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      5 Design of the Endoscopy Suite

       Hans-Dieter Allescher

      5.1 Introduction

      Endoscopic techniques continue to develop rapidly, and a myriad of other diagnostic imaging modalities have become more and more important and clinically relevant. When planning and designing a new endoscopic suite, these changing demands of technical equipment and information technologies have to be considered. Former guidelines can only be partially adapted to these recent changes. New demands to imaging, flexibility, and connectivity have to be defined. In general, the space and facilities required in endoscopic units depend on the spectrum and quantity of the procedure performed and the staff available. Additionally, it is important to predefine which endoscopic techniques should be performed or subsequently introduced. When required, the facilities should be sufficiently versatile and flexible to allow handling of emergency cases without disrupting routine procedures.

      There are some general questions and considerations which should be answered in a checklist before planning and building an endoscopic suite.

      5.2 General Questions and Considerations

      1. For what purposes are the endoscopy suite used?

      a) Only elective/planned procedures?

      b) Only outpatient or ambulatory patients or also inpatients?

      c) Estimated number of procedures and procedure types per day/week?

      d) Number and frequency of complex procedures (e.g., endoscopic submucosal dissection [ESD], peroral endoscopic myotomy [POEM], double-balloon endoscopy, cholangioscopy)?

      e) What types of therapeutic and invasive procedures are performed?

      f) Are special patient groups treated (e.g., pediatric patients, bariatric patients)?

      2. What types of complex procedures are performed?

      a) Frequency of X-ray and radiological demands?

      b) Need for navigated work or procedures?

      c) Need for combined imaging (e.g. endoscopic ultrasound [EUS] plus radiology)?

      d) Are there plans for NOTES (natural orifice transluminal endoscopic surgery) procedures (POEM, peroral endoscopic tumor resection [POET], ESD)?

      e) Are other procedures and tests (manometry, capsule endoscopy, function tests) performed within the unit?

      3. What are the streams of material/patients/doctors/nurses?

      a) What is the most effective way for patients to navigate from the time of admission until the end of recovery?

      b) Which pathway is most effective for endoscopic staff and nurses?

      c) How can the time and efficiency of physicians be optimized?

      d) How can the endoscopic equipment be used most effectively?

      e) How and when is the endoscopic report generated and given/explained to the patient?

      4. Which reprocessing concept is planned?

      a) Processing of endoscopes within the unit or in central facility?

      b) Reprocessing of material or exclusive single use?

      c) What concept of reprocessing the endoscopes is carried out (separation of unclean and clean area), and what type of reprocessing machines will be used?

      d) What room concept (ceiling supplies or trollies) is planned?

      5. How is sedation performed in the endoscopic suite?

      a) Percentage of procedures with sedation.

      b) What type of sedation is used and what is the process for patient monitoring during and after the procedure?

      c) Need for and frequency of general anesthesia.

      d) How is general anesthesia performed?

      e) Does the endoscopy suite provide care to children of all ages?

      5.3 Guidelines for Planning an Endoscopy Suite

      The space concept of an endoscopic suite is influenced by many factors. If the endoscopy suite is planned de novo or in a new building, an ideal room concept can be realized. However, if the unit is built into an existing building, there is always a compromise between demands and technical feasibility. The number of endoscopy rooms within the endoscopy suite depends on several factors such as the estimated number of endoscopic procedures and the breakdown by type, complexity, and need for fluoroscopy or radiography. Precise updated numbers and a development plan for the upcoming years should be made available for planning, as these statistics are often outdated.¹

      Furthermore, transport and waiting times as well as the management of patients outside of the procedure rooms are relevant. A clearly defined and structured monitoring of sedated patients is mandatory, and sufficient space, monitors, and staff personal for this need to be considered. Some units have individual pre-procedural rooms for each patient, to assess, undress, recover, dress, and review patients before discharge. In some countries, the requirements for the postprocedural recovery are clearly regulated and need to be considered before planning.² When there is limited recovery space and when more than one patient shares a room, there should be one or two interview rooms available for postprocedure consultation (

Fig. 5.1,

Fig. 5.2).

      5.4 Pathways for Patients, Staff, and Material

      When planning a new unit, it is advisable to first plan the pathways of individual patient populations (inpatients, outpatients), endoscopes, doctors, and nursing staff. Questions to be addressed include: where does the patient (outpatient or bedbound) enter the endoscopy unit, where do the preparation, undressing, and preprocedural assessment take place, and how and where does the patient leave the unit. If possible, preparation and recovery of the patients should be carried out independently of the procedure rooms, as this increases flexibility and productivity of the unit. On the other hand, separated recovery areas require additional staff and space. Furthermore, it is advisable to separate patients waiting for procedures from those recovering. Additionally, the number and timing of outpatient procedures performed without sedation have to be estimated, as these patients require less infrastructure and nearby changing rooms eventually with direct access