When it opened in November 1991, the $78 million hospital was equipped with three operating rooms. A fourth - a small one - was soon created out of what had been the room for putting plastercasts on children's fractured arms and legs.
"The relentless increase in the numbers and complexity of operations and medical procedures requiring an anaesthetic began to expose the limitations of the facility," says the hospital's 21st birthday book, Starship: Inside our national children's hospital, edited by Dr Lochie Teague, the clinical director of haematology and oncology. The mainly taxpayer-funded Auckland District Health Board is undertaking an upgrading and expansion of the Starship theatre suite, at a cost of around $9 million. The Starship Foundation, a fundraising organisation based at the health board offices, has pledged to contribute $3.1 million of the total cost, including $500,000 donated by customers of Mercury Energy.
A seventh theatre will be added by December and, excluding the cardiac theatres, which are still considered adequate, the other four theatres will be refurbished, one by one. Approximate completion dates are staged from October to next April.
The small theatre which was originally the plaster room will become a dedicated procedure room for relatively minor or quick procedures such as threading a catheter via a child's arm into a vein near the heart for the delivery of medicines.
It is hoped that having this room will alleviate the juggling of patients and postponement of less urgent procedures.
Some Starship surgery will be done at the adjacent Auckland City Hospital - in addition to the paediatric liver transplants and neurosurgery already done there - during the upgrading.
Stage one of the project has its official launch today and will be open to patients and their families from Wednesday. This stage involves the pre-operative and waiting areas. The foundation said those new facilities would greatly improve patients' and families' experiences because the current set-up lacked the space and privacy needed by patients and their families at what was a stressful time.
"The new pre-operative/parent waiting area is over twice the size of the existing area. It will provide more side rooms for privacy, a dedicated waiting area, a bathroom - [there is] currently only one in the whole department - and a fantastic play room to distract patients and their siblings waiting in the OR. The area is designed to be patient-friendly and will include colourful murals and entertainment devices to distract and relax children."
The play room would be staffed by a play specialist.
A certification audit report on the DHB's hospitals last year drew attention to poor privacy at the Starship pre-operative area and noted the "work under way to improve pre-op environment including private space to discuss consent".
Starship's clinical leader, Dr Richard Aickin, echoed the privacy concern when he explained the case for the upgrade.
"Our pre-op area is too small for the number of kids coming through. It doesn't give sufficient privacy and quiet for getting anaesthetic consent and explaining things to families. The post-operative area is quite open and lacking privacy.
"Occasionally bad things happen and we have to give bad news to families or talk about difficult things with families.
"Families who have children in the operating room don't want to go a long way away. They want to be there when their child is waking up. We haven't had a comfortable waiting space for parents. They have had to go back to the day-stay [area] or the atrium, or have gone for a walk.
"We have outgrown the facility in terms of the numbers of people and requirements to do the work we do.
"The current, 22-year-old facilities are getting old and tired as you might expect with the high volume and throughput. The predominant focus is on the child and making the experience as non-traumatic and supportive for the child as we can. Coming into hospital is a very scary experience and often involves discomfort and a whole lot of things a young child has a great deal of difficulty understanding. We are committed to having parents with the child as much as we can.
"We have to be able to explain to the parents in an appropriate setting where they can relax, listen and hear what we are saying, rather than in a crowded, noisy environment where they are distracted by other children who may be crying or distressed.
"Obviously we want to be nice to people and have a facility we are proud of. This is about a standard of care for children, what you do to make a hospital procedure or attendance of the child actually acceptable."
The number of cases seen in the operating theatres has doubled since 1998 to more than 9000 a year.
Dr Teague said in his book: "Further increase is not currently possible, and so an increasing number of cases are going out to the private sector and to the Greenlane [Clinical Centre] surgical unit."
The kinds of conditions that can be treated surgically has expanded - such as a greater range of scoliosis (curved spine) cases - and far greater use is made of laparoscopy (keyhole surgery). More staff and more gear are now typically present in the OR and more space is needed. The brand new theatre will, at 66sq m, be twice the floor area of the minor procedures room.
Dr Aickin said: "The old days of having an anaesthetist and a relatively simple gas machine and a machine that displays an ECG trace and one surgeon and a scrub nurse are well and truly over."
A disadvantage of the upgrading of the pre-operative and waiting areas is that it takes about one-third of the floor area of Starship's atrium, where children can play and some functions are held.
"We anguished over that because it's where we hold hospital celebrations for kids," said Dr Aickin. "The hospital staff ... recognise we are losing something by taking over a portion of the atrium space but it's going to make a big difference to the operating rooms that are such a big part of our core hospital business."
