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Broadgreen Hospital – Barn Theatre

19 November 2008

Healthcare-TeaserA four unit barn theatre, open at Broadgreen Hospital in Liverpool, is the first of its kind in the UK and forms part of a £60m development at the site.

Royal Liverpool and Broadgreen University Hospitals and the Cardiothoracic Centre NHS Trust were behind the joint development, which is not only the largest single Procure21 project but is entirely funded by government. 


“The development is a real success story,” said trust project manager Nick Brooks.  “Not only have we been able to build an attractive and high quality building, but it’s also within budget and on schedule.”



The project has many innovative features but the “barn theatre” stands out.  During the early planning stages, surgeon Donal O’Donaghue suggested the idea as a way of improving team work and sharing expertise.  Barn theatres are more commonly found on the continent but some have been installed in parts of the UK, including Oswestry and the Royal Orthopaedic Hospital in Birmingham where the operating spaces in these “barns” are separated by room dividers.


As the image shows, the units in Liverpool are entirely open.  However, removable sliding screens have been installed for a trial period because of concerns about flying chips of bone & privacy – in rare cases where the patient may be conscious.  Advantages of the barn theatre include, better opportunities for working in a team and improved supervision of less experienced surgeons and anaesthetists.  As hip revisions are rarely performed and relatively few orthopaedic surgeons have experience in this procedure, it can be useful to have an expert in the same room – even if they are dealing with another patient.


There is also an expectation that peer pressure in the open environment will improve surgical practice and good hygiene.  Put simply, surgeons are likely to behave better if they know they are being observed by their peers. There are clear cost savings because the four theatres share some facilities including wash areas, and dividing walls are not required.  Brooks suggested that saving space may be possible in future barn theatres, depending on their needs – for example, four theatres occupying the space normally required for three separate units.



Contamination and cross-infection were a major concern and a challenge to company Howorth Air Technology, which won the contract to supply the four ultra-clean canopies and associated lighting, air handling units, ductwork and controls.  The four Exflow 32 units supplied and installed by Howorth each provide a 3.2m2 clean zone.  The laminar flow of clean air produces positive pressure around each operating table with air moving away from the patient.  HEPA filters remove particles down to 0.3 microns, which could carry infectious organisms.  Return air grilles around each canopy perimeter draw in air and filter it to reduce the potential infectious hazard.  Each canopy has a large, clear and easily cleaned membrane control panel mounted on an adjacent wall. 


The Howorth canopies meet HTM 01 03 requirements but there was some concern about how they would function in a single space with other units.  Would their performance be affected if one of the other four units was not working?  It would be unacceptable for all units to be closed because of one malfunctioning unit.


Fortunately, air flow tests show there is no problem and as a precautionary measure, Howorth have made adjustments to the way air leaves the room.


Air flow from the Howorth canopies effectively act as dividers. They prevent cross-contamination or infection between patients as well as dividing walls without the consequent loss of space or extra material cost.


Norwest Holst is the main contractor for the barn theatre, which has been built with sliding doors for ease of access and reduced air turbulence.  Stainless steel partitioning walls around the theatre allow outside access for services maintenance and all walls and services are watertight so decontamination is easier.  Although there were discussions about sharing anaesthetic rooms, the final decision was to build the barn theatre with four attached rooms, each dedicated to a single operating table.  The two wash areas are shared with space at each end of the theatre.  There is also a single observation chamber, which opens onto a ‘dirty’ corridor and has no access directly into the theatre.


If successful, the barn theatre in Liverpool is likely to be adopted for other surgical procedures.  However, obstetric uses are unlikely for reasons of patient privacy, so it is improbable that we will ever see the day when people can literally say they were born in a barn.