HYBRID FACILITIES

Created - 24.10.2017

These facilitate combined image guided procedures and open surgery. They may also be referred to as Interventional Radiology Theatres and others. A number of hospitals and organisations are investing substantial funds into such facilities, to improve the care of vascular, cardiac and trauma patients. Most will not find it financially viable to have more than one such suite.

BSIR was invited by the MHRA, to contribute to a Joint Working Group, which issued a report in 2010. This report was precipitated by a number of reports to the MHRA of EVAR (endovascular aneurysm repair) devices being placed in environments with poor imaging equipment. This was resulting in poor device placement, and high radiation doses to patients and operators. The subsequent report highlighted the need for improved facilities, and provided information intended to give details on the facilities that NHS and other organisations should aspire to provide. Of note, it was specifically stated that there was a need for back up imaging facilities in close proximity.

It was also recognised that, at the time, there was a preference for such facilities to be located close to a theatre environment (to allow for anesthetic and recovery areas). In the intervening time, Major Trauma Centres have developed, and the need to accommodate the rapid treatment of such patients. As a consequence of this, and other, changes there has been an expansion of the routine nature of delivery of anesthetic and recovery facilities outside theatre complexes. It has also become clearer that there is a pivotal role of Interventional Radiology (IR) in bleeding control. Trauma investigation and treatment (including image guided techniques) need to be co-located with Emergency Departments.

As a result, BSIR considers that, whilst the underlying principles of good imaging and environments remain current, requirements (and modern practice) of trauma care have changed the landscape of hybrid facilities. In the modern environment, these need to not just cater for EVAR delivery, but also trauma care. IR departments are generally located close to diagnostic radiology, CT scanners and Emergency Departments, ensuring safe and rapid patient treatment pathways. Such places offer considerable advantages in terms of back up imaging, power supply, power injectors and disposables, which are essential to the resilience for delivery of trauma care and combined image guided/open surgery. In many circumstances, these needs may outweigh other factors, making them more functional and economically viable if placed close to other IR and imaging facilities.