of the microscopes that lets him move the microscope as needed for
his specific cases.
• Space and flow. Having ORs that are sufficient in size is important
in any facility. One thing that is different about ENT compared with
other surgical disciplines is that a large number of the procedures per-
formed are done bilaterally. This, along with considering the ideal
locations of the anesthesia machine and other equipment, factored
into how much space was needed in our ORs (about 400 square feet
each).
We studied the flow of patients, equipment, instruments and sup-
plies into and out of the ORs, and decided to design two doors in each
room. The patient goes into and comes out of the OR through one
door. At the conclusion of the cases, and after the patient is out of the
room, staff remove soiled instruments and dirty items through that
same door. Sterilized items are brought into the ORs through the sec-
ond door, which is connected to the sterile storage area. It's a very
good flow.
• Sterile fields. Maintaining positive air pressure in the ORs is
imperative. Our MEP added a sensitive detection system to the ORs to
ensure the air pressure is properly maintained. Once we started oper-
ating in the center, the staff quickly discovered an alarm would sound
if the OR door was held open for more than 15 seconds. At first, the
alarm was annoying (although very useful). However, it quickly
changed our behavior. Staff no longer hold OR doors open.
• Outside opinions. During the planning phase, we visited another
ENT-only surgery center to see how they were set up and how they
operated day to day. This was very helpful because it helped us to
think about some useful design elements we'd overlooked to that
point.
• Keeping tabs. During construction, the entire design "dream team"
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