Children’s hybrid cardiac theatre and intraoperative MRI project, Leeds General Infirmary

Defying gravity

Built by BAM four storeys above the ground, the new operating theatre is designed to improve patient outcomes for the most complex cases.

Towards the end of 2018, BAM delivered a ground breaking, purpose-built cardiac hybrid operating theatre at Leeds General Infirmary, where some of the most complex heart surgery in the country is carried out on children and young people.

The new theatre also features an intraoperative MRI (iMRI) facility, which is used during complicated neurosurgery procedures to create live images of the brain. Neurosurgeons rely on iMRI technology to create accurate pictures of the brain that guide them in removing brain tumours and other abnormalities during operations.

Creating such specialist facilities would have been challenging enough. But this project added an extra twist: the theatre had to be built four stories up, cantilevered out from the existing hospital building, with no supporting stories below.

Project details

  • Customer: Leeds Teaching Hospitals NHS Trust
  • Contractor: BAM Construction
  • Architect: DAY Architectural
  • Civil and structural engineer: Mott MacDonald

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Leeds General Infirmary (LGI) is the one of the busiest specialist surgical facilities in the UK. Only three other hospitals in the country carry out more cardiac procedures on young children and babies.

Operating on children with serious health conditions has its own very specific challenges. When it comes to cardiac surgery, for example, the margins for error are tiny.

A baby’s heart is only about the size of a large strawberry, so any vibrations during surgical procedures on such tiny organs can have horrendous consequences, even for a surgeon with the steadiest of hands.

In practical terms, this means there cannot be any bounce in the floor of the operating theatre: the usual miniscule background vibrations in the building have to be damped. The hybrid theatre and MRI room required the vibration performance with a response factor of less than 1.0.

Having easy access to real-time MRI facilities is also extremely valuable in the most complex surgical procedures.

At the Leeds Children’s Hospital (Clarendon Wing), part of the Leeds General Infirmary, the solution to these issues was an ingenious part new-build, part refurbishment, which involved extending its existing fourth-floor operating facilities out into thin air, 16 metres above ground level.

The new theatre is a steel construction on pad foundations, supported on eight raking circular columns, with a braced steel central core providing its fundamental stability.

The concept for the new facility was to link it to the existing neurosurgery theatre, cardiac theatre and associated support rooms on site, to enable the new MRI suite to be used intra-operatively with existing facilities.

Directly connecting the new facility to the existing Clarendon Wing also enables cardiac surgeons and cardiologists to work together during the same procedure, reducing treatment time and increasing the chances for young patients.

As part of the project, the existing theatre areas, stores and support office areas have also been reconfigured to provide a new entrance and waiting area.

Understanding complex clinical needs

In April 2017, BAM was appointed as the Principal Supply Chain Partner through the ProCure22 framework, to deliver the new intraoperative 3T MRI scanner and hybrid cardiac theatre.

Working closely with clinical staff from the very start was a key success factor on this project. BAM modelled the new building and associated work areas with BIM, which enable the client to visualise and experience their specialist facilities from an early stage.

As a result, the stakeholders could be sure that the brief was met before construction actually began. The BIM models also formed part of the ‘Soft Landings’ and countdown to handover processes during construction.

To help mitigate potential effects on patient activities, BAM organised collaborative engagement meetings and shadowed clinical teams. Working with clinicians in the live hospital environment helped the BAM team to fully appreciate the operational constraints and clinical requirements.

For example, the site team attended a live operation to see first hand how the theatre worked and the clinical requirements. This not only helped in the design of the construction programme, but also resulted in agreed changes to the scope of works. For example the theatre layout was reorganized to provide a more efficient design.

Global recognition

The project was shortlisted for the ICE People’s Choice Award 2019, organised by the Institution of Civil Engineers (ICE): one of the world’s oldest professional membership bodies.

The awards recognise the most impressive civil engineering feats from around the globe and in 2019 the shortlisted projects included bridges, green energy and water treatment facilities, as well as the Leeds cardiac theatre. Voted for by the public, they reflect what the people who actually benefit from them really think about these projects, and are a chance to say a big ‘thank you’ to those who delivered them.

Speaking at the official opening of the facility in 2019, Dr Yvette Oade, Acting Chief Executive of the Leeds Teaching Hospitals NHS Trust, explained that “the new facility will transform how we care for our children and ensure we can continue to provide the highest possible level of care for children from across Leeds, Yorkshire and beyond.”

BAM’s Construction Manager, Daniel Marsh, was also shortlisted for the Chartered Institute of Building (CIOB) construction manager of the year awards for his work on the project.

“Our new facility is a magnificent feat of engineering and unlike any other operating facility I’ve seen in the NHS. Some of the procedures we undertake in the building are highly delicate and the need for reduced noise levels and stability within the building is paramount. The team worked incredibly hard to ensure our specification was met so that we can continue to provide the safest care for the most vulnerable children.”

Mr John Goodden

Neurosurgeon at Leeds Teaching Hospitals

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