British Journal of Anaesthesia, 2002, Vol. 89, No. 1 187
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Correspondence |
Mobile operating theatre. Why must it be mobile?
Editor—I was interested to read the letter by Watts, Ni and Alfa,1 evaluating some of the precautions and highlighting the limitations of a mobile operating theatre. I could not agree more with the authors that patient safety is of paramount importance. If the morbidity and mortality were higher in such a unit, we would have a rapid condemnation of this facility and a speedy curtailment of the use of mobile operating theatres for surgery under general anaesthesia.An alternative does exist, however. I was recently engaged to offer advice pertaining to the location of anaesthetic equipment and services in a pre-formed Kingdom Operating Theatre, manufactured by the Marske Machine Company in Middlesborough, UK, for installation in Eire.
This facility included patient reception, anaesthetic room, theatre, scrub, sterile preparation area, disposal, office storage and changing facilities, and was built to comply fully with the specifications and dimensions governed by NHS building standards.
Although not mobile, this unit can be grafted onto the ground or elevated levels within a matter of weeks. Thus, the unit is no longer isolated; and patients are able to pass seamlessly into a new department, indistinguishable from a conventional operating theatre. I understand that these modular units can be made to individual specifications and needs. Therefore, if the unit is properly integrated, in-patients can be accommodated, no selection of patients is needed, and heavier equipment can be accessed easily.
Being part of the main hospital, it is permanently connected to the information systems, and permanent nursing staff will be conversant with equipment, drug storage and the working environment. I also feel that, in addition to the concerns about patient safety, there is some financial advantage to acquiring or hiring a modern construction on a short-term, long-term, or permanent basis, rather than paying the higher premium attached to a vehicle that is moved around on a day to day basis.
P. T. F. Newnam
Cleveland, UK
Editor—Dr Newnam’s letter illustrates once again the efforts and innovations that hospitals are forced to adopt in order to maintain levels of activity and meet performance targets. Burnley General Hospital was faced with several simultaneous capacity problems including a shortage of trained theatre staff and a long-postponed refurbishment programme for inadequate theatre facilities, resulting in a reduction in available theatre space when a desperate increase was required.
The mobile operating theatre could be housed immediately on a temporary site, avoiding a costly short-term build, and came fully equipped with its own trained staff. In addition, its location within the main hospital grounds meant that it was more acceptable to anaesthetic staff, including staff grades, than increased usage of a more isolated day case hospital, a 10-min drive away. The contract was more attractive financially than that being offered by the local private hospitals.
The unit was mobile because it toured the country providing services for four other hospitals per week. It was only when we were convinced of the audit figures of the unit relating to the quality and standard of the work performed there, and after discussion with the other service users, that the contract was confirmed. This year, the new theatre suite has re-opened, and the numbers of theatre staff available has been increased. The capacity provided by the mobile operating theatre is, therefore, no longer required and the contract has been terminated.
Dr Newnam is correct in that a short-term investment in a more permanent facility may make greater fiscal and practical sense, but the unique circumstances in which we found ourselves meant that the use of a temporary, mobile, fully equipped, fully staffed theatre facility made greater logistical sense.
J. C. Watts
Burnley, UK
References
1 Watts JC, Ni KM, Alfa J. Mobile operating theatre in a district general hospital. Br J Anaesth 2002; 88: 458–9
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