General requirements

The key functions required in the CCS include:

1.

Pre-procedure planning.

2.

Procedure simulation, patient modelling  (“Digital Twin” creation, 3D anatomic modeling unit, 3D printing) and procedure warmup.

3.

Creation and coordination of advanced imaging (image overlay, enhanced reality, etc.) [7].

4.

Post-procedure analysis

5.

Research and education

6.

Robotics engineering

7.

IT infrastructure coordination (remote monitoring (clinical), ambient intelligence, AI answers engine)

8.

Communication and operations (access to PACS/EMR, intra- and extra-department, patient flow, resource utilization, incoming admissions)

9.

Predictive resource delivery systems (predictive space utilization (PACU bypass, etc.) digital assistant/navigator, automatic and predictive room setup for each specific surgery case)

10.

Staff management (integration of staff shortage info and best spatial distribution to ensure OR turnaround)

11.

Efficiency management (patient throughput, financial resources, cost-effectiveness of decisions, and schedules) [8].

12.

Operation of preplanned processes including management of unintended events and complications

13.

Further dedicated studies for research and education purposes [9].

In addition, the spatial implications for each of these functions were categorized into three groups:

High

Changes departmental spatial relationships and/or has structural implications

Medium

Changes room spatial relationships

Low

Changes room requirements within the boundaries of a room typology

As the CCS represents an area where functionality and architecture/design are connected interdependently more than ever, both fields are described more in detail.

Functional design conceptPreparation

The concept of MGM is based on the availability and the access to data of any kind (imaging, patient data, resources, staff, etc.) and temporal relation (pre-, peri-, postoperative, patient reports and history, PROMS, etc.), so the digital interconnection to any of such resources is a core prerequisite. In future, ideally a team of people (medical, technical, administrative, etc.) will be responsible for the design, management and orchestration of such models and will work in close proximity to one another in defined areas of the CCS. Here, they will prepare the different components relevant to a treatment process on the patient level. Different patient-specific treatment models will be merged for the construction of the OR planning and will all of them define the required resources necessary for their execution (staff, devices, room functionalities, duration, pre- and postoperative monitoring and care, etc.). The responsibility for the optimized scheduling of interventions is given to another team of experts, which needs to be closely connected to the resource managing team. The preparation part of the CCS designs OR schedules weeks before their execution but revises them on a daily basis depending on their executability and effectiveness.

Execution

The second core functionality within the CCS, and the more demanding one, is the observation of running processes and the real-time adaptation (e.g., troubleshooting) [10]. Although any adoption and necessary modification of the preplanned schedule will impact on the preparation of subsequent interventions and resource management, decisions to be made here are much more time-critical. Accordingly, the executive team needs to be closely connected to the planning and acts as a superior authority and at the highest functional level within the CCS. The coordinating authority must be directly supported by a responsible party from the planning and design level, so that necessary modifications can be directly dispatched to the teams in charge (Fig. 1).

Fig. 1

In MGM and in a semi-autonomous approach data will be processed and integrated into models on which basis treatment pathways will be formulized. Stacking of such pathways will facilitate optimized OR schedules, which serve as a planning, but which need to be supervised for complications and in case of emergencies. (Modified concept according to H.U. Lemke [1])

Room concept

The architectural design of the CCS follows the functional requirements and therefore is organized in different teams and executive levels. The core area is provided to the executive coordinators and their teams which will have supervision to all running processes, and which adapt the planned schedule in case of complications (exceeding duration, missing resource, modification of surgery) or emergencies coming in. Large video screens inform the coordinators on the current state of tasks execution and allow for adaptive zooming to different granularity levels, either to observe the overall processes or to identify interfering issues [11]. In the same room the planning unit merges patient pathways and surgical process models for a perfect OR schedule, but serves also responsible for the preparation of workflows for acute cases and emergencies. This core area is surrounded by the many modeling and data processing units, which are obligated with the design and patient and process-individual adaptation of medical models. Although many of these processes will be realized as automatized approaches and facilitated by AI, the curation of data, validation of models and final approval of processes must remain a human responsibility and follow ethical and legal considerations [12]. For such purposes the teams at the different units will have access to all necessary data, but will also be equipped with necessary technologies, e.g., AR/XR devices and simulation suites, segmentation and annotation tools, etc.

Figures 2 and 3 show a first conceptual visualization of a future central command suite as a workspace for human–digital collaboration. In our presentation, we will elaborate on such spatial considerations and discuss the potential of different concepts in more detail.

Fig. 2

Modular design strategy with potential command suite functions

Fig. 3

Command suite interior view (Architect rendering)

Our team determined several benefits associated with our CCS concept including:

Centralized data management Serves as a hub for collating and managing these data efficiently. It ensures that all relevant information is accessible in one place, leading to more informed decision-making and better coordination among medical staff [13].

Enhanced communication and collaboration Acts as a control center for coordinating tasks, sharing updates, and responding to emergencies promptly. This integrated approach can significantly improve the efficiency and effectiveness of surgical procedures [14].

Integration with advanced technologies Assists in tasks such as patient monitoring, surgical planning, and postoperative care, enhancing patient outcomes and surgical precision.

Scalability for future innovations Offers a scalable platform that can adapt to future advancements. Whether it’s the integration of new AI algorithms, telemedicine capabilities, or advanced diagnostic tools, having a dedicated space that is designed to evolve with technology ensures that the surgery department remains at the forefront of medical innovation.

Improved patient outcomes Contributes to more accurate diagnoses, more precise surgeries, and better overall patient care. By leveraging AI and data analytics, the suite can support early identification of potential complications, thus improving the rate of uncomplicated surgical procedures.

Operational efficiency and cost-effectiveness By centralizing operations and utilizing advanced computer science including AI for data analysis and decision-making, a central command suite can streamline workflows, reduce redundancy, and optimize resource utilization. This efficiency not only saves time but also can result in significant cost savings for the medical center [15].

Our presentation describes the process to understand and decide how to implement each function early in the design and planning process to ensure the resulting concept can accommodate the vision.