Ambulatory Surgical Centre OR
ASCs have operating rooms on site that are not supported by those units you would expect in a typical tertiary hospital, such as, intensive care, recovery wards, blood banks etc. Consequently, the procedures tend to be low risk and draw on less resources such as imaging devices etc. Often, the patient is under local or regional anaesthetic and so is conscious of their surroundings.
A typical configuration could be:
|Endoscope CCU||Surgeon monitor|
|Surgical light camera||Assistant monitor|
The workflow would be a software application running on a server and the capture device would be required to pre-populate the case form with patient data and then attach images and clips, intraoperatively, in a report template with a DICOM wrapper and exchange that information on HL7 messaging after the case is closed. The subsequent report would either be paperless (PACS archived), or printed for immediate posting to the referring physician.
Digital / Integrated OR
Digital operating rooms are what most people understand an integrated OR to be: distributing video from a number of sources to LCD displays and capture systems. Often, they will connect one OR to another OR, or an office or classroom. They will use digital forms of radiology for example, and integrate those images into the routing system.
They are generally designed mostly with elective minimal invasive surgery in mind, following a checklist and protocol and utilising workflow software for imaging records on DICOM and PACS. There tends to be a central control console for setting up, uploading patient information, control of various medical devices and the management of multimedia sources such as video, imaging and audio (music or conference).
Hybrid ORs are the most complex and require the most imaging sources and consequently multiple displays, and so generally have a large IO count. The idea is to leave the patient static and move imaging devices in and out as required, such as CT, MRI, C-arm, ultrasound etc. Often 2 endoscopes are in use simultaneously. Hybrid ORs are generally geared for the most complex cases where up to date information is vital: spine, trauma, brain etc.
The key difference is the simultaneous use of different and independent intraoperative imaging devices, while this is done to some degree in integrated ORs, it is standard practice in a hybrid OR. The alternative is a scanning room and then procedures subsequently carried out in a more traditional OR, requiring the patient to be moved. This movement, and the time required to move a patient, is particularly dangerous in trauma or emergency surgery rather than elective, where the golden hour is often all that separates the patient from life and death; the resources are there, they are just not accessible quick enough. Understandably, saving the patient’s life is more important than uploading information and calmly following workflow protocols, however, video capture services are a nice-to-have, if only for learning opportunities post emergency.