Memorial Sloan-Kettering's New State-of-the-Art Surgical Suites Open

	Memorial Sloan-Kettering Cancer Center Surgeon William Jarnagin (far right) and his team perform laparoscopic surgery in a new operating room.

"The only limits now are our own imaginations," observed David P. Jaques, Vice Chairman of Memorial Sloan-Kettering Cancer Center's Department of Surgery, of Memorial Sloan-Kettering's new surgical center in the days leading up to its opening. Approximately a decade in the making -- from the earliest discussions to the opening on May 1 -- the center "provides our teams with all the tools they need to be more innovative than ever before," Dr. Jaques said.

The new center had its genesis in 1996 when it became clear to Department of Surgery Chairman Murray F. Brennan and then-Memorial Sloan-Kettering President Paul A. Marks that new operating rooms were needed. "The challenge was, where to put these state-of-the-art ORs," said Dr. Jaques.

	(From left) Director of Design and Construction George Mejias; Department of Anesthesiology and Critical Care Medicine Chairman Roger Wilson; Aileen Killen, Director of Perioperative Nursing; and David Jaques, Vice Chairman of the Department of Surgery, all played key roles in the development of Memorial Sloan-Kettering Cancer Center's new surgical center.

"With no available real estate, our only option was to use the little zoning capacity we had," explained George Mejias, Director of Design and Construction. "We decided to build a five-story extension atop the Winston Pavilion of Memorial Hospital. The question then became, 'How to build on top of an existing structure and allow the occupants to continue to work during construction?'" The answer? "Super columns" -- four enormous columns driven through the corners of the Winston Pavilion to the bedrock below. "Imagine four legs of a table," Mr. Mejias elaborated. "From that infrastructure we 'hung,' as if from a bridge, the floors needed for the ORs to go into what we called 'the infill.'"

Construction took about three years and involved creating a new home for the pediatric day hospital on the ninth, or top, floor and building a new surgical laboratory for the Department of Pathology on the fifth floor. All this was accomplished with minimal disruption to the flow of work and patient care.

"One of the most important things to say about the process is that it was born in a collaborative spirit and stayed that way right to the end," Dr. Jaques elaborated.

"The team was talking from the beginning," emphasized Director of Perioperative Nursing Aileen Killen. "But it wasn't just sitting in a room and talking -- it was nurses, physicians, anesthesiologists 'kicking the tires' on mockups and having a say about what the new environment would be like." Indeed, an actual operating room mockup was built in a giant tent "where we tested everything from floors to scrub sinks," said Mr. Mejias.

	Head and neck surgeon Bhuvanesh Singh (right) and his colleagues on May 1, the first day of surgery in the new center. Visible on the wall at left are four flat-panel displays that comprise the "Wall of Knowledge," state-of-the-art technology that brings together real-time patient information, including physiologic data, and surgical, laboratory, and radiology images.

Surgery, and in particular surgery for cancer, has many special requirements. "The new intraoperative radiation therapy rooms, the robot-capable rooms, the intraoperative MRI rooms [to be initially used for neurosurgery later this year] -- and the fact that every operating room combines the capability for both minimally and maximally invasive surgery -- all of this is key to performing the best possible surgery for people with cancer," said Roger S. Wilson, Chairman of the Department of Anesthesiology and Critical Care Medicine. "In addition, the facility was designed to be sufficiently innovative to take advantage of what's available today as well as to have built-in opportunities for expansion in the future."

One of the most dynamic innovations is the "Wall of Knowledge," deployed in all 21 operating rooms. A state-of-the-art visual system, the Wall of Knowledge comprises four large, wall-mounted flat-panel displays that include complete, real-time patient information -- generated by diverse information systems, physiological monitors, and medical devices -- as well as surgical, video, laboratory, and real-time radiology images. "This sharing of information will enhance patient safety, contribute to efficiency and learning, and allow continuing improvements in patient care," said Dr. Jaques.

"Situational awareness is vital for the circulating nurse in the OR," Dr. Killen said. The circulating nurse "circulates" the operating room outside the sterile field, observing the surgical team from a global perspective, and is responsible for managing the nursing care of the patient and assisting the team to create a safe, comfortable, and efficient environment. "The Wall of Knowledge will transform our work," Dr. Killen said. Perhaps most critically, the line of sight of the circulating nurse will be vastly improved. "Our 'documentation stations' [where computer monitors sit] will now face the patients. The Wall of Knowledge itself will permit nurses to have both a visual image of an operation as it proceeds plus constantly updated information on a patient's status on the screen."

Anesthesiologists, too, will be employing the latest equipment, ranging from the anesthesia supply boom to the various monitoring modalities. "And we'll be working in much more space," Dr. Wilson elaborated. "In the older ORs, as more and larger equipment was introduced, anesthesiologists got pushed into a corner. Here, we've got plenty of room to integrate new devices as they become available."

Yet all the new technology has not been at the expense of the humanity of patients and their families, whose needs were of paramount importance in the design process. Greeted the moment they step off the elevator, patients are shepherded through the entire presurgical process by the nursing staff of the Presurgical Center. After surgery, the Postanesthesia Care Unit (PACU) has no more than four beds together in one bay, cutting down on noise and lack of privacy. Nurses also have a wireless "cart system" that enables them to bring all their tools to patients' bedsides. "The PACU is probably the most dramatically different area in terms of nurses' ability to deliver care," said Dr. Killen.

In addition, incorporated into the center are a family waiting area and private consultation rooms. "You don't have to have been around Memorial Sloan-Kettering long to know that postsurgical information has traditionally been shared with families in the lobby at the top of the escalator in Memorial Hospital," said Dr. Jaques. "That's now been 'engineered out.' "

Instead, privacy will be ensured by having families brought up to the sixth floor as an operation reaches its conclusion. "They'll know that, good news or bad, the surgeon will sit down and spend time with them in the privacy of a consultation room," explained Dr. Wilson.

Speaking at an open house for Memorial Sloan-Kettering staff in April, Dr. Jaques observed, "Sixteen thousand times a year, patients put their trust in Memorial Sloan-Kettering and the surgical teams who work here. And 16,000 times a year we deliver. Now we'll deliver with the innovation that this center's capabilities provide."

Added Physician-in-Chief Robert E. Wittes, "It's really about the people who'll inhabit this place and for whom the physical facilities are a means to an end -- serving our patients."