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The MarkeTech Group

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ISSUE 1 VOLUME 14 SUMMER 2015

INTERVIEW OF THE SEMESTERHybrid room: At the root of hybrid room creation.

Mr. Yann Bubien (YB) Director of Angers CHU

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Interviewer: Julien Regnard (JR), TMTG Partner

JR: It is with pleasure that I welcome today Yann Bubien, Director of the University Hospital (CHU) of Angers who accepted to share a specific experience within the Angers University Hospital, the creation of a hybrid room.

Sharing this experience will continue throughout 2015 and will include 4 major phases: the project birth, its implementation, a first activity report and a perspective with similar projects in the United States or France.

Let’s get started with this interview of Mr. Bubien, I thank him for his involvement in this project.

The aim of our conversation today will be to define what a hybrid room is and to understand the reasons that led the University Hospital of Angers to develop such a tool.

For our hybrid room, the medical project was conducted in conjunction between the radiology - the room will be under the control of the chief of radiology-, the cardiac surgery, the cardiology, the vascular surgery and the neurosurgery.

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JR: Mr. Bubien, hello, my first question is actually quite simple, what is your definition of a hybrid room?

YB: Hello, I don’t know if there is a strict definition of a hybrid room but it is clear that for the Angers University hospital a hybrid room is a room that must have specifications to perform surgical procedures using in priority minimally invasive surgical techniques that rely heavily on imaging.

Therefore, a hybrid room must benefit from air handling compatible with an operating room, optimal imaging quality and obviously. The room must have all the characteristics of an anesthesia area.

There are other University Hospitals who already have hybrid rooms within the last years with Lille and Tours or Nancy; Angers University hospital will be among the first institutions of France to provide such environment for patients and professionals. The particularity of the Angers’ project is to have integrated the hybrid room in the interventional imaging area by bringing together three operating theaters. The architectural dimension of this space was particularly shaped with the creation of suitable premises. The whole implementation is scheduled for September 1st this year.

One of the hybrid room characteristics of the Angers University Hospital is to provide different surgical specialties, which use the room; a particularly powerful imaging system in a space that can easily "alter" in conventional surgery if needed. This space of about 100m2 promotes the integration of technology to come. At the University Hospital several surgical specialties will occur in this room: the heart surgery of course but also vascular surgery, interventional cardiology and neurosurgery.

Therefore, it should be understood that the hybrid room is not an architectural and equipment restructuring, but has above all been designed as a new patient pathway; a path that changes and involves a new organization between doctors, anesthetists and radiologists who have to work differently within the hybrid room.

In a nutshell, here is our hybrid room project at Angers university hospital!

JR: How did you come up to consider the implantation of such a room?

YB: The idea was not born at the Angers University Hospital, it already exists abroad in major centers that adapt their technologies to contemporary medicine; they inspired us. Our will and our mission as University Hospital is to maintain a high level of expertise, so we need to adapt to medical innovation and make available to the public this medical excellence that characterizes a University hospital.

It is now clear that the future of surgery will increasingly involve a combination of minimally invasive surgery and imaging techniques.

Also, the patients care in the hybrid room will provide mini-invasive surgery with high quality. Performed under 2D/3D imaging and fusion imaging - imaging that combines scanner, MRI, ultrasound with real-time imaging, equipment in place will prevent, in many cases, the use of a heavier conventional surgery.

By making it easier, the complex procedures while reducing post-operative complications, this advanced technology will allow to bring an optimal response to the need for an aging and fragile population.

The hybrid room, is both a technological adaptation and a new organization by combining surgery and imaging while offering patients a mini-invasive procedures.

JR: You spoke of difficulties that may arise in the teams’ organization, is the clinical component the core of the implementation of this project kind? Is this a joint approach with the teams?

YB: I think this is really an institution policy; it cannot just be the University Hospital director wishing implementation; if there is no medical project behind, it does not make sense.

In fact, there is necessarily a conjunction between the will of the general direction to go to such a tool, the desire to build or adapt an existing building, the will to buy equipment that is quite expensive and the will of medical and paramedical staff to provide patients advanced service involving internal organization changes.

For our hybrid room, the medical project was conducted in conjunction between the radiology - the room will be under the control of the chief of radiology-, the cardiac surgery, the cardiology, the vascular surgery and the neurosurgery.

It is a brand new organization; new practices are in the process of being set. Radiologists and surgeons will work together in the institution’s medical committee.

This new room also involves paramedical staff reorganization. It is a joint work for a different care path. In my opinion, this is a solution for the future.

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JR: Is this kind of tool led to replace in a sustainable way the current practices or alternatively will both coexist, hybrid room becomes a complementary tool in the " surgical tools’ box"?

YB: For now it is the coexistence between the two approaches that prevail, the hybrid room is an additional tool in a complex array of equipment and practices.

It is possible that other technologies emerge, but either way I’m sure we are heading to the less and less invasive acts where the alliance between surgery and imaging will be more tenuous; it is a radical evolution of radiology in recent years.

JR: In consideration of the numbers of constraints we also understand the need to adapt staff training.

CA: I have told you, we work to optimize the overall functioning upstream of the room’s opening. The room won’t be opened until September 1st 2014, so it is difficult to tell you from now how will it happen in the field.

It is clear that we will be led to make organization’s readjustments according to actual operation.

In fact, it is necessary to overhaul existing medical and paramedical organizations and also strengthen skills; I think particularly for radiology technicians (manipulators), nurses, IBODEs, the IADEs, caregivers.

Everyone has new skills which must be assimilated; physicians such as allied health professionals; this is also a very interesting collective project because it is always rewarding to update together, as a team, practices and gain new skills in this occasion.

JR: What is the impact for the CHU from an economic and financial point of view?

YB: It is a first-rate investment. Beyond the acquisition of equipment and adaptation of its environment, it had to reckon with the architectural investment; we have built an extension to one of our buildings. It is a heavy investment but an investment for the future. I'm sure it will work.

For the youngest physicians and as for paramedics, I think it's very exciting to have such tool available. There is no doubt patients will also be very demanding.

JR: Does the thought of brand image affect the decision to invest in such a project

YB: Sincerely no. I will not tell you that it is not interesting, but the real benefits in terms of brand image don’t impact the decision to launch this kind of project.

The lead is the medical project which is part of an institution project; and there is nothing else that matters. What counts is that physicians will want to do something together on a defined project, in this case, the hybrid room; and there is a match between the institution project and its ambitions for the future, its general policy for the years to come.

At CHU of Angers, the brand image is built on our reality; it is built on who we are and what we offer to the population. There is no question of reversing the process. However, we must recognize that in France, there aren’t many hybrid rooms yet, and even fewer hybrid rooms as we have conceived in Angers. We bring the innovation, this one can only be a promise for our image and of course we are going to sell it.

What really matters is to respond to a growing need for patients in this new way to operate. One more time, the brand image doesn’t mean anything if it doesn’t work, if the team can’t get along with one another, if we can’t organize the works between physicians and paramedics.

JR: Does that mean you don’t predict a rapid democratization to other kinds of institutions? I think of the general hospitals or even the private ones?

YB: I don’t know, it is a relatively expensive investment on surgical and imaging specialties rather within the public service. Cardiac surgery and neurosurgery are almost exclusively done in the public. This could take place in the private sector and in some general hospitals but it is a big investment; to use it requires having health professionals adequately trained to operate the system. Moreover, such equipment is a tool for research.

If the economic model rather meets the need of a CHU, I don’t see why the other institutions cannot acquire this kind of tool.

In 5 to 10 years, I think this practice will develop, other types of institutions will probably get equipped.

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JR: Referring to the industrial partners involved in the project, is it principally the traditional operating rooms’ industrials or rather the medical imaging partners?

YB: I prefer not to comment on that because it is not me who has led the project on these aspects. I only followed the institution and medical project side. Biomedical engineers took care of this.

From my point of view, everything went well, we are on time, and the works are done properly.

JR: In terms of future hybridization projects of surgery rooms in France, do you have a visibility of the institutions in reflection on this subject?

YB: I don’t have the visibility on other projects. As far as I know, CHU have or are currently being deployed such rooms with sometimes different positioning of Angers project. In this regard, let your readers know that the CHU organized an inauguration on September 25.

JR: Mister Bubien, Thank you very much for these clarifications in Angers project.

Appointment is made with the CHU of Angers for the next step of this experience sharing, in September for an explanation of the room implementation.

Thank you one more time and see you soon.