Puzzling in existing grids

Two years after the commissioning of two hybrid ORs, OLVG East has recently been able to have six new generic ORs. All eight are part of a major renovation operation. As a result, the OLVG locations East and West will each increasingly have their own identity: OLVG West for 24/7 acute care, and East as a center for minimally invasive surgery. The six newest ORs were realized in a construction team by EGM, Royal HaskoningDHV, Van Wijnen Lelystad, CCG, ULC and Kropman. 

Lack of space is often a problem for hospitals; for OLVG East this is true to a severe degree. It is an inner city location with no possibility for expansion, so everything has to take place within the existing walls. A creative solution was devised for the two hybrid ORs: they were suspended above two polipleins in the three-lot OR complex on Eerste Oosterparkstraat. After that, space continued to proliferate. The six new units were eventually built in Lob B where there were previously four ORs, an inpatient and a day treatment department. "Together with the eight existing ORs in lob A, this always left the desired capacity of ten ORs available," explains Milan Cuylits, Project Manager at OLVG Vastgoed. "Lob B was stripped down to the shell for the new facilities except for a few vital pipes. A temporary building facility was created in the courtyard for the recovery room, sterile warehouse and changing rooms. This allowed the day treatment to be situated at the location of the old sterile warehouse."

The Program of Requirements for the six ORs was developed by the OLVG with Royal HaskoningDHV (technical) and Roubos OK Expertise (functional). "Based on this, the construction team started work for the VO and DO phases," Cuylits continued. "In this, the consultants and architect EGM were in the lead, but the executing parties were already at the table. In the TO and UO phase, the construction parties were in the lead for the elaboration of the technical and execution design, with the consultants in a controlling role." The result is an efficiently divided second floor, with the six generic ORs, each with its own upstairs area, a baby care area, storage facilities for goods and equipment and offices, centrally located in Lob B. The two hybrid ORs are suspended on either side of lob B above the polyclinics. "Everything immediately necessary for an OR center is on this floor," says Letty Koopman, operations manager for the OLVG. "Only the route to the bed house means moving by elevator."

At over 49 and 58 square meters, the new ORs are considerably larger than the old ones. A trend that has been going on for some time, according to Koopman, and one that represents enormous progress for OLVG. "Equipment is getting bigger and more numerous. Think of the shuttles, operating robots and many screens and consoles, sometimes duplicated for learning assistants. With that, everything hangs from the ceiling or is hidden in walls; you won't see cords running across the floor. In fact, you want to keep the room as empty as possible, leaving only an operating robot in the OR. The larger ORs are for robotic surgery and cardiac surgery. OR 102 is directly connected to a baby care room where CPR can be used if necessary."

The ORs themselves were thought out down to socket level with the construction team and with input from the OR staff. Koopman: "For this, one-on-one mock-ups were made in which we went through all possible scenarios to determine the optimal positions of doors, pendants, Bender panels and OR table. We were dealing with an existing column pattern (6.60 by 6.60 m; ed.), then a mock-up like this is extra instructive and necessary to do risk analyses of all scenarios. Why is there no standard OR solution? Because everyone wants to throw their own gravy on it anyway. We have to deal with ideas of specialists, the prevailing culture in a hospital, the handling of hygiene and guidelines. And in this case also with the existing frameworks."  

Working in an existing and running hospital also required all of Van Wijnen's attention. "That is complex yes," says Arnold van der Werf, project manager for the Lelystad-based contractor, "but as an experienced hospital builder we know how to do our work almost unnoticed. That started not long after the two hybrid ORs were commissioned with the installation of dust partitions and soundproof panels to shield and depressurize the work area. The areas we were most adjacent to - the two hybrid ORs - are already at positive pressure, so then you're automatically already at negative pressure. Logistically, the problem was that we didn't have a facade available. All logistical movements had to go through an existing shaft of the technical layer, then through the roof and then to the Eerste Oosterparkstraat where the construction chain and elevator were located. A quiet electric mini-crane with cutter was used for the demolition work. To keep the inconvenience to a minimum, fixed times were agreed with the OLVG, as a small hole drilled for a plug could already be too much. During critical activities in an OR, the client could indicate that it had to be quiet for a while. Because of the short lines of communication and the good consultation atmosphere, it all went well." 

Van Wijnen installed all the metal stud base walls in the existing shell, made the necessary new recesses in the shell, and modified the technology room on the second floor. Van der Werf: "You could say all the preliminary work so that the installers could do their work and CCG could build the box-in-a-box construction. Throughout the entire process we worked very pleasantly with all the partners in the construction team, with the common goal of achieving the best result. It wasn't a very big project, but when you consider two years of construction, you can imagine how complex it was."

OLVG is very pleased with the new ORs. Cuylits: "You build something like this based on the latest insights and the newest techniques and for the next fifteen or twenty years. For example, we no longer work with a traditional UDAF plenum, but with Avidicare's TcAF Opragon system as our ventilation system. This system has two rings of spheres in the ceiling that provide an ISO class 5 in the entire OR. In addition, the ORs are designed to switch between an OR class 1, performance level 1 and OR class 1, performance level 2. In the latter mode, 50% requires less air, resulting in huge savings. Between 7:00 p.m. and 7:00 a.m. and on weekends, the ventilation system automatically revs down to 30%, and automatically revs up again if a patient is reported within that time period." Koopman is very happy with the Krion® walls. "This is fairly new and is also in the hybrid ORs. It looks nice, is easy to clean well, is chemically resistant and the sheets can be glued together thermally; a little sanding and you won't see anything of it. For example, in each OR there are only two caulk joints in the walls. The floors are finished with semi-conductive PVC with angled corners. One last plus: the cheerful colors on the outside. EGM and the OR staff completed this process together and ended up with Amsterdam sculptures and works by Amsterdam artists that were graphically elaborated. OK 103 we now already call in the corridors the RembrandtOK." 

Client:
OLVG 

Construction team (design, consulting, execution):
EGM, Royal HaskoningDHV, Roubos OK Expertise, Van Wijnen Lelystad, CCG, ULC, Kropman.

Construction Management:
OLVG, Project Management Department

Construction time:
July 2022 - April 2024

Gross floor area:
1.320 m2