B3C: Building for the New Century at Mass General
The Clinics Building has come down, and we can see the beginnings of the Building for the Third Century, or B3C (architect's rendition at right). The new building, expected to be completed in 2011, will mean big changes for the Department of Anesthesia, Critical Care and Pain Medicine, as three floors of the B3C will house operating rooms.
Planning for the B3C began in 2005. In December of 2005, Dr. Peter Dunn and Dawn Tenney, RN, were named co-chairs of planning for procedure areas at Mass General, including the B3C, the new Post Anesthesia Care Unit on Ellison 3, and renovation of the current Same Day Surgical Unit space on Wang 3. Since then, they have visited hospitals and facilities across the U.S. and in Europe, exploring ideas for the new construction and for existing spaces, sometimes accompanied by other members of the departments of surgery, anesthesia and nursing.
From the DACCPM, Drs. Wilton Levine, Michelle Szabo, Neelakantan Sunder, Ed George, and Lisa Warren have all played a signficant role in planning. In addition, Val Buckley, Ryan Forde, and Luis Melendez have provided input and expertise throughout the process. The result has been a plan for reorganization that encompasses the existing, or “legacy,” operating rooms, existing and new pre-op and recovery spaces, and construction in the B3C.
The new building will include:
- Ten floors above ground and four below grade. Floors 2, 3 and 4 will be operating-room floors. The 6th floor will house a new Neurosciences ICU. Floors 7, 8, 9 and 10 will be inpatient floors. Floors 2 and 3 will connect directly to the existing hospital in several ways. There will be a walkway across the front of the hospital entrance connecting Wang 3, where patients will continue to check in before surgery, with the third floor of the B3C. Floors 2 and 3 will connect directly to the Ellison building.
- Four operating rooms will be on the second floor, as well as 13 perioperative bays, locker rooms, the OR pharmacy, central sterile supply, and a blood bank. The second-floor ORs will be used primarily for small, rapid turnover procedures, and patients will recover in the perioperative bays on that floor.
- A third floor with 13 orthopedic operating rooms arranged to surround a central core to allow centralization of instruments and other equipment, a particularly significant issue for orthopedics. There will be nine perioperative bays, which can be used for pre-op preparation and for recovery.
- A fourth floor that will house 12 Neuro and Vascular ORs, 12 perioperative bays, and four hybrid interventional/open rooms with the highest concentration of technology in the B3C. These services were chosen for the B3C because the legacy operating room space does not have the infrastructure needed for significant technological advances in those two areas of surgery. Intraoperative CT and MRI suite will be used initially for neurosurgical procedures, but will be available to other services in the future.
- All ORs will be at least 600 square feet. Each OR floor will have its own control desk and its own anesthesia workroom. Each floor will have omnicell machines, but narcotics will be dispensed at the main pharmacy on the second floor. There will be elevator and stair connections between floors, a dumbwaiter system, and limited pneumatic tube connection with the main hospital. Storage space will be provided for all equipment and for patient stretchers so that the hallways remain clear.
- Several computer workstations. The perioperative bays on each floor and in the new space in Ellison and Wang will allow for pre-op care, workups, line placement, epidurals and blocks to be done in private, more spacious areas close to the operating rooms. With many perioperative bays in the B3C, 35 new PACU beds in the Ellison 3 PACU, and 28 PACU beds in the existing White PACU, the PACU waitlist should become a thing of the past.
- The largest central sterile supply area in the USA. The arrangement of the floors will resdesign equipment and supply management at Mass General. For example, orthopedic instruments will be on a cart system, without the need for resterilization between cases.
Some changes to the legacy ORs will begin soon. In the next six to nine months, OR 33 will be redesigned to bring in a new technology for complex hybrid vascular cases.
Once the new operating room space opens, reorganization and renovation of other legacy OR space will begin. It is likely that Plastics and Surgical Oncology will co-locate, Pediatrics will move to Gray or White ORs, and the aim is to move the Thoracic ORs closer to Cardiac. The lithotriptor will ultimately be removed and become a hallway, as newer, portable lithotripsy equipment is now available. The endoscopy set-up area in the hallway that ends in OR 14 will possibly become a pre-op area for White operating rooms. Some of the other operating rooms throughout the existing buildings will be renovated, possibly consolidated or decommissioned.
Operational planning for Anesthesia staffing will also begin soon. Our current team approach to the ORs will likely remain, though reorganized, and the Gray desk is likely to stay the central hub for scheduling. Nighttime staffing is yet to be determined, and will possibly include two call teams, as floors 3 and 4 in the B3C will remain open round the clock.
According to Dr. Dunn, "As we start the phase of operational planning, many more members of the DACCPM will be participating, and we welcome input from all.” He and Dr. Wilt Levine will present comprehensive plans for the B3C at an upcoming DACCPM staff meeting.
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