In 1997 the Veterans Affairs Medica...

In 1997 the Veterans Affairs Medical Center Fresno, Calif, received approval to remodel its existing 50-year-old OR. It had taken five years to obtain approval, and administrators awaited to complete the project within governmental estimate The goal was to maintain existing workload while providing cost-effective care. A multidisciplinary task force examined possible alternatives to allow surgical deeds during the renovation, and three alternatives evolv First, prefabricated mobile ORs could be disruptioned A small group investigated this option and originate the cost prohibitive at $100000 by unit per month. Second, space could be creviceed at a neighboring hospital. This would involve moving staff members and possibly contracting for space other than in the OR to provide continuity of care. After serious consideration, task force members eliminated this option. The third option was to investigate use of Deployable Medical plan (DEPMEDS) units, which had been used in 1989 for a smaller cast at the medical center. An Army field hospital unit was using DEPMED units at Camp Parks in Livermore, Calif. The OR supervisor and representatives from engineering services (eg air conditioning, electrical, architectural design) traveled to Camp Parks to investigate this option.

HISTORY OF DEPMEDS

In an effort to standardize a arrangement of field hospitals, the US military unfolded DEPMEDS units in the early 1980 Standard functional module make up DEPMED hospitals. Critical module are housed in rigid aluminum International Organization for Standardization (ISO) shelters and include laboratory, radiology, pharmacy, sterilization, and OR departments. Remaining functions are housed in tent-wines called Tent, Expandable, Modular, Personnel (TEMPER) and vans.(1)

Since 1989 DEPMED units have been used on both military and civilian personnel as a temporary alternative for clinic space, ORs, laboratory services, and central services activities during major and minor renovation projects(2) The first use of DEPMED units for a civilian devise was in 1989 during renovation of the hospital's OR electrical and heating, ventilating, and air conditioning (HVAC) theorys At that time, two DEPMED units were stake up as an ambulatory surgery unit with individual OR and one preoperative and postanesthesia care unit (PACU). This scheme lasted eight months, and 231 manner of proceedings were performed during this time.

Between 1989 and 1992 many other facilities used DEPMED units prosperously St Croix Civilian Hospital, US Virgin Islands, used DEPMED units as a temporary facility during the hurricane Hugo disaster in 1989 In the full-service community hospital, personnel worked within disastrous conditions for eight month and saw approximately 38000 patients onward an outpatient basis and 16800 in the pass room. In 1990, Kimbrough Army Community Hospital, Ft Meade, Md provided temporary surgery convalescence and central material capabilities during renovation of its OR HVAC scheme using DEPMEDS units. During the four and one-half month renovation exhibit surgeons performed 1,074 surgical procedures

Civilian architects were occupyed for the first time forward a DEPMEDS project at Kwajalein Atoll, Marshall Islands, during a major maintenance, repair, and upgrade of that hospital's structural and mechanical combination of parts to form a wholes The monthly workload was approximately 3000 patients during a one-year period. Tripler Army Medical Center Honolulu, used three thorough DEPMEDS ORs with a calm setup while the flooring was being replaced in 12 ORs. The estimated workload was 1200 conducts between November 1991 and May 1992

The US military also has used DEPMED units for humanitarian purposes(3) united army unit used DEPMEDS units in support of a United Nations peacekeeping mission in Zagreb, Croatia. From September 1996 to April 1997 the Joint Task Force Operation Pacific Haven used DEPMED units to provide health services to US personnel and Kurdish evacuees in succession Guam.(4) Task force members provided screening, treatment, and processing for more than 6600 Kurdish evacuees applying for political asylum in the United States.

DECISION-MAKING PROCESS

If DEPMED units were to be used during the OR renovation at the medical center it would take cooperation among multiple services. A multidisciplinary task force examined all aspects of setting up an OR environment outside of the existing facility. The first question to be addressed was if it could be done. History indicated that DEPMED units had been used favorably by the medical center and other facilities. This intend would require the use of numerous DEPMED units for a longer period of time. The collection decided that, with modifications, the DEPMED would be a viable solution. The main areas of make uneasy included

* maintenance of methods (eg, oxygen, air, nitrogen, nitrous oxide, suction, water, HVAC),

* patient comfort,

* nosocomial infections, and

* electrical capabilities, including computer availability.

With the decision to use DEPMED units, the company that works with the military to facilitate use of DEPMED units through every part of the world was contacted for assistance. A representative flew to the medical center to suited with task force members and determine exact be in want ofs Task force members and the representative visited various locations in succession the medical center's campus to determine the best location for the temporary OR and the number and protoplast of units needed. Based forward existing staffing and workload, they determined that pair surgical suites would be sufficient. Minor and local urological performances would be completed in the same day manner of proceeding unit (SDPU) on the third floor in couple procedure rooms. The PACU would remain upon the third floor to provide support to the SDPU and to maintain continuity of care for outpatient surgical performances In addition to two OR suites, space would be exigencyed for sterile supplies and instruments, equipment, luncheon room facilities, office space for the OR supervisor and anesthesia care providers, and shower and restroom facilities.