Читать книгу Practical Pediatric Gastrointestinal Endoscopy - Группа авторов - Страница 25

Proper design of the pediatric endoscopy unit is crucial to the experience of the patient as well as the efficiency of the endoscopy team. Pediatric‐focused facilities prioritize the child and family experience with the goal of reducing patient anxiety and providing age‐appropriate analgesia [1,2]. Design and management of the endoscopy unit needs to be specialized for this unique patient population. A calming environment and smooth patient flow are critical. Ideally, encounters between preprocedure and postprocedure patients should be minimized.

In the United States, endoscopy procedures in children are performed in a variety of locations, including operating rooms, procedure rooms, dedicated endoscopy suites, and ambulatory surgery centers [1,2]. In low‐volume centers, use of the operating room may be appropriate. For those units located in general hospitals, a combined adult/pediatric unit can offer cost savings in terms of equipment and facilities, as well as close proximity for pediatric endoscopists to adult therapeutic endoscopists. Recent survey data suggest up to 40% of centers in the United States currently perform endoscopy in a dedicated pediatric endoscopy unit [1]. Sharing space with other specialties such as pulmonology may be an option, but this can decrease the ability to customize the space for gastrointestinal endoscopy.

An endoscopy suite with at least two procedure rooms is desirable depending on the number of endoscopists and volume of procedures. Two rooms allow for concurrent procedures to take place and the ability to perform emergent inpatient procedures. Adult teaching hospitals are generally expected to do 1000 procedures per room per year [3]. In addition, the unit can include a motility room, capsule endoscopy viewing room, and advanced endoscopy room for fluoroscopic procedures. Plans for designing a pediatric endoscopy unit should include anticipated volume, procedural complexity, and growth of the unit over time. Considerations of space are difficult and carry the greatest implications for overall construction costs [4].

All units should have a reception area and waiting room, where children and caregivers are greeted when they first arrive. The waiting areas should be child friendly. Bathrooms should be easily accessible, with special considerations for obese patients or handicapped patients in a wheelchair. Once escorted into the unit, patients require a clear area to be prepared for the procedure. From this area, the patient is transported directly to the procedure area. In general, a procedure room should be at least 400 square feet with more space often needed for advanced therapeutic cases involving fluoroscopy. Two separate doors should provide access to the procedure rooms: one to allow for the entry of the patient and clean supplies and the other for the removal of used equipment and specimens. Procedure rooms should be equipped to provide CO₂, oxygen, suction, and adequate electrical socket outlets for ancillary equipment. Ceiling‐mounted booms may be helpful in keeping lines and equipment off the floor. One side of the room should be dedicated to nursing. Anesthesia and associated medications and supplies should be located at the head of the bed. After the procedure, a dedicated space for immediate and/or final recovery is needed.

A work area for physicians is an important consideration so endoscopists can complete procedure notes, enter patient orders, and coordinate care by phone. Including a room for consultation with patients and families to allow for confidential conversations is also important [1].

A major decision that must be made is where endoscopes will be stored and reprocessed between cases. Ideally, reprocessing is most efficient when it can be located directly adjacent to and shared with the other procedure rooms. Contaminated endoscopes have been linked to many outbreaks of device‐related nosocomial infections. There have also been outbreaks recently related to the elevator mechanism of the duodenoscope [5]. Endoscopy staff should be well trained in disinfection procedures and skills should be annually assessed. Flexible GI endoscopes should first be comprehensively cleaned manually and then subjected to at least high‐level disinfection (HLD). HLD can be performed in an automated endoscope reprocessor or using manual processes. Step‐by‐step guidelines on appropriate scope disinfection can be found in the multi‐society guidelines originally published in 2011 [6] and updated in 2016 [7]. An understanding of how a specific reprocessor might be integrated into a unit under design is critical to avoiding last‐minute space refitting, as well as potential breaches in patient safety once procedures are being performed.

When preparing plans for construction of the endoscopy unit, thorough discussion should take place with the hospital system facility management or a licensed architect familiar with healthcare facilities. The coding of these facilities will vary from state to state and country to country. To prevent future problems, the architect and licensing agencies should be consulted regarding all possible uses of the unit, as regulations vary depending on the use of the unit. Attention to these possibilities may prevent the possibility of retrofitting after the unit is already built.