Nijmegen is building the hospital of the future

CWZ in Nijmegen is constantly investing in modernization to provide the best possible care. At the end of last year, a high-profile project was completed: a new hybrid operating room where a conventional operating room and an advanced X-ray room come together in one space. This combination has many advantages for patients and surgeons.

Ale Houtsma, chairman of the CWZ board of directors, says: "With the arrival of the hybrid OR, CWZ has taken another important step toward becoming the hospital of the future. This fits with our hospital's ambition, together with external healthcare partners, to build high-quality second-line medical-specialty care in the Nijmegen region, so that patients receive valuable and sensible care in the right place." Building Care sat down in Nijmegen to talk about these innovations. An interview with Jurgen Maatkamp (Head of Construction & Housing), Monique Latta (Department Head ORC), Rianda Moed (OR assistant clinical surgery department), Ellen König (Project Manager MIT), Arthur Beukelaar (Project Manager MIT), Nout Reichgelt (Project Manager Project Office Reichealth), Michiel van Summeren (Commercial
Director Cornelissen Aannemersbedrijf) and Jarno van Griensven
(Project Manager Cornelissen Construction Company).

"The desire to have a hybrid OR had existed for some time," says Latta. "That became a business case, with the final conclusion of the Board of Directors that it would be a good decision strategically. That meant we could put our shoulders to the wheel." With putting the plan into action, also came the challenge: building in an existing environment or: working with "the store open. Says Maatkamp, "With the right consultation and by taking into account all stakeholders within the hospital, (almost) anything is possible. In both the new angio room and the hybrid OR, we are now working with X-ray equipment from Canon Medical Systems. This X-ray machine can both screen (show moving images) and also make a 3D reconstruction. Thanks to this imaging, a procedure can be performed minimally invasively by operating under direct vision."  

Courage adds, "Having the angio room in the OR complex allows for very efficient collaboration between interventional radiologists and other medical specialists. More can be done in one session." Latta: "By bringing the angio and the hybrid OR together, we make consultation between the two department easier. All the cutting specialists use the OR, the POK1/angio is used by the interventional radiologists and surgeons."

Maatkamp outlines the construction of both rooms as an expansion to the existing OR complex. "Space had to be created for that. Thus, the angio is located on the site of the former children's day unit. The pediatric day unit is still independent but has been redesigned: a waiting/preparing room has been created in the ORC and aftercare takes place in the pediatric unit. We now offer more care in a concentrated area. Nout Reichgelt was "flown in" from our flexible shell because of his expertise. Reichealth provided the complete design, structural and installation engineering, project execution and project management on behalf of CWZ. We now have a long-term cooperation in this area, to our complete satisfaction."

Reichgelt adds, "Together with Medical Information Technology (MIT) and healthcare providers, we looked at how we could best set up the space both technically and practically, with a pleasant look for both patients and staff." Courage agrees and explains, "In a dummy session, we recreated everything 1 on 1 and plotted it out with tape and ribbon. That way we could see exactly how much space we needed. We looked at walking routes, positions of shuttles, et cetera." Breukelaar: "The power to achieve a good layout here lay in excellent consultation between the users and the MIT department." Maatkamp nods in agreement: "By combining the strengths of users, MIT and the Projects Office, we were able to make efficient strokes."

Cornelissen contracting company was commissioned to do the construction. Van Summeren: "We were at the table with the contractors at an early stage. All praise for the efforts of Reichealth, which supervised this project superbly. By consulting well with Kropman Installatietechniek and the technical people at the CWZ, we were able to work very systematically. Speed was crucial, as the equipment for both rooms had already been ordered. The structural facilities were therefore quickly realized." Van Griensven: "A number of rooms and transport passages had to be realized before the hybrid OR could be started so that CWZ's primary work process would not be disrupted." In total, construction took place in six phases. "An additional challenge was posed by the applicable regulations and conditions surrounding corona. Nevertheless, through proper consultation, we were able to work quickly, efficiently and safely."

Says Maatkamp, "In terms of accommodation, we have arranged everything as optimally as possible; in connection with the zoning, part of the public corridor is involved in the project." Moed explains the biggest differences in use from the old situation: "We have more space, advanced equipment and new software. Everything is linked in the system. Because the angio room and the hybrid OR are now adjacent, we can call on each other's help more quickly." Latta: "Supplies are now very efficiently located in a warehouse adjacent to the rooms and no longer have to come from elsewhere." Work is now in full swing in both rooms. König: "It was exciting to be able to work with the new X-ray equipment for the first time. We were already using smart ICT solutions in our OR, including in the area of supply. A good example is the App2Order to quickly and easily order and deliver logistical materials for operations in the OR via an app. We are now letting the hybrid OR use that as well. In terms of innovation, we have taken another giant step forward. For example, there are cameras, microphones and speakers so we can stream the surgery from both rooms. This allows remote viewing."

Mark Rotteveel, angio expert, and Renee Metzelaar, radiology lab specialist, are also very pleased with the results and believe that the arrival of both new rooms and the new equipment has made everything even more complete. "The detailed imaging ensures that surgery can be done in one session. Patients do not have to undergo treatment at radiology first and then treatment in the operating room."  

"This hybrid mode of surgery (minimally invasive) reduces the risk of complications. Patients can go home earlier and reoperations are needed less often. Another big advantage is that the new equipment exposes patients to less radiation. In addition,
patients who were previously ineligible for treatment because they were not fit enough for "open" surgery are now being operated on. Patients receive valuable and sensible care in the right place. As a result, patients can often go home sooner. How nice is that?" concludes Latta.