Medical Centre Leeuwarden, The Netherlands

The Need The Medical Centre Leeuwarden in the Netherlands was planning a major renovation of its Central Sterilisation Department, the area of the hospital where all items used in procedures by the hospital’s surgeons and clinical staff are intensively cleaned and sterilised. Situated in the Friesland area, the hospital is the largest non-university hospital in […]

The Need
The Medical Centre Leeuwarden in the Netherlands was planning a major renovation of its Central Sterilisation Department, the area of the hospital where all items used in procedures by the hospital’s surgeons and clinical staff are intensively cleaned and sterilised.

Situated in the Friesland area, the hospital is the largest non-university hospital in the country and is one of the its major top clinical centres, offering secondary and tertiary care across its 647 beds and in clinical specialties including pulmonology, cardiovascular surgery and neurosurgery. It serves a population of more than 120,000 people.

Therefore, any closing of the sterilisation department or reduction of its operating capacity – either in terms of hours it could be open or the numbers of items which could be sterilised – would have a major impact on the hospital and those working within in. A solution was needed to ensure the equipment used in surgery at the hospital could continue to be sterilised quickly, effectively and preferably, on site.

The Plan
A number of options were potentially available to the hospital including sending items off site to be sterilised, building a temporary structure within its own grounds or equipping and repurposing an alternative area within the hospital building.

However, all of these would have a significant impact on both the investment required, the space required and the capacity levels which would be achievable.

The hospital team approached Q-bital Healthcare Solutions to discuss potential solutions which would not involve sending the items to another hospital off site or significant building and infrastructure work at the existing medical centre.

Q-bital worked with one of its suppliers in Europe on the development of a fully mobile central sterilisation unit department which they felt was the ideal solution for Medical Centre Leeuwarden.

The stand-alone facility could be quickly deployed, installed in a place convenient for the hospital and, following use, be quickly decommissioned and moved once renovations were completed.

The Solution
To create the perfect solution, the Q-bital CSSD mobile unit, which was designed specifically to provide replacement capacity for the cleaning, sterilising and repackaging of surgical instruments, was installed.

The unit provides all required cleaning, sterilisation and repackaging services over a space of just 120m and includes a pre-cleaning station with a built-in ultrasonic cleaner, washer disinfectors and steam sterilisers, packing area, independent plant room, electronic datacentre, staff welfare areas and HEPA filtered environmental air, ensuring it provides a fully clinically compliant alternative to a permanent department.

The unit offered a capacity of approximately 241 DIN trays per day, or 30 per hour which met the hospital’s capacity needs.

The unit is designed to be fully portable by sea, air and road and could therefore be quickly installed at a hospital’s preferred location, in this case in the car park, having no detrimental impact on available clinical or patient care space.

The Outcome
Following a commissioning and testing period which took 10 days, the unit was used on site for 16 hours per day during the week, and 14 hours per day over weekends. Throughout any shift, nine staff worked comfortably in the mobile environment – three in receipt and manual clean, four in the inspection, assembly and packaging area and two in the post-sterilisation room.

The unit was on site for just over six weeks and in that time processed 25,000 DIN trays and packages without any need to send off site.

While it was in use, a standard time for the washing and disinfecting process was 45 minutes, including drying while the sterilisation process took 45-48 minutes per process, including drying.

These timings, along with the capacity the two washers were able to provide, allowed for the processing of 30.24 DINs per hour in the washing and disinfecting process and 11.4 STUs per hour in the sterilisation process.

Once the renovation of the hospital’s permanent sterilisation department was completed, the hospital’s decontamination team was able to simply move operations back to their department while the CSSD was decommissioned and moved off-site.

Hospital San Francisco, Bonaire

When the only hospital on the Caribbean island of Bonaire needed to refurbish its operating theatres, mobile facilities provided interim capacity to prevent patients having to fly to other islands to receive treatment

The Need

As a provider of acute services, Hospital San Francisco serves a population of 19,000 people (as well as approximately 70,000 tourist visitors annually) and is the only hospital on the island of Bonaire, a Dutch territory off the coast of Venezuela.

With its sole operating room requiring refurbishment, the hospital needed a solution to allow its clinical teams to continue to deliver all necessary procedures while improvements and updates were made or face the prospect of having to fly patients to neighbouring islands for treatment.

The Plan

Working alongside the hospital’s team, we developed a plan to provide a mobile laminar flow theatre. This would allow delivery of necessary surgical procedures.

Detailed planning and a close working relationship were essential in making this project a success. It required the development of a robust logistical plan for delivery, installation and maintenance.

The Solution

As both the temperature and the average humidity are higher in Bonaire, additional equipment was fitted to ensure air quality and maintain optimal air humidity. The theatre features laminar flow air systems to allow clinicians to conduct orthopaedic with a reduced risk of post-operative infection. It was therefore essential that the engineers calibrated the modifications accurately.

We plotted a unique shipping route, allowing the unit to cross on a USA-bound cargo vessel from Rotterdam. The ship then made an additional stop in Bonaire to deliver it.

Shipped across 4500 miles in an 18-day voyage, the theatre was in place and fully validated within hours of its arrival. Procedures were due to begin the following day. It proved to be the perfect solution when an emergency caesarean section case came in at 2am, hours before the theatre was officially to ‘start work’. The clinical team were able to swing into action, open the unit early, and successfully deliver a healthy baby girl.

Estates team supervise installation on Bonaire

The Outcome

In the two years the unit was on the island, it hosted almost 2,000 procedures, with not one procedure missed. Over the course of the contract, we continued to support the unit. This included the provision of spare parts, technical expertise and delivering training to the local clinical team.

Tristan Botjes, the Internal Project Leader at Fundashon Mariadal which runs the island hospital, told us: “They excelled in delivering and installing the operating room within a very short timeframe. As a result we have been able to carry on treatment without delay; the best possible result for both staff and patients.”

Kreisklinik Gross-Umstadt, Germany

The deployment of a mobile operating theatre to a district hospital in Germany helped to deliver an accelerated refurbishment programme

The Need

A short-term closure of two of District Hospital Gross-Umstadt’s operating theatres was necessary to accommodate a brief refurbishment. It meant that the hospital needed an efficient solution to maintain patient flow.

The Plan

Working with the hospital’s team, we developed a plan to help the hospital achieve a completed refurbishment in four weeks. However, following the hospital’s successful programme of works, the project was completed in 10 days – two weeks ahead of schedule. This accelerated refurbishment rate cut the hospital’s costs and minimised disruption to patients.

The Solution

Following the commissioning and testing period, the facility was able to receive its first patients within two weeks of delivery. The team worked closely with the host hospital staff during the critical set-up time. During this period, they monitored the necessary testing. This ensured that the resulting clinical environment met the rigorous standards required.

Staff at Gross-Umstadt spent a week alongside our team, working in close partnership. Together, they achieved an efficient and effective implementation of the unit during the refurbishment period. The hospital’s clinical staff adapted quickly to the new environment too. Their professionalism was a significant contributing factor to the ultimate success of the project.

Clinicians performs surgery in mobile operating theatre

The Outcome

Through the deployment of a mobile operating theatre equipped with a laminar flow air system, which permits greater flexibility than a standard theatre, the hospital maintained its service levels across a range of surgical specialities while the refurbishment was ongoing. This preserved continuous patient care, and patients continued to have local access to procedures.

Refurbishments were completed within 10 days with no loss of service provision.

Dr. Achim May, OR Coordinator of the District Hospital Gross-Umstadt, told us: “Due to the efficient and constructive cooperation with Q-bital in advance, we implemented the transport and the construction of the mobile units without any problems.”

The Haaglanden Clinic, Netherlands

The Haaglanden Clinic found its single operating theatre out of use following flooding. We provided a rapid response that protected the hospital's revenue and maintained patient access to services

The Need

The Haaglanden Clinic is a specialist provider of skin therapy and plastic surgery. Its single operating theatre flooded following an issue with a heating system. The clinic, based in The Hague, needed a quick solution to supplement its clinical capacity while the theatre was closed.

The Plan

We responded quickly. Along with the management and estates teams at the clinic, they planned the deployment of a mobile operating theatre. The thorough planning process ensured that they could install the unit and treat patients in as short a time as possible. Working alongside the clinic’s teams and insurers, we implemented the swift delivery of the unit, just one working day from its dispatch from the depot.

The Solution

The mobile operating theatre was fully functional in less than 10 days from the clinic’s original enquiry. The transport team delivered the facility safety and quickly. It was installed and validated for use four days after it was delivered, with operations being performed in the clinical environment three days after that.

Mobile operating theatre in use at the Haaglanden Clinic

The Outcome

The installation of the unit radically reduced the time the clinic were unable to perform procedures. It therefore protected their revenue and delivered the best service for patients.

The Haaglanden Clinic’s Clinical Director Dr. J.F.A van der Werff, told us: “We had heard of the success of other mobile healthcare facilities but we were unsure of exactly how rapid the response would be. They exceeded our expectations in this sense and it allowed us to continue to treat patients in a relatively short time.”

Algemeen Stedelijk Hospital (ASZ), Belgium

Algemeen Stedelijk Hospital needed a solution to cover their five month refurbishment programme. We offered them a fast and effective answer to the challenge of theatre downtime.

The Need

With a planned refurbishment of three of its theatres over a period of five months, the Algemeen Stedelijk Hospital (ASZ) needed a solution to enable it to continue to treat the up to 55,000 patients it sees annually in its acute and general services.

The solutions provider needed to be able to mobilise quickly and provide an environment that met the clinical standards required to conduct surgery, as well as provide a configuration that would help manage and maximise patient flow.

The Plan

To best meet the hospital’s needs to maximise capacity while refurbishment work was underway, our logistics team, working alongside commissioning partner Simed International, planned to install a mobile laminar flow operating theatre which includes dedicated anaesthetic and recovery rooms and a full operating theatre.

The Solution

The revolutionary design of the temporary theatre and the ultra-clean air supplied by the laminar flow hood enabled staff at the ASZ to treat patients in both the operating and recovery room. This innovative arrangement maximised patient flow and essentially doubled the surgical capacity of the facility.

Clinical staff who work in mobile healthcare unit

The Outcome

The operating room was able to carry out invasive surgeries where the ultra-clean air supplied by the laminar hood significantly reduced the chances of infection. The secondary theatre which had been established in the recovery room was used to carry out other low risk procedures such as cataract surgery. The ventilation in the additional theatre space was compliant to the necessary standard for these less invasive procedure types.

Pascal De Ras, Manager of ASZ Wettern’s Technical Department told us: “They were the only company that could respond to our needs both quickly and within the budgetary constraints. The mobile theatre complied with all requirements including hygiene, ventilation, electrical safety and comfort.”

The Wilhelmina Hospital Assen, Netherlands

Maternity Unit

The Need

An increased demand for maternity services was expected in Assen and Emmen in the Netherlands as a result of planned closures of obstetrics and paediatrics services  in nearby Hoogeveen. These services had already closed in Stadskanaal – it was anticipated maternity services at the Wilhelmina Hospital Assen would come under increased pressure to support mothers in labour who previously would have been cared for and delivered their babies in Hoogeveen or Staskkanaal.

The Plan

The WZA wanted to prepare for the potential increased demands on its maternity and obstetrics services by expanding its capacity through the introduction of the mobile ward to be used as an additional delivery room.

They approached Young Medical to explore what solutions could be offered to create a safe, high quality and still warm and welcoming delivery suite for expectant mothers.

The Solution

We worked alongside the hospital to modify a mobile ward to create a delivery suite which helped the hospital continue to maintain the level of clinical obstetrics support available for pregnant women in the area.

Seamlessly linked to the hospital, the delivery room was customised to ensure it met the hospital’s requirements and provided them with a fully equipped delivery room of the very highest standards. This customisation included laying a new flooring and including homely and welcoming wall coverings to make the environment less clinical and more appealing.

The Outcome

The mobile unit was on site for six months where it served as a fourth delivery room for the team. During that time, we received very positive feedback, both from the staff working on the unit and mothers and their families about the welcoming and high-quality environment the unit provided for this extremely important hospital experience. Around one baby a day was born in the temporary delivery suite – giving a grand total of around 125 brand new babies who were welcomed into the world in the mobile delivery room!

St. Maarten General Hospital, Duffel, Belgium

The Need The St. Maarten General Hospital had been receiving a growing number of requests for vascular procedures and identified a need for a new hybrid operating theatre to increase its capacity. However, the construction of a new hospital had already started and was scheduled for completion within five years. As the facility would only […]

The Need

The St. Maarten General Hospital had been receiving a growing number of requests for vascular procedures and identified a need for a new hybrid operating theatre to increase its capacity.

However, the construction of a new hospital had already started and was scheduled for completion within five years. As the facility would only be operational for a few years, the total cost of operation for a new internal hybrid operating theatre would be relatively expensive, and the hospital’s management wanted to look into alternative options. Young Medical, a Q-bital Healthcare Solutions company, was approached to come up with a modular solution.

The Plan

The proposal provided by Young Medical was to build a bespoke, modular hybrid operating facility, which would be operational for about five years but would be designed for permanent use.

A seamless connection between the new hybrid operating theatre and the existing operating theatre complex was required, and since this unit was located on the first floor, this provided an additional challenge.

The solution would be fully flexible, meaning that the medical equipment housed within the operation theatre could be transferred to the new hospital once this was completed and the temporary, modular building could be returned to Young Medical to be repurposed.

The Solution

In collaboration with the equipment manufacturer, Young Medical designed a modular hybrid operating facility which met the same requirements as a traditional building. The facility was placed on a steel structure above the ambulance entrance of the accident and emergency department, enabling a connecting corridor to be provided to the existing operating theatre complex of the hospital.

The theatre has a large plenum and is ISO 5 certified, and there are also facilities in the ceiling for the installation of pendants and monitors. The walls are covered with high-pressure laminate with an antibacterial layer and the floor consists of a concrete base, finished with a semi-conductive PVC floor covering.

The Outcome

Young Medical completed the project within just three months of signing the contract, with the operating room itself being installed within one day.

Five years later, the new hospital became operational. The equipment from the temporary operating theatre was deployed in the new hospital as planned, and the modular theatre was removed by Young Medical from the old hospital.

This facility can be reused either temporarily or permanently as required and can be deployed within the delivery time of new equipment. The size of the facility is currently 90 m2, but it can be adapted to the requirements of the new user and can take hybrid equipment of any make.

Isala Hospital, Zwolle, The Netherlands

The Need Isala hospital in Zwolle is one of the largest non-academic hospitals in the Netherlands. It serves a wide catchment area, including the region between the university cities of Groningen, Utrecht and Nijmegen and also has a large and renowned plastic surgery facility. Wezenlanden, the hospital’s day surgery centre, was originally located in an […]

The Need

Isala hospital in Zwolle is one of the largest non-academic hospitals in the Netherlands. It serves a wide catchment area, including the region between the university cities of Groningen, Utrecht and Nijmegen and also has a large and renowned plastic surgery facility.

Wezenlanden, the hospital’s day surgery centre, was originally located in an annexe elsewhere in the city, but the plan was to replace and relocate this to the main hospital site. It was no longer cost-effective to maintain a separate hospital that provided just a few operating theatres and a clinic.

The assignment was to create a new treatment centre incorporating an outpatient clinic with a nursing department and a surgical unit for procedures that require a maximum of two overnight stays. The complex was to be physically connected to the main hospital, but with its own entrance and reception area.

The Plan

Since a new hospital was under construction, one option considered was a traditional build project to extend the main hospital. This, however, would have taken around 18 months to complete, extending the lead time of the overall hospital construction project.

Another important factor was that while the main hospital provides top clinical and extremely specialised care, the day surgery centre provides less complex care in a very competitive marketplace, where the atmosphere and identity play a key role in making the decision.

Setting up a unique facility separate from the main building allowed the clinic to position itself with the luxury look and feel of a private clinic, while retaining and capitalising on the strong reputation of the main hospital.

As the footprint was relatively large for a modular build, and the area for the build was compact, Young Medical set up a ‘pop-up factory’ two kilometres from the hospital. This meant that the prefabrication and pre-engineering could take place off-site, while achieving a shorter transport distance.

The Solution

In close collaboration with the hospital building director, Young Medical delivered a spacious combined treatment centre with a footprint of 4,500 m2. The facility included six operating theatres with holding and recovery areas, a nursing department and clinic facility with a range of dedicated spaces to suit a highly efficient, independent day surgery facility.

The operating rooms were equipped with the most up-to-date equipment, surgical lamps, pendants and monitors, and offered enough space to perform all surgical procedures safely and efficiently. As the ceiling pendant was heavier than normal, additional reinforcements were needed for the ceiling to support the extra weight. As a result, the construction can now safely support a weight equivalent to a small Volkswagen car.

The operating rooms had to meet the strictest requirements and comply with ISO 5 to meet international standards. The build was validated according to the VCCN RL-7 guidelines to guarantee a safe environment optimal for surgical procedures.

The Outcome

The new outpatient clinic was completed in just 8 months from start to finish, which provided a cost saving of 30% compared with traditional build. The facility was produced independent of the ongoing traditional build of the new hospital, with both projects able to run in parallel.

The facility is now operational five days per week. The number of procedures carried out has increased, as the new facility has been designed for higher throughput and higher efficiency. The day surgery centre can also provide a back-up facility for the main hospital. During downtime in the main facility, all surgical procedures could be carried out in the new centre if required.

Young Medical’s modular solution is designed to serve for a period of 10 to 12 years, offering additional flexibility for the future. Part of the building could be repurposed for use in another location once the new hospital in Zwolle is complete.

 

Bergman Clinics, Rijswijk, The Netherlands

The Need Bergman Clinics is a large chain of private clinics in the Netherlands undertaking scheduled procedures including orthopaedic procedures, eye surgery, skin improvement and aesthetic surgery. Its orthopaedic mobility care clinic in Rijswijk, the Netherlands, required extensive renovation work and as a result of an increase in patient numbers from the region it covers, […]

The Need

Bergman Clinics is a large chain of private clinics in the Netherlands undertaking scheduled procedures including orthopaedic procedures, eye surgery, skin improvement and aesthetic surgery. Its orthopaedic mobility care clinic in Rijswijk, the Netherlands, required extensive renovation work and as a result of an increase in patient numbers from the region it covers, a need for increased clinical and surgical capacity had also been identified. It was decided that the renovation and expansion of the clinic, which was expected to take around six months, would be done at the same time.

Closing such a busy and successful clinic for this length of time was not an option for Bergman, and the company investigated several options for managing demand in the meantime, including the possibility of renting clinical capacity from neighbouring hospitals. However, it soon became evident that this would not be practical so Bergman’s management approached Young Medical to build a temporary operating theatre complex.

The Plan

Young Medical gladly accepted the challenge of building an operating theatre complex, containing two operating theatres and a nursing ward where patients could stay for one to two nights, within a time period of just three months.

It was decided that the temporary clinic would be located on a leased site within the municipality of the Hague. The facility was to have a footprint of 1,000 m2 and the space had to meet the strictest requirements and specifications for orthopaedic surgery procedures, since hip and knee replacement surgery would account for the lion’s share of the operations conducted in the temporary clinic.

The Solution

In consultation with the clinic’s management, a temporary clinic was designed to include two operating theatres, a preparation room, a recovery room, a sterile storage area, changing rooms, a consultancy room and a staff room. In addition, a nursing department containing nine two-bed wards with en-suite bathrooms, a waiting room, dispensary, reception, offices and a dirty utility was added.

The operating theatres were equipped with the most modern surgical lamps, pendants and monitors and offered sufficient space to perform the procedures adequately. The operating theatres had to meet the most stringent requirements in line with the latest Dutch guidelines for a protected area (VCCN RL8). The entire operating theatre was also tested according to the ISO 5 standard to ensure CFU in the air was <10/m3. This created a safe, ultra-clean operating room, where optimal patient care could be performed.

The Outcome

Young Medical delivered a fully operational temporary clinic in June 2019, just three months after the initial order was issued – on time and to the requirements specified by Bergman. The clinic ended up using the temporary facility for six and a half months to perform surgery while the main clinic building was being refurbished and extended.

Both the medical teams and the patients found the temporary facility a pleasant place to be treated in and work in. Frequent comments that the temporary unit provided a professional working environment with all the convenience, logistics and facilities expected of such a clinic were received. While the unit was in use, surgery was performed four days per week, to allow patients treated on Thursdays to return home on Saturday, and on average six patients were treated per theatre per day.

 

The Royal Infirmary of Edinburgh, NHS Lothian, Scotland, UK

To help manage patient flow, it was decided that a modular Minor Injuries Unit (MIU) would be created alongside the hospital’s A&E department

The Need

As a major acute teaching hospital serving a population of around 500,000 people, the RIE estimated its busy A&E department was seeing 70 fewer patients a day than optimum. People were waiting in A&E for treatment for injuries or conditions which would be better dealt with elsewhere, placing the department under pressure. Due to the high volume of people, privacy was also sometimes difficult to maintain.

To help manage patient flow, it was decided that a Minor Injuries Unit (MIU) would be created alongside the hospital’s A&E department. The new MIU would treat those with less serious injuries, diverting them away from A&E to a more suitable environment.

The Plan

The Royal Infirmary of Edinburgh needed help with establishing a temporary ward to house an MIU. In consultation with the hospital’s staff, the Young Medical team worked with NHS Lothian to determine their exact requirements and were able to offer a bespoke solution that met the hospital’s needs while also using both the existing estate and Q-bital’s fleet creatively.

The solution combined an existing Q-bital mobile laminar flow theatre with a number of modular buildings to create a suite of bespoke spaces. The end-to-end consultation process meant the project could deliver a complete clinical environment where patients could be booked in, prepared, have their treatment and recover, providing a seamless experience for the patient.

The Solution

Converting one of Q-bital Healthcare Solutions existing mobile theatres, Young Medical coupled this with a custom-built modular ward to create a unique assessment and treatment solution. The newly created stand-alone unit provides all the space the hospital needs to deliver an MIU service for its patients, including a reception and waiting area, treatment room, plaster room, eye wash room, six treatment bays, clean and dirty utility spaces, lavatories and a changing room.

The converted theatre unit was driven and unloaded onto the pre-determined location beside A&E, while the ward element was lifted into position on site by crane. It was important also that the department was accessible from the existing A&E, something which has been achieved through the building of a purpose-built walkway which brings the two departments together.

The unit was expected to initially be on site for two years and the service runs 24-hours-a-day, seven days a week. It is supported by a Q-bital Healthcare Solutions Operating Department Practitioner who facilitates alongside NHS Lothian’s existing staff team.

The Outcome

Within hours of opening, the impact was already apparent. In its first hour, more than 20 patients were diverted from A&E to the MIU, and within its first week upwards of 100 people a day were being seen and treated in the unit.

To date, more than 3,500 patients have received treatment for a range of injuries and conditions, such as fractures, sprains, back and neck pain, soft tissue injuries, bites and other minor ailments. Those people would previously have been seen in A&E under less than optimum conditions and facing a longer wait.

Staff working in the department report that A&E is much calmer and quieter and people can be seen quicker and with more privacy. There is greater privacy also for the people using the MIU, as the bays have fixed walls. The clinical team are enjoying working within the new unit, which is bright and spacious, well-equipped and has flexible space for triage, consultation and treatment.