More than three years and nearly $21 million of work to expand, renovate and update Billings Clinic's suite of operating rooms is nearly finished.
Designed to meet growing patient numbers, the effort increased the number of operating rooms from 10 to 13 while adding a new high-tech hybrid operating room that allows for complex treatments not available at the hospital before and new catheterization and electro-physiology laboratories.
In 2013, when the expansion efforts began, about 10,000 cases came through the hospital's ORs, and that number has grown to about 17,700 for the 2015-16 fiscal year. At the same time the number of specialists working in the OR has increased from 44 to 65.
"We designed it to make it safer for patients and staff and used the evidence to back it up," said Jackie Hines, director of perioperative services.
The three new 600-square-foot operating rooms are equipped to handle numerous procedures, and the staff who work in them say they mean more rooms open up more quickly for patients who need them.
But the 1,100-square-foot hybrid operating room might be the most high-profile addition, combining state-of-the-art imaging technology and techniques with the expertise and resources of multiple specialties in an OR to create a space that allows for medical teams to perform new procedures they couldn't do before.
"It's really enabling for us," said Dr. Per Sommer, a Billings Clinic interventional cardiologist. "It enables us to come together as a team to do something we couldn't do otherwise. We all come together and bring our skills to the table."
It uses high-tech imaging equipment, such as CT scanners and surgical video systems, that put the images directly in front of a surgeon or medical team in the room. A fixed but movable arm can scan any part of a patient from just about any angle needed.
The hybrid operating room can be used for a number of procedures in a number of specialties, but most commonly for cardiovascular issues. One of the most well-known procedures performed using such an OR is a transaortic valve replacement, in which a medical team replaces valves in a patient's heart by running a small catheter to the heart through a small incision near the groin and into the femoral artery.
While not everybody is a candidate for the procedure, it provides an option for some patients who otherwise wouldn't be healthy enough for surgery.
"To be able to have the TAVR, this is really the only option some of these patients have," Hines said.
Since the first procedure on May 11, the hybrid OR has been home to an additional 15 TAVR surgeries in the ensuing three months.
One of the benefits of the hybrid OR is that it brings multiple specialties together in one room. A transaortic valve replacement might include up to 25 people, including from the cath lab, OR staff, cardiologists, surgeons and anesthesiologists. In total, about 80 people work in Billings Clinic's OR, not including physicians, and 25 work in the cath lab.
Dr. Mark Morash is a vascular surgeon who works in the OR. He said it makes things easier on the patient because the surgeries aren't as invasive and often result in them going home earlier.
"A part of, as a program, where we are is because of improvements in imaging," he said. "I think everybody's been very happy with it. I know I am."
Officials at the hospital also point to the cath lab expansion, which provides diagnostic imaging equipment to show parts of a patient's heart, as helping reduce patient wait times for its services, from several months to four to six weeks.
Included in the new technology is an extracorporeal membrane oxygenation machine, an intensive care life-support machine that can support the lungs and hearts of people who otherwise might die without it — including for conditions such as hantavirus or severe influenza — while awaiting treatment, surgery or transport.
Added up, the expansion cost about $20.9 million, with $13.5 million going to the OR expansion and renovation and $7.4 million for the hybrid OR, cath lab and electro-physiology lab.
A massive capital campaign by the Billings Clinic Foundation raised about $10.3 million for the OR expansion and proceeds from the 2013 Billings Clinic Classic went to the effort.
In addition, the Lorene W. And William F. Welch Foundation of Sheridan, Wyo., provided a $1.45 million gift for the cath lab expansion.
Hines said that the entire process was carefully planned, with a team from the hospital traveling in early 2013 to five hospitals in Colorado and Texas to see their recent expansions
"We were starting to plan back then," she said. "We asked them what they would've done different, what they wish they'd done."
The team brought along with them all of the different aspects of their plan and, each day, would gather and have a "gaming session," in which they moved those various parts around in different layouts to find out how they best fit together.
Construction began in 2013 and, because the hospital couldn't just stop operating room services, was completed in six phases in order to keep most of the existing rooms open and in use. Hines described the hybrid OR as "phase 6a," and a seventh phase to build new employee lockers and a lounge-type area is underway.
"We just stair-stepped it until we had all of those finished," she said.
Sommer said that the expansion was possible because of detailed planning at a time when Billings Clinic could put it into place with proper funding, the right staff and modern technology.
"The technology has gotten to the point where it's fantastic for a procedure," he said. "It's the perfect time to do this."
In 2014, St. Vincent Healthcare in Billings opened its hybrid OR, which performs similar procedures.