Opened in February, Penn Medicine’s 100,000-square-foot Interventional Support Center consolidates its clean sterile services to an off-campus location—a move that helped the organization right-size operations and improve efficiency and staff safety. But before they could realize those goals, the project team, including Stantec (Philadelphia and Chicago), had to design a new central sterile facility that supported a new way of processing, cleaning, and storing operating rooms case carts for multiple locations.

While in an on-site setting, soiled instruments go directly from the operating room to central sterile services for cleaning, with the new offsite facility, the project team had to figure out how to process and handle instruments from several facilities. For example, instead of receiving one cart at a time, here, the case carts would be bundled into groups of 20. “So the whole flow starts to change a little bit,” Huff says. “And a key mandate from Penn medicine was that everything had to be broken down and started to be cleaned as it was arriving so we couldn’t let things build up.”

Unlike other healthcare projects where teams can look at past case studies for ideas or lessons learned, here, there was no peer facility to help guide the Penn Medicine project, says Scott Huff, principal at Stantec (Philadelphia). “This was that the largest of its kind, so there was nowhere that we could go and say well you know what what’s a good starting point,” he says.

To begin managing this new flow, the project team observed every step of the process, including breaking down a cart, cleaning all the instruments, stocking, cleaning, sterilizing, and rebuilding the carts. “We had to extrapolate that then into a time motion study and test the facility design as it was evolving to make sure that we weren’t going to have any bottlenecks,” he says.

Another nuance to the process was the addition of air locks between the loading dock and the interior of the facility. While designed to ensure air pressure and temperature requirements and a dust-free environment, their presence added an extra step in moving carts through all the different stages. “What we realized as we were going through these simulations was that the original design wasn’t going to work for the way the cases were going to be set up and staged to wait for the trucks to take them back to the hospital campuses,” he says.

The original design had one large vestibule that could accommodate all the carts but would have been inefficient as employees moved in and out of the airlock. The design was changed to create two different vestibules on the shipping side so that at any given time, one of the vestibules could be open for staging carts that were going to go out in a couple hours, while the other one that was filled with finished case carts could be open to the loading dock for transport. “That simple move to make two vestibules out of one really improve the flow of the carts as they were getting completed and getting ready to be shipped,” he adds.

For more on Penn Medicine’s new Interventional Support Center, check out the article “Clean Slate” in Healthcare Design’s August issue or click here.