as well as materials from an area to the 'other.

This feature can be illustrated with reference to Figures 1 and 2 for example. The ground floor comprises the entrance, the reception of patients, a service entrance for supplies, a cafeteria and changing rooms. The whole area is not sterile and is public.

The sterile material, packaged accordingly, and coming from outside the surgical center is introduced through the service entrance, specific elevators, into a special room for sterile delivery. From there this material is transported through the clean corridor, therefore sterile or at least of a medium sterility degree to sterilization or reserve rooms or sterile arsenal located in the center of the clean corridor 6 between it and the operating theater.

These storage rooms as well as the entry and exit airlocks for patients and hospital staff, for example 12,15,19, are of an even higher degree of sterility, and finally a maximum degree of sterility in operating theaters 5.

Surgeons and hospital staff access the clean corridor 6 by the elevator 17, the changing rooms 18 and the "hand" preparation airlock, for example. They therefore follow a path of progressive sterility.

The same applies to patients who, from a non-sterile area on the ground floor, arrive in cloakroom 11 where they exchange their soiled clothes for sterile operating clothes and can take a shower, they then pass through the clean corridor up to an entry or local airlock where they are prepared for the surgical procedure to be undergone and where the sterility is even more advanced then finally are introduced into the operating room 6 with maximum sterility.

Patients and hospital staff leave the operating room through exit airlocks where they leave their soiled clothes which are packed, as well as the equipment used in the operating room, before being evacuated for example by the drain.

The patients are transferred to the post-operative rest room then return to the cloakroom and the ground floor where it is taken care of by their family or their companion while the hospital staff can circulate on the first floor by the clean corridor between the different high sterility zones.

By these arrangements and pathways, optimum conditions are created to maintain high sterility conditions in the clean corridor, airlocks and operating theaters.

In addition, the circular, modular design in the sector of circles of this center allows great ease of adaptation, modification, enlargement, etc. In a variant, it is possible at first to design a surgical center having only one ground floor; in this case the modular operating unit would include the two sectors illustrated in Figures 3a and 3b arranged side by side on the same floor. A sector of the same size as that illustrated in FIG. 3a could then be devoted to the entry and exit of hospital staff and equipment. So here too the paths are different for patients, hospital staff and equipment. In the sector corresponding to FIG. 3a there is no sterile zone on the other hand in the sector corresponding to FIG. 3b the degree of sterility of the premises also increases from the periphery of the building towards its center.

If the surgical center is later to be enlarged, a first floor is added to the existing ground floor and the surgical operating unit (Figure 3b) is simply transferred in its entirety to the first floor to occupy the configuration described in relation to Figures 1 to 3. This shows the flexibility of this modular structure in a circle sector and the ease of adaptation that it allows.

Claims (10)

1. Modular surgical center comprising at least one ambulatory operating unit, characterized in that it has a circular shape with a radially and concentrically divisible structure; by the fact that it comprises a ground floor comprising at least one module having the form of a sector of a circle constituting an operating unit and at least one other module in the form of a sector of a circle constituting a unit for accessing the patients so that the different sterility zones are separated as well as the round trips of patients and hospital staff. 2. Center according to claim 1, characterized in that it also comprises at least a third module in a circle sector for the delivery of sterile material and the disposal of used material. 3. Center according to claim 1 or claim 2, characterized in that in the operating and material delivery modules the degree of sterility of the premises increases from the periphery to the center of the building. 4. Center according to claim 1, characterized in that it has a circular shape with a structure of at least one floor on radially and concentrically divisible ground; the ground floor, serving as access to the center for patients, hospital staff and equipment and constituting a non-sterile area; by the fact that access to the first floor is via different routes for patients, hospital staff and equipment; and by the fact that this first floor comprises a clean corridor separating a high sterility zone comprising operating theaters and rooms for accessing them from a low sterility zone comprising waiting rooms, changing rooms, reception material etc. 5. Surgical center according to claim 4, characterized in that the ambulatory operating unit comprises on the ground floor a waiting room for patients giving access to an elevator; this unit comprising on the first floor a clean corridor, said elevator being located outside this clean corridor; an operating theater located in the center of this clean corridor and a post-operative rest room located outside this clean corridor. 6. Surgical center according to claim 4, characterized in that the operating unit comprises on the ground floor, an individual waiting room and changing rooms and by the fact that on the first floor the elevator gives access in the clean corridor and in the post-operative rest room which is also individual. 7. Surgical center according to claim 4, characterized in that the operating unit comprises on the ground floor a common waiting room and on the first floor a service room giving access to the elevator, to the common post-operative rest as well as a common cloakroom all these premises being located outside the clean corridor, this cloakroom giving access to the clean corridor and being accessible from the post-operative rest room; by the fact that the operating room is connected to the clean corridor by entry and exit airlocks, and by the fact that the operating room is connected by an airlock for communication with the common post-operative rest room. 8. Surgical center according to one of the preceding claims, characterized in that it comprises a second building on the ground floor, also circular and modular divided into sectors allocated to specific consultation premises. 9. Center according to claim 5, characterized in that these two buildings are connected by corridors and a modular circular pavilion. 10. Center according to one of the preceding claims, characterized in that its sectoral modularity allows great flexibility of adaptation making it possible to compose at the request of the user specific centers comprising one or more ambulatory operating units as well as all additional premises.

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