Innovations in Surgical Environments_Workshop presentation_part 3

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e T d n a DESIGNING PREOPERATIVE & n g i s e y D t POSTOPERATIVEieWORKSPACES i s rs t e i l v i i c n a U F n h o t l s a m e e H l r C o f r e t n e C

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

IN A SNAPSHOT

n g i s e y D t i s s r e i t e i l v i i c n a U 01 02 h F 03 04 n o t l s a m e e H l r C o f r e t n

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g n i t s

02

2019

VR development VR evaluation

Case studies data collection Data analysis Dissemination Workspace ergonomic evaluation Design criteria Student design project

2018

2017

Literature review

2016

2015

DESIGN DEVELOPMENT

Implementation Mock-up development Mock-up evaluation

05

Prototype redesign

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PROJECT TEAM

ANJALI JOSEPH

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02

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f DAVID ALLISON

HANNAH SHULTZ

DEBORAH WINGLER

LANSING DODD

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SUSAN O’ HARA

WENZ TUTTLE

g n i t s

RUTALI JOSHI

JAMES DOMINIC

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ACKNOWLEDGEMENT

02

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e T dInnovation Center Funding for this research was provided as a gift from Haworth through the Watt Family n a n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f r e t n e C

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PUBLICATIONS Journal of Interior Design

Advances in Human Factors and Ergonomics in Healthcare and Medical Devices

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The Center for Health Facilities Design and Testing (CHFDT) website

g n i t s

Health Environments Research & Design Journal

https://www.clemson.edu/centers-institutes/health-facilities-designtesting/resources/tools/index.html

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f An Ergonomic Evaluation of Preoperative and Postoperative Workspaces in Ambulatory Surgery Centers

Balancing the Human Touch with the Need for Integrating Technology in Ambulatory Surgical Environments: Barriers and Facilitators to Nursing Work and Care Team Interactions Anjali Joseph, Ph.D., Deborah Wingler, MSD-HHE, and Zahra Zamani, Ph.D., Clemson University

ABSTRACT Ambulatory surgical environments are dynamic and complex, involving coordination across multiple groups of care providers and requiring numerous sources and handoffs of information. As in other areas of healthcare, these settings have grown increasingly complex over the years with the integration of new equipment and technology such as electronic medical records. However, little thought has been given to the design of workspaces in these settings to support evolving work processes and emerging technologies. The purpose of this research study was to understand nurses’ work patterns in preoperative and postoperative workspaces of ambulatory surgery centers, and to identify environmental design strategies that support or act as barriers to critical interactions between care teams due to the integration of new technologies.

In-depth case studies were conducted at two ambulatory surgery centers using a multimethod approach consisting of behavior mapping, shadowing, spatial analysis, and semi-structured interviews with nursing staff. The study data were collected over two consecutive days at each site. The majority of patient care activities such as bedside care and charting were carried out directly with the patient in the patient bays. Nurses were observed standing or walking for approximately 70% of the observations, and face-to-face interactions were dominant in both case studies regardless of the technology implemented. Key environmental facilitators and barriers to nurses’ work in surgery centers include: accessibility, flexibility, visibility, size, and privacy. Architects and interior designers can play an important role in designing human-centered work environments for nurses in surgical settings that effectively support the critical tasks and interactions that must take place. Designing work systems requires a human-factors approach to design that examines the range of activities, interactions, people, technology, and design of the workspace and its elements.

Background

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Association, 2016). This rapid growth has been supported through innovations in technology and advances in surgical and anesthesia techniques, allowing surgical procedures that once required lengthy inpatient hospital stays to now be performed in outpatient settings where the patient is able to go home the same day (Cullen, Hall, & Golosinskiy, 2009). Benefits associated with increased efficiency

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The number of surgical procedures conducted in outpatient environments, such as ambulatory surgery centers (ASCs), has risen significantly over the last couple of decades due to changes in the Medicare reimbursement policy, with more than 3600 types of procedures being performed in over 23 million surgeries annually (Ambulatory Surgery Center

Journal of Interior Design

02

39

© Copyright 2017, Interior Design Educators Council, Journal of Interior Design 42(1), 39–65

Deborah Wingler ✉ , Anjali Joseph, and Rutali Joshi (

)

Center for Health Facilities Design and Testing, Clemson University, Lee Hall 2-105, Fernow Street, Clemson, SC 29634, USA {dwingle,anjalij,rjoshi}@clemson.edu

Abstract. Healthcare organizations are faced with the challenge of renovating existing infrastructure or building new facilities to enable the inclusion of computer workstations and address growing technological demands. The majority of existing ergonomic tools for evaluating computer workstations primarily focus on the interface between the care provider and the computer. This paper describes the development and application of an expanded ergonomic eval‐ uation framework that focuses on the work system versus the workstation. The tool was tested and refined through visits to five facilities where the ergonomic evaluation tool was used to assess five preoperative and seven postoperative rooms/bays in surgical suites with varying spatial configurations and types of workstations. The comparative evaluation showed that all workstations met most of the basic checklist requirements, but there were significant differences related to the location of the workstation and adjacencies to other zones in how effectively the workstations were integrated into the space.

Keywords: Healthcare · Ergonomic · Workstation · Evaluation · Work system

1

Background

The number of ambulatory Surgery Centers (ASCs) has rapidly expanded over the last two decades from 1,000 in 1998 to over 5,400 in 2016 due to the dramatic increase in the number of surgical procedure being conducted in outpatient settings in the United States each year [1].

To improve the quality of care, an influx of $20 billion for the investment of infra‐ structure and systems to support the implementation of health information technology (HIT) was inserted in 2009 into the US healthcare system with the American Recovery and Reinvestment Act [2]. As a result, computers have been incorporated into the clinical workflow in a diverse range of healthcare settings. The inclusion of healthcare infor‐ mation technology (HIT) has transformed the ambulatory surgical environment by increasing the amount of computer work that is done by care team members while in the presence of patients and their care partners. © Springer International Publishing AG 2018 V. Duffy and N. Lightner (eds.), Advances in Human Factors and Ergonomics in Healthcare and Medical Devices, Advances in Intelligent Systems and Computing 590, DOI 10.1007/978-3-319-60483-1_2

THE CLEMSON HEALTHCARE WORK SYSTEM ERGONOMIC ASSESSMENT TOOLKIT A Macro-Ergonomic Evaluation for Ambulatory Workspaces

| DR. ANJALI JOSEPH |

Spartanburg Regional Healthcare System Endowed Chair in Architecture + Health Design, Director, Center for Health Facilities Design and Testing Clemson University

| DEBORAH WINGLER |

Doctoral Candidate | Architecture + Health Planning Design and the Built Environment Clemson University

| RUTALI JOSHI |

Doctoral Student | Architecture + Health Planning Design and the Built Environment Clemson University

Research

Using Virtual Reality to Compare Design Alternatives Using Subjective and Objective Evaluation Methods

Health Environments Research & Design Journal 1-16 ª The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1937586719851266 journals.sagepub.com/home/her

Deborah Wingler, PhD, MDS-HHE, EDAC1 , Anjali Joseph, PhD, EDAC1 , Sara Bayramzadeh, PhD, MArch2 , and Andrew Robb, PhD3

Abstract Objective: This study sought to develop a method that supports a more evidence-based approach to evaluating multiple design options in virtual reality (VR), combining subjective insights gathered using traditional approaches and objective feedback gathered using the VR platform. Additionally, this study sought to understand how objective data garnered from the VR platform could be used to compliment traditional evaluation strategies. Background: VR can be a viable research platform for supporting evidence-based design practices. Prior studies have predominately utilized experiential user feedback.

While able to provide valuable subjective insights, these approaches are less effective in making objective comparisons between multiple designs alternatives. Method: A repeated measures study was conducted with nursing faculty. User feedback was captured through surveys, interviews, and the VR platform. Results: The survey, interview, and the objective VR data converged in terms of identifying the highest performing design option. Survey data showed that Room 2 performed best in terms of perceived physical access to supplies, unobstructed movement, and availability of space to accommodate additional equipment. VR data showed that participants in Room 2 had significantly higher visibility to both patient and care partners throughout their simulated interaction. Conclusion: Simulation-based evaluations in VR that use a combination of users’ subjective insights and objective data obtained from VR can be an effective tool for helping designers evaluate multiple design options.

The use of scenario-based simulations provided a structured and clinically relevant approach to comparing three preoperative rooms, supporting a more robust assessment of users’ physical response to a simulated healthcare environment.

1 2 3

School of Architecture, Center for Health Facilities Design and Testing, Clemson University, Clemson, SC, USA College of Architecture and Environmental Design, Kent State University, Kent, OH, USA School of Computing, Clemson University, Clemson, SC, USA

Corresponding Author: Deborah Wingler, PhD, MDS-HHE, EDAC, Center for Health Facilities Design and Testing, Clemson University, 323 Fernow St. Lee Hall 2-105, Clemson, SC 29634, USA. Email: dwingle@clemson.edu

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

KEY FINDINGS YEAR 1 ONE

TWO THREE

High touch and high tech spaces -need to reassure, comfort and engage patients and families -demand quick turnaround -increasingly high tech as more complex procedures are done on an outpatient basis

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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Face to face interactions (talking and listening) constituted majority of staff interactions Nursing staff were primarily observed standing while interacting with patients Accessibility

Mobile workstation created barriers to movement within the room as well as in the hallways Challenges faced in accessing supplies, equipment and medication Inadequate space for family in rooms

Flexibility

Workstation that support different users (height, postures) were preferred Portability of the workstation is important

Visibility

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EMR and space configuration perceived as a barrier to making eye to eye contact with patient and care partner Visibility to patient bays as well as information boards important

Privacy and confidentiality Mobile workstations integrated into existing pre-op and post-op spaces created privacy and confidentiality challenges INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ERGONOMIC ASSESSMENT TOOL DEVELOPMENT

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REVIEW OF EXISTING RELEVANT TOOLS AND DESIGN CONSIDERATIONS

ONE

OSHA computer workstation checklist Cornell Healthcare Computer Wall-Station Ergonomic Checklist

n g i s e y D MODIFICATION OF EXISTING TOOL t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f r e t en

g n i t s

Weinger, M. B., Wiklund, M. E., & Gardner-Bonneau, D. J. (Eds.). (2010).Handbook of human factors in medical

device design. CRC Press.

TWO

Started with the base of the 20 item Cornell Healthcare Computer Wall-Station Ergonomic Checklist Removed items pertaining specifically to a wall mounted system or specific technology Collapsed similar items into a single concept

Added to the checklist concepts of: visibility to care partner, flooring attributes and support, accessibility to supplies, medication and electrical outlets, visual and auditory access to central nurse station, visibility to outdoors, inclusion of horizontal

work surface, spatial limitations, multiple configurations

Added elements pertaining to: facility area, workstation type, task identification and usable configurations Added a photo protocol

Added physical assessment including: furniture and equipment layout, spatial measures and enclosure type

02

C

Added Insights and design challenges identification

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ERGONOMIC ASSESSMENT

5 12

FACILITIES

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

PREOPERATIVE & POSTOPERATIVE ROOMS | BAYS

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SITE3

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g n i t s

SITE1

SITE2

SITE4

SITE5 INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

STRUCTURE SECTION 1

CONTEXT Facility area, workstation type, task identification and usable configurations

SECTION 2

n g i s e y D t i s s r e i t e PHOTO PROTOCOL i l v i i c n a U F n INSIGHTS AND DESIGN CHALLENGES DOCUMENTATION h o t l s a m e PHYSICAL ASSESSMENT e H l r C o f r e t n e C 28 ITEM CHECKLIST

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16 General questions 12 Questions for each usable configuration

SECTION 3

minimum 8 photos

SECTION 4 SECTION 5

Location of 12 environmental features Minimum 3 standard measurements Type of enclosure

02

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSTATION STAFF MOVEMENT

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CARE PARTNER

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SUPPORT SUPPLY

02

monitor patient during procedure

escort patient back to operating theater

verify if patient is ready for surgery

perform induction*

explain anesthetic process

verify surgical site

verify medical history

transport and monitor patient during anesthetic induction

monitor patient

ensure patient can undergo anesthetic induction and performs anesthetic induction

administer any necessary medications

get patient prepared for surgery

NURSE ANESTHETIST

prepare surgical site

ANESTHESIOLOGISTS

start IV

PRE OP NURSE

explain surgical process

take medical history

escort patient from waiting to preop bay/ room

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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SURGEON

CARE PARTNER

performs surgery

Individual who is supporting the patient

wait with patient in preop

PREOPERATIVE

g n i t s

answer last minute questions

TASK IDENTIFICATION

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

get patient prepared for surgery

POST OP NURSE

get patient prepared for discharge

WORKSTATION

STAFF MOVEMENT

CARE PARTNER

SUPPORT

SUPPLY

02 n e C r te

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f escort patient to pickup

transport patient and hand off procedure information

get necessary medication

ANESTHESIOLOGISTS NURSE ANESTHETIST

e T d n a receive discharge instructions assist getting patient dressed for discharge

ensure patient is able to be discharged

hand off care to postop

POSTOPERATIVE

provide postop nurse with procedure info

montior emergence process

prescribe necessary medications

escort patient to pickup

explain discharge instructions

monitor patient

administer necessary medications

provide nourishment

escort care partner from waiting area

arouse patient

TASK IDENTIFICATION

g n i t s CARE PARTNER

Individual who is supporting the patient

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ERGONOMIC ASSESSMENT

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02

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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pre-op post-op admin staff support/work area OR INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PRE OP ROOM

yes

no 33.8”

Is the height of the workstation adjustable?

Is seating provided for seated work?

For standing use, can the platform be easily raised to 48” from the floor?

For sitting use, can the platform be easily lowered to 25” from the floor?

Is there easy and independent adjustment of the monitor and keyboard adjustment?

Can the caregiver swivel and tilt the computer screen to a comfortable viewing position?

Does the design provide a horizontal surface for setting/signing a paper chart?

Do wrists or hands rest on sharp or hard edges while operating the keyboard?

Is the workstation positioned to provide timely access to central supplies?

Is the workstation positioned to provide timely access to medication?

Is the flooring material stable, firm and slip resistant?

Does the flooring material provide adequate support to reduce fatigue?

Is there adequate space around the workstation to perform patient care tasks?

Are electrical outlets accessible above 2 ft. from floor level?

Does the design have concealed and integrated cable management?

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f wall curtain staff care partner patient

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g n i t s

23”

74.4”

156.7”

ERGONOMIC ASSESSMENT

129.6”

gloves container garbage bin sharps hand sanitizer electrical outlets

area : 141.03 sq. ft.

ERGONOMIC ASSESSMENT

yes

no

PRE OP ROOM

Are the surface finishes porous, smooth and easily cleanable?

Can the caregiver easily position the keyboard and screen to maintain visual contact with the patient?

Can the caregiver easily position the keyboard and screen to maintain visual contact with the care partner?

For standing use, are supplies accessible within a 73” vertical reach?

For standing use, are supplies accessible within a 29.7” horizontal reach?

For standing use, are vital monitors accessible within a 73” vertical reach?

For standing use, are vital monitors accessible within a 29.7” horizontal reach?

Is glare from ambient light reflected on the monitor?

Is glare from natural light reflected on the monitor?

Is the workstation positioned to have a view of the outdoors without twisting of the head, neck, or torso?

Is the workstation positioned to provide visual access to the central nursing station without twisting of the head, neck, or torso?

Is the workstation positioned to provide auditory access to the central nursing station?

If seated workstation is possible, is there space in the bay to accommodate height adjustable?

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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g n i t s

N/A N/A

wall curtain staff care partner patient

gloves container garbage bin sharps hand sanitizer electrical outlets

work station & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

ZONE IDENTIFICATION

G

SU

33.8”

SITE 3

PRE OP ROOM

n g i s e y D t i s s 2 INDUSTRY GUIDELINES r e i t e i l v i i c n a U ZONES & EVALUATION CRITERIA F 5 n h o t l s a m e e H l r C o f r e t n e C

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g n i t s

156.7”

T

SH

02

129.6” HS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ZONE IDENTIFICATION

G

SU

33.8”

SITE 3

PRE OP ROOM

n g i s e y D t i s s r e i t e i l v i i c n The dimensions and arrangement of a U rooms shall be such that there is a minimumF of n h o t 3 ft. between the sides and foot of the bed and l s a any wall or any other fixed obstruction m e e H l r C o f r e t n e C T

3’

3’

3’

SH

156.7”

Minimum spatial requirements of an overall clear floor area of 80 sq. ft. for a pre or postoperative bay and an overall clear floor area of 100 sq. ft. for pre or postoperative rooms

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g n i t s

AIA F. Guidelines for Design and Construction of Health Care Facilities. Washington DC, American Institute of Architects. (2014)

02

AREA: 141.03 SQ FT

129.6” HS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ZONE IDENTIFICATION

G

SU

SITE 3

PRE OP ROOM

n g i s e y D t i s s r e i t e i l CRITERIA v i i c n easy access to supplies for direct patient a U F care activities; visibility to both patient h n o t l and care partner simultaneously from the s a e space m most commonly used configuration; e H l optimization; ease of physical access to r C o patient f r e t n e C WORKSTATION ZONE area that encompasses the workstation and vital monitors

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g n i t s

T

3’

3’

02

work station & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

3’

SH

HS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ZONE IDENTIFICATION

G

SU

SITE 3

PRE OP ROOM

n g i s e y D t i s s r e i t e i l CRITERIA v i i c n ability to access patient from all sides; a U F accessibility to direct patient care supplies n h o t l s a m e e H l r C o f r e t n e C STAFF MOVEMENT ZONE area around patient bed where direct patient care activities occur

e T d n a

g n i t s

T

3’

3’

02

workstation zone staff movement zone care partner zone support zone supplies zone

wall curtain staff care partner patient

3’

SH

HS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ZONE IDENTIFICATION

G

SU

SITE 3

PRE OP ROOM

n g i s e y D t i s s r e i t e i l CRITERIA v i i c n visibility to patient and staff simultaneously; a U F not in the direct path of staff travel patterns n h o t l s a m e e H l r C o f r e t n e C CARE PARTNER ZONE area where seating for the care partner is located

e T d n a

g n i t s

T

3’

3’

02

workstation zone staff movement zone care partner zone support zone supplies zone

wall curtain staff care partner patient

3’

SH

HS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ZONE IDENTIFICATION

G

SU

SITE 3

PRE OP ROOM

n g i s e y D t i s s r e i t e i l CRITERIA v i i c n a unobstructed space to accommodate the U F circulation of multiple care team members; n h t unobstructed space to accommodate lthe flow of so a m e additional equipment e H l r C o f r e t n e C SUPPORT ZONE area that supports the movement of equipment and care team members

e T d n a

g n i t s

T

3’

3’

02

workstation zone staff movement zone care partner zone support zone supplies zone

wall curtain staff care partner patient

3’

SH

HS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ZONE IDENTIFICATION

G

SU

SITE 3

PRE OP ROOM

n g i s e y D t i s s r e i t e i l CRITERIA v i i c n a co-location of direct patient care supplies; U F accessibility of sharps to direct patient care n h t l activities; accessibility visibility of hand sanitizer so a m e to care team members e H l r C o f r e t n e C SUPPLY ZONE area where direct patient care supplies, sharps and hand sanitizer are located

e T d n a

g n i t s

T

3’

3’

02

workstation zone staff movement zone care partner zone support zone supplies zone

wall curtain staff care partner patient

3’

SH

HS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ERGONOMIC ASSESSMENT PRE | PEDS | BLOCK |POST

AMPLE allocation of zones

r te

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increased PRIVACY for patients & care partners

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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VISUAL AND AUDITORY ACCESS to multiple patients

lack of CORD MANAGEMENT

increased CONNECTIVITY to central nursing area

increased RISK OF FAILURE due to increased capabilities

g n i t s

INSUFFIECIENT WIDTH of opening

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SITE 2

SITE 3 HS

G

G

SITE 4

SITE 5

HS

G SU

3’

e T d n a 3’

SH

3’

3’

T

SH

3’

3’

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 3’

T

SH

HS

SU

SH

HS

T

SU

3’

PRE OP ROOMS

3’ SU

g n i t s G

SU

SU

3’

3’

3’

SITE 1

HS

104.8 SQ FT

83.20 SQ FT

140.44 SQ FT

SH

SU

T

SH

141.03 SQ FT

HS

T

HS

91 SQ FT

SH

3’

3’

3’

3’

3’

3’

3’

3’

STAGE-I POST OP

123.34 SQ FT

HS

G

71.60 SQ FT

135.66 SQ FT

3’

r te

SH

101.06 SQ FT

3’

size and placement of work station

3’

02

T

3’

n e C

95.12 SQ FT

SU

3’

3’

3’

3’

3’

G

SU

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

3’

POST OP ROOMS/ BAYS

SU

G T

149.92 SQ FT

HS

STAGE-II POST OP

equipment & supplies zone staff movement zone

workstation zone staff movement zone care OF partner zone MATRIX DIAGRAMS | WORKSTATION ZONE support zone INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019 supplies zone

SITE 2

SITE 3 HS

G

G

SITE 4

SITE 5

HS

G SU

3’ 3’ 3’

3’

T

SH

3’

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 3’

3’

3’ T

SH

HS

e T d n a 3’

SH

3’

SU

SH

HS

T

SU

3’

PRE OP ROOMS

3’ SU

g n i t s G

SU

SU

3’

3’

3’

SITE 1

HS

104.8 SQ FT

83.20 SQ FT

140.44 SQ FT

SH

SU

T

SH

141.03 SQ FT

HS

T

HS

91 SQ FT

SH

3’

3’

3’

3’

3’

HS

G

71.60 SQ FT

135.66 SQ FT

3’

3’

room/bay configuration placement of the bed

3’

3’

3’

STAGE-I POST OP

123.34 SQ FT

3’

r te

SH

types of workstations

02

T

3’

n e C

95.12 SQ FT

SU

3’

3’

3’

3’

3’

G

SU

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

3’

POST OP ROOMS/ BAYS

SU

G T

149.92 SQ FT

HS

STAGE-II POST OP

101.06 SQ FT

workstation zone staff movement zone care partner zone support MATRIX OF zone DIAGRAMS | STAFF MOVEMENT ZONE supplies zone INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

equipment & supplies zone staff movement zone

SITE 2

SITE 3 HS

G

G

SITE 4

SITE 5

HS

G SU

3’ 3’ 3’

3’

T

SH

3’

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 3’

3’

3’ T

SH

HS

e T d n a 3’

SH

3’

SU

SH

HS

T

SU

3’

PRE OP ROOMS

3’ SU

g n i t s G

SU

SU

3’

3’

3’

SITE 1

HS

104.8 SQ FT

83.20 SQ FT

140.44 SQ FT

SH

SU

T

SH

141.03 SQ FT

HS

T

HS

91 SQ FT

SH

3’

3’

T

3’

3’

SH

STAGE-I POST OP

123.34 SQ FT

3’

3’

HS

G

71.60 SQ FT

135.66 SQ FT

3’

r te

n e C

95.12 SQ FT

SU

3’

3’

3’

3’

3’

G

SU

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

3’

POST OP ROOMS/ BAYS

SU

3’

02

3’

fragmentation

workstation zone staff movement 101.06 SQ zone FT care partner zone support zone supplies zone

direct access to patient care supplies

MATRIX OF DIAGRAMS | SUPPLY ZONE

G T

149.92 SQ FT

HS

STAGE-II POST OP

equipment & supplies zone staff movement zone

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SITE 2

SITE 3 G

SITE 4

SITE 5

HS

G

3’

SU

3’ 3’

3’ SH

3’

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 3’

3’

3’ T

SH

HS

e T d n a 3’

SH

3’

SU

SH

HS

T

SU

3’

PRE OP ROOMS

3’ SU

g n i t s G

SU

3’

3’

3’

SITE 1

HS

104.8 SQ FT

83.20 SQ FT

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer SH

141.03 SQ FT

SH

SU

T

140.44 SQ FT

HS

T

HS

91 SQ FT

SH

3’

3’

C

T

3’

3’

3’

3’

3’

STAGE-I POST OP

123.34 SQ FT

HS

G

71.60 SQ FT

135.66 SQ FT

3’

r te

SH

3’

impedement of staff movement spatial constraints

MATRIX OF DIAGRAMS | CARE PARTNER ZONE

G T

149.92 SQ FT

101.06 SQ FT

workstation zone staff movement zone care partner zone support zone supplies zone

3’

room/bay configuration

02

3’

3’

en

95.12 SQ FT

SU

3’

3’

3’

3’

3’

G

SU

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

3’

POST OP ROOMS/ BAYS

SU

HS

STAGE-II POST OP

equipment & supplies zone staff movement zone

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SITE 2

SITE 3 HS

G

G

SITE 4

SITE 5

HS

G SU

3’ 3’ 3’

3’

T

SH

3’

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 3’

3’

3’ T

SH

HS

e T d n a 3’

SH

3’

SU

SH

HS

T

SU

3’

PRE OP ROOMS

3’ SU

g n i t s G

SU

SU

3’

3’

3’

SITE 1

HS

104.8 SQ FT

83.20 SQ FT

140.44 SQ FT

SH

SU

T

SH

141.03 SQ FT

HS

T

HS

91 SQ FT

SH

3’

3’

T

3’

3’

3’

3’

3’

STAGE-I POST OP

123.34 SQ FT

HS

G

71.60 SQ FT

135.66 SQ FT

3’

r te

SH

3’

3’

size and placement of work system components

02

3’

3’

n e C

95.12 SQ FT

SU

3’

3’

3’

3’

3’

G

SU

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

3’

POST OP ROOMS/ BAYS

SU

fragmentation due to spatial constraints

MATRIX OF DIAGRAMS | SUPPORT ZONE

G T

149.92 SQ FT

workstation zoneSQ FT 101.06 staff movement zone care partner zone support zone supplies zone

HS

STAGE-II POST OP

equipment & supplies zone staff movement zone

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SITE 2

SITE 3 HS

G

G

SITE 4

SITE 5

HS

G SU

3’ 3’ 3’

3’

T

SH

3’

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 3’

3’

3’ T

SH

HS

e T d n a 3’

SH

3’

SU

SH

HS

T

SU

3’

PRE OP ROOMS

3’ SU

g n i t s G

SU

SU

3’

3’

3’

SITE 1

HS

104.8 SQ FT

83.20 SQ FT

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer SH

141.03 SQ FT

SH

SU

T

140.44 SQ FT

HS

T

HS

91 SQ FT

SH

3’

3’

T

3’

3’

3’

STAGE-I POST OP

123.34 SQ FT

3’

3’

3’

3’

SH

HS

G

71.60 SQ FT

135.66 SQ FT

3’

r te

n e C

95.12 SQ FT

SU

3’

3’

3’

3’

3’

G

SU

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

3’

POST OP ROOMS/ BAYS

SU

work station & supplies zone

101.06 SQ FT

3’

staff movement zone 3’

02

care partner zone support zone sharps and hand sanitizer

MATRIX OF DIAGRAMS | ZONES

G T

149.92 SQ FT

HS

STAGE-II POST OP

equipment & supplies zone staff movement zone

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SITE 2

SITE 3 G

SITE 4

SITE 5

HS

SU

G

3’

SU

3’ 3’

HS

SH

3’

3’ SH

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 3’

3’

3’

3’

T

SH

HS

e T d n a 3’

T

SU

3’

PRE OP ROOMS

3’ SU

g n i t s

3’

3’

3’

SITE 1

HS

83.20 SQ FT

141.03 SQ FT

140.44 SQ FT

3’

3’

SU

3’

3’

3’

3’

n e C

3’

3’

3’

STAGE-I POST OP

123.34 SQ FT

3’

HS

3’

r te

SH

G

3’

3’

96”

95.12 SQ FT

3’

3’

3’

91 SQ FT

equipment & supplies zone staff movement zone care partner zone support zone sharps and hand sanitizer

107.5”

POST OP ROOMS/ BAYS

104.8 SQ FT

71.60 SQ FT

135.66 SQ FT

101.06 SQ FT

3’

02

3’

restricted visibility unrestricted visibility

MATRIX OF DIAGRAMS | SIGHT LINES

G T

149.92 SQ FT

HS

STAGE-II POST OP

equipment & supplies zone staff movement zone

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

VISIBILITY Maintaining visual connectivity between care team members, patient and care partner is vital for supporting the critical interactions

02

n g i s e y D t i s s r e i FACILITATORS t e i l v i i placement of work c n a station affords or U F n restricts visibility to h o t l s patient or care partner a m e e H l r C o f r e t n e C BARRIERS

e T d n a

g n i t s

SITE 3-PRE OP

SITE 3-POST OP

SITE 1- PRE OP

SITE 4-POST OP INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PRIVACY location of workstation outside the bay increases privacy for tasks like disrobing but decreases privacy regarding medical information sharing between the care team member and patient

02

n g i s e y D t i s s r e i FACILITATORS t e i l v i i c n a U F n h o t l wall or curtain enclosures s a m e affect visual and auditory e H l privacy r C o f r e t n e C BARRIERS

e T d n a

g n i t s

SITE 3- POST OP

SITE 5- PRE OP

SITE 2- PRE OP

SITE 1- POST OP INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ACCESSIBILITY curtain enclosures on three sides of the bay or use of glass doors affords greatest visual and auditory access

02

n g i s e y D t i s s r e i FACILITATORS t e i l v i i co-location of direct c n a patient care supplies U F n provides increased h o t l s accessibility for care a m e team members e H l r C o f r e t n e C BARRIERS

e T d n a

g n i t s

SITE 5- POST OP

SITE 3- POST OP

SITE 1- PRE OP

SITE 4- INDUCTION INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FLEXIBILITY spatial constraints affect mobility of Wows

02

n g i s placement of e y D workstation and t i s s adjustability of its r e i FACILITATORS t e i components allows or l v i i c inhibits flexibility n a U F n h o t l s a m e e H l r C o f r e t n e C BARRIERS

e T d n a

g n i t s

SITE 4- INDUCTION

SITE 3- POST OP

SITE 5- PRE OP

SITE 5- POST OP INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

DESIGN CONSIDERATIONS Design Criteria

11 design features

for each room design option

1

2

3

4

COMFORT

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

adequacy and quality of three-dimensional space through furniture ergonomics, material selection, color and light

WORKSPACE ERGONOMICS

5

6

design and integration of computer workstation to support staff performance

VISIBILITY

support communication and collaboration between care team, patient and care partner within room/bay

r te

PRIVACY

provision of acoustical and visual privacy while allowing for staff connectivity to unit

02

e T d n a

g n i t s

n e C

7

8

FLEXIBILITY

in each room design option

ability to flex over time and between functions

Patient bed

DAYLIGHTING/LIGHTING STRATEGIES

Vitals monitor

Computer workstation Hand sanitizer

absence/presence of outdoor views, impact of artificial or natural light on glare

Storage for care supplies

AMENITIES

Care partner seating

Storage for patient belongings

provision of positive distractions, access to technology, toilet, other?

Sharps container

FUNCTIONALITY functionality of zones and adjacencies, and

Trash can

Glove dispenser Enclosure materiality

support for nursing tasks

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

STUDIO TEAM

n g i s e y D t i GOALS s s r e i t e i l v i 1 i c n a U F n h o t l s a 2 m e e H l r C o f FOCUS

BYRON EDWARDS, AIA, ACHA, EDAC, LEED AP PROFESSOR OF PRACTICE IN ARCHITECTURE + HEALTH

e T d n a

g n i t s

Designing a patient care room/bay in the preoperative or postoperative area of an ambulatory surgery center

Expose design students to the range of ergonomic issues at play in the design of preoperative and postoperative spaces in ambulatory surgery centers

CAROLINE WYRICK

LANSING DODD

MASTER OF ARCHITECTURE + HEALTH STUDENTS

r te

SECOND SEMESTER OF PROGRAM

n e C

LANEY TUTEN

02

MALONE HOPKINS

SHAHROOZ BEHESHTI

SHICONG CAO

MEGAN GIRVAN

WENZ TUTTLE

LUKE DAVIS

Develop innovative design solutions for a preoperative or postoperative room/bay that addresses a range of design and performance goals including the integration of a computer workstation to support electronic charting

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

Room 1

2D Floor Plan

3D Perspective

RENDERING-OPTION 1: CARE PARTNER VIEW

Virtual Reality

n g i s e y D t i s s r e i t e i l v i i c n a U F n h 19 o t l s a m e e H l r C o f

e T d n a

g n i t s

Room 2

CARE PARTNER VIEW

Room 3

ENTRY VIEW

n e C

r te

26

PRE-OP POST-OP PROTOTYPE PROJECT | JANUARY 27 | ARCH 8960

01 17

ARCHITECTURE + HEALTH | JANUARY 27 | PRE-OPERATIVE/POST-OPERATIVE PROTOTYPE

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

RESEARCH DESIGN

n g i s common study area within the School of Nursing e y D t i s s r e 21 nursing faculty (male=2, female=19) i t e i l v i i c n a U HTC Vive headset, HTC Vive hip tracker, two hand-held controllers F n h so t l a m Unity3D e e H l r C o rf

Research Design Setting Participants VR Gear VR Platform

e t n

02

e C

e T d n a

g n i t s

A repeated measure study

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

RESEARCH METHODS PERFORMING A SCENARIO Completing 6 tasks in each prototype

r te

02

n e C

e T d n a

SURVEYS

INTERVIEWS

Rating perceived work performance within each prototype

Providing insight into prefered prototype and participants VR experience

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

g n i t s VR PLATFORM Capturing movement and visual orientation within each prototype

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SURVEY RESULTS

[

]

en

r te

flexibility

02

C

g n i t s

Room 2 m (SD)

Room 3 m (SD)

SD

M

SD

0.97

4.29

0.96

0.262

1

e T d n a

F

P

M

SD

M

direct visibility to patient & family simultaneously from computer workstation

4.48

0.93

4.38

visual access to team members outside the room

4.14

1.2

4.50

0.70

4.20

1.00

1.07

3.61

visual access to vital monitor from the computer workstation

4.38

0.86

4.57

0.926

4.62

0.67

0.66

0.528

visual privacy for patients while performing patient care activities

2.67

1.37

2.90

1.37

2.71

1.38

0.45

0.643

physical access to patient care supplies

3.76

1.14

4.57

0.75

3.24

1.34

8.94

0.002

physical access to all sides of patient

3.29

1.10

4.10

0.94

4.00

1.05

4.32

0.028

unobstructed movement during patient care activities 2.81

0.98

4.00

0.95

3.71

1.01

8.36

0.002

adjustability of the computer workstation to support 4.43 patient care activities

0.81

4.24

1.091

4.57

0.98

0.55

0.584

availability of space to accommodate flow of additional equipment

1.02

4.14

0.912

3.95

0.86

8.14

0.003

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

Significant differences were found for all three accessibility questions and for one of two flexibility questions

accessibility

Room 1 m (SD)

3.05

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

VR DATA

02

g n i t s

e T d participants ACCESSIBILITY: distance Visibility: Accessibility: VISIBILITY: proportion of time when the n patient and care partner were visible to the traveled when completing their tasks in each a n patient room g i s e patient and care partner were significantly participants traveled the shortest y D t more visible to the participant in Room 2 distances i [ ] ties e[ rs when in the Room 2 ] i l v i i c Un a F n h o t l s a m e e H l r C o f r e t n e C INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PREFERRED DESIGN FEATURES 1

ACCESS

e T 3 EQUIPMENT d n a n g i s e y D t i s s r e i & FINISHES 4 TEXTURE t e i l v i i c Un a F n h o t l s a m e e H l 5 CEILING FINISH r C fo

»» Equal width around patient on all sides to support fluid movement during patient care activities »» Size and location of care partner zone »» Supply and computer workstation mobility/portability

g n i t s

»» »» »» »»

Co-location of sharps and waste disposal Co-location of supplies and computer workstation Co-location of hand sanitizer and computer workstation Vital monitor & computer workstation mobility

»» »» »» »»

Light wood grain on headwall & built-in storage Seating fabric with natural motif Roller shades on window & tv monitor Nora rubber floor

»» Proportional space allocation to support unobstructed f low of equipment supplies and people »» Wall tilt angle allows for expanded floor area by foot of bed and increased care partners visibility

2

VISIBILITY

»» Multiple viewing options for patient in supine position (i.e., tv height, view to outside, ceiling art, and wall art)

r te

»» Rotated/angled axis for equipment and furniture position/ placement that affords visibility to patient, partner, and additional care team members simultaneously

n e C

»» Ambiance created through the ceiling treatment

»» Patient, care partner, and staff view to the outside

02

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ORIGINAL DESIGN | 140 SQ. FT. ACCESS

r te

02

n e C

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

WALL TILT ANGLE

SIZE AND LOCATION

EASE OF PATIENT ACCESS

MOBILITY

EQUAL WIDTH AROUND PATIENT

PROPORTIONAL SPACE ALLOCATION TO SUPPORT UNOBSTRUCTED FLOW

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ORIGINAL DESIGN | 140 SQ. FT. VISIBILITY

r te

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

MULTIPLE VIEWING OPTIONS

02

n e C

ROTATED/ANGLED AXIS FOR EQUIPMENT AND FURNITURE

e T d n a

g n i t s

VIEW TO THE OUTSIDE

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ORIGINAL DESIGN | 140 SQ. FT. EQUIPMENT

TEXTURES & FINISHES

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

CO-LOCATION OF SHARPS AND WASTE DISPOSAL

r te

n e C

CO-LOCATION OF SUPPLIES AND COMPUTER WORKSTATION CO-LOCATION OF HAND SANITIZER AND COMPUTER WORKSTATION

e T d n a

LIGHT WOOD GRAIN ON HEADWALL & BUILTIN STORAGE

SEATING FABRIC WITH NATURAL MOTIF

ROLLER SHADES ON WINDOW TV MONITOR

NORA RUBBER FLOOR

g n i t s CEILING FINISH

AMBIANCE CREATED THROUGH THE CEILING *ARTWORK BY HENRY DOMKE FINE ART

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ORIGINAL DESIGN

MODIFIED DESIGN Provision of sufficient storage

r te

e T d n a

Ease of movement

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

g n i t s

Angular to rectangular plan

Visibility of patient and care partner

n e LIMITATIONS C OF THE DESIGN

Impracticality of construction of angled room Lack of space for movement near the carepartner zone INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

MODIFIED DESIGN | 150 SQ. FT. ACCESS

r te

02

n e C

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

WALL TILT ANGLE

SIZE AND LOCATION

EASE OF PATIENT ACCESS

MOBILITY

EQUAL WIDTH AROUND PATIENT

PROPORTIONAL SPACE ALLOCATION TO SUPPORT UNOBSTRUCTED FLOW

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

MODIFIED DESIGN | 150 SQ. FT. VISIBILITY

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

MULTIPLE VIEWING OPTIONS

r te

02

n e C

ROTATED/ANGLED AXIS FOR EQUIPMENT AND FURNITURE

e T d n a

g n i t s

VIEW TO THE OUTSIDE

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

MODIFIED DESIGN | 150 SQ. FT EQUIPMENT

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

g n i t s

CO-LOCATION OF SUPPLIES AND COMPUTER WORKSTATION CO-LOCATION OF HAND SANITIZER AND COMPUTER WORKSTATION

CO-LOCATION OF SHARPS AND WASTE DISPOSAL

r te

02

n e C

COMPUTER WOWs MOBILITY

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

g n i t s

e T d n a DESIGNING WAITING ROOMS IN n g i s e y D t SURGICAL ENVIRONMENTS i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f r e t n e C

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PROJECT TEAM

ANJALI JOSEPH

r te

03

n e C

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f DAVID ALLISON

HERMNIA MACHRY

DEBORAH WINGLER

HANNAH SHULTZ

e T d n a

ROXANA JAFARI

HEATHER HINTON

g n i t s

RUTALI JOSHI

JAMES DOMINIC

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

STEPS IN THE HEALTHCARE EXPERIENCE REGISTRATION AND WAITING AREA

r te

03

n e C

PRE-OPERATIVE AREA

OPERATION ROOM

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

g n i t s

POST-OPERATIVE AREA

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WAITING ROOM EXPERIENCE REGISTRATION AND WAITING AREA

PRE-OPERATIVE AREA

OPERATION ROOM

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

g n i t s

POST-OPERATIVE AREA

Roller coaster of emotions while confronting challenges related to diagnosis and treatment

r te

n e C

Sanson-Fisher et al., 2000, Kutash & Northrop, 2007

03

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SIGNIFICANCE

Waiting room physical environment and functionality can help reducing anxiety & stress

Edwards & Clarke, 2004; Beukeboom et al., 2012; Fenko & Loock, 2014

r te

03

n e C

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

g n i t s

Close proximity to family members; access and visibility to staff can comfort family members

Waiting rooms can positively impact health outcomes by increasing patient compliance

“Atmospherics” of the waiting room can impact psychological readiness & physiological state

Overall decor and physical environment of waiting rooms and linked with perception of quality of care & satisfaction

Biddiss et al., 2014; Kutash & Northrop, 2007

Biddiss et al., 2014

Biddiss et al., 2014; Kutash & Northrop, 2007; Tsai, 2007; Leather et al., 2007

Tsai, 2007; Arneill & Devlin, 2002; Deitrick et al., 2005; Donahue, 2017

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SIGNIFICANCE

e T d n a

g n i t s

In a healthcare setting, the design of waiting environments play an important role in serving as the first interaction points between user and the environment, shaping user impressions and experiences of the overall setting and service (Andrade et al., 2012, Ibrahim et al., 2010)

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

The primary end-users of healthcare waiting environments are friends and family of the patients (Vuong et al., 2012)

r “nte e C

Waiting areas are added-on. It is rare that hospitals spend time and effort and finances concerned about the treatment of people in the waiting rooms, or about the emotional state of patients, relative and friends.�

Norman (2008)

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

RESEARCH IN WAITING AREAS Nursing researchers began to address family needs, stress, and coping while waiting in intensive care unit (ICU) waiting rooms

(Butzlaff, 2005; Jonsen, Athlin, & Suhr, 2000; Leske, 1996; Locsin & Matua, 2002; O’Mahony, 2001)

Late 2000

Studies established that those who wait may experience intense psychological and physiological stress reactions by measuring Mean arterial pressure (MAP), heart rates, salivary cortisol levels of family members waiting

1990

1970-1980

1960

n e C

“Waiting is a waste” The goal is to reduce and/or eliminate waiting.

Recent studies recognize the difficulty to eliminate waiting for family. For example, a patient’s family members have downtime during the appointment or surgery; unscheduled emergencies and other situations can also extend waiting times.

Waiting was acknowledged as the most stressful aspect of the hospitalization experience whether waiting during a surgery, to see a patient in the ICU, or waiting for a diagnosis or transplant

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

(Chartier & CoutuWakulczyk, 1989; Molter, 1979)

r te

Alpen and Halm (1991) focused on the needs of the family of the critically ill patient while Jamerson et al. (1996) studied behaviors of waiting family members when obtaining information about the patient.

2000

Davis (1966) was one of the first health care authors to describe waiting in terms of a waiting room

e T d n a

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WHAT THE LITERATURE SAYS GAPS IDENTIFIED

e T d n a

g n i t s

Interview findings from a study suggest that seating arrangement, privacy, and comfort, position of the reception desk and knowledge about patient’s well-being (access to information), proximity to cafÊ and toilets, welcoming atmosphere can have positive impacts on the end-users

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f (Vuong et al., 2012)

Arrangement of furniture in the waiting room and its physical attributes have not received adequate attention in the existing research

(Ibrahim et al., 2010)

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No research was found that addressed furniture type, layout and variety in waiting areas and choices that people made while waiting.

(Malone & Dellinger, 2011; Clapton & Reid, 2017)

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WAITING ROOM CONFIGURATION In this study, participants will evaluate an outpatient waiting room (designed by LS3P Associates) using virtual reality (VR) platform

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

For the purpose of this study we included furniture from Haworth Health Environments.

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Plan of ASC

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WAITING ROOM PERSPECTIVES Architecture + Health, School of Architecture

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School of Computing

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

RESEARCH GOALS GOAL:

To determine how the seating type and location impact care partner preferences based on simulated tasks in a virtual environment.

DESIGN CATEGORIES privacy Access to intimate spaces

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Visual privacy to consult with physician or nurse/ perform task

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Auditory privacy to consult with physician or nurse/ perform task

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accessibility

Visual access to registration desk Visual access to staff

Physical access to cafe

Physical access to toilet

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comfort

g n i t s

aesthetics

Proximity to patient

Interior finishes and furnishings

Access to daylight

Color

Access to views

Presence of indoor plants Presence of artwork

Presence of reading material Presence of TV

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

RESEARCH QUESTIONS

n g i R1 s e y D t i s s r e i t e i l v i i c n a U R2 F n h o t l s a m e e H l r C o f R3 r e t en

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What are the most important factors affecting user’s seat selections in a surgical outpatient waiting room?

What is the relationship between the type of activity/task during wait time and factors considered by users for seat selection?

How differently users evaluate real and virtual pieces of furniture? (usability evaluation)

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

EACH PARTICIPANT WILL BE ASKED TO:

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Perform tasks based on 4 scripted scenarios in the waiting room eg. check in at the registration desk, answer a phone call, get coffee from the cafeteria

Rate the experience by completing a survey after each scenario

Answer open-ended interviews questions and demographic survey at the end of the experiment

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Survey Scenario 2

within VR environment

METHODOLOGY OVERVIEW

Prebriefing and consent Scenario 1

Survey Scenario 3 Survey Scenario 4 Survey Usability Survey Exit Survey Open-ended questions Demographic Survey

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SCENARIO 1 The participant enters the virtual waiting room through the main entrance. The participant is accompanying an elderly patient waiting to undergo cataract surgery. The duration of the surgery will be about 30 to 60 minutes.

Task

Steps

Accompany the patient to the waiting area

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 1.

2.

3.

Walk to the concierge Pick up the map/catalogue from the counter Go to the waiting area

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Picking up the map/catalogue will activate a recorded voice guiding the participant to the waiting area on their right side.

1.

Patient check-in

2.

3.

4.

Receiving the pager

1.

2.

3.

C

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Waiting to be paged to the pre-operative area

Go to the patient self-check-in kiosk located next to the registration desk Press patient check-in button (the green button) Confirm your surgery appointment by pressing the button again Choose a place to sit while waiting to be called by the registration

Put down the map/catalogue on the nearest table Go to the registration area Pick up the pager from the counter (the pager is used for tracking patient information)

Putting down the map/catalogue will activate a recorded voice calling the participant to the registration area and asking them to pick up the pager.

1.

2.

Choose a place to sit while waiting to be paged to the pre-operative area Put down the pager on the nearest table.

The pager will vibrate/beep 10 seconds after it is placed on the table and a recorded voice message will notify the participant that he/she should go to the pre-operative area.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SCENARIOS SCENARIO 2

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

The patient has been transferred to the OR and the care partner (participant) is back in the waiting room waiting for the surgery to be completed. The participant has a conference call scheduled for 9:30 am. The participant decides to call in and has 5 minutes to select a location for setting up the tablet and taking the call.

SCENARIO 3

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The participant decides to get coffee from the cafĂŠ in the waiting room and watch TV.

SCENARIO 4

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The surgery is almost over and the pager alerts the participant that he/she will likely be called into consultation room in another 10 minutes to meet the surgeon and receive information regarding patient’s status.

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

METHODOLOGY SAMPLING PHASE 1 | Pilot study

n g i s e y D t i PHASE 2 s s r e i t e Heathcare Design Conference & Expo, Phoenix i l v i i c 16 participants n a U F n h o t l s a PHASE 3 m e e Watt Center, Clemson University H l r C February-March 2019 fo r e t n e C School of Architecture, Clemson University 13 participants

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

METHODOLOGY SAMPLING PHASE 1 | Pilot study

n g i s e y D t i PHASE 2 s s r e i t e Heathcare Design Conference & Expo, Phoenix i l v i i c 16 participants n a U F n h o t l s a PHASE 3 m e e Watt Center, Clemson University H l r C February-March 2019 fo r e t n e C School of Architecture, Clemson University 13 participants

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

DEMOGRAPHIC INFORMATION

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TOTAL PARTICIPANTS: 92

n VR experience g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f age ranges

gender distribution

18-24 years

53%

25-34 years

54% females

46% males

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35 years +

g n i t s

36%

11%

1 novice

2.55 mean VR experience

5 expert

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS

Division of waiting area into sub-regions

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The floor plan of the waiting room was divided into 19 regions based on the furniture type and location

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

Couch/Bench Chair (type 1) Chair (type 2) Chair (type 3) Stool Sofa Occupied seat

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS Participants’ seat choices were captured using observation logs in each scenario.

Scenario 2

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Scenario 4

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The most selected seats in each scenario

Scenario 1

Scenario 3

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS VR EVALUATION KEY FINDINGS

Scenario 1

The most significant factor influencing seat selections in the scenarios

The most selected seat type in the scenario (VR Model)

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Seat location (p <.0001)

Riverbend- High Back

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Scenario 3

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Sitting with the loved one (p <.0001)

Riverbend- Mid Back

The most selected region on the waiting room floor plan (VR Model)

Scenario 2

Seat location (p <.0001)

Selma

g n i t s

Scenario 4

Seat location (p <.0001)

Riverbend- Mid Back

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS USABILITY EVALUATION KEY FINDINGS

Scenario 1

The most Selected seat type in the scenario (VR Model)

Top-ranking features in the real furniture piece [Student’s t Test (p < 0.0001)]

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Low-ranking features in the real furniture piece [Student’s t Test (p < 0.0001)]

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Scenario 2

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Scenario 3

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g n i t s

Scenario 4

• Stable (M=4.76, SD=0.43) • No sharp or hard edges (M=4.70, SD=0.46) • Usable by individuals within a wide range of size (M=4.4, SD=0.80)

• Stable (M=4.80, SD=0.45) • No sharp or hard edges (M=4.73, SD=0.57) • Enough space for belongings (M=4.58, SD=0.58)

• Stable (M=4.72, SD=0.45) • Comfortable cushion (M=4.56, SD=0.62) • Usable by individuals within a wide range of size (M=4.51, SD=0.63) • Usable by individuals within a wide age range (M=4.44, SD=0.67)

• Stable (M=4.76, SD=0.43) • No sharp or hard edges (M=4.70, SD=0.46) • Usable by individuals within a wide range of size (M=4.4, SD=0.80)

• Detectable power outlets (M=2.90, SD=1.40) • Adjustable to individual needs (M=2.72, SD=1.06)

• Detectable power outlets (M=2.34, SD=1.04) • Shapeable into flexible groupings (M=2.28, SD=0.98) • Easily moveable pieces (M=2.00, SD=0.79)

• Shapeable into flexible groupings (M=2.60, SD=0.95) • Easily moveable pieces (M=2.37, SD=0.87) • Accessible power outlets (M=2.30, SD=1.01) • Detectable power outlets (M=2.23, SD=0.92)

• Detectable power outlets (M=2.90, SD=1.40) • Adjustable to individual needs (M=2.72, SD=1.06)

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

DISCUSSION

Importance of factors across the scenarios

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ONE

The importance of visual appearance of seating from usersâ&#x20AC;&#x2122; perspective did not change significantly across different scenarios and tasks.

TWO

The importance of other factors including auditory privacy, visual privacy, seat comfort, seat location, type of seat, and visibility of registration desk changed significantly (p < 0.0001) across different scenarios:

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

Visual and auditory privacy as well as seat location were considered important in scenario 2 (Receiving a conference call).

Visibility of the registration area was considered important in scenario 4 (Being called to the post-operative area).

Perception of seat comfort and the seat type were considered important in scenario 1 (patient check-in) and scenario 3 (getting coffee from the cafe).

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ANALYSIS

SCENARIO 1

Factor considered while choosing seats SAFETY

“I would say that the presence of other

2%

not having their back to people

7%

SCENARIO TASKS

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f PRIVACY

21%

68% peer distance 18% presence of secluded area 7% visual privacy 4% accompanying the loved one 4% auditory privacy

13%

PROXIMITY TO 50% other people 27% OR corridor 23% registration desk

SEAT QUALITY

17%

VISIBILITY TO 41% registration desk/staff 28% OR corridor 24% waiting room space 3% power outlets 3% information display

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21%

56% comfort 14% seat location 6% individual seats 3% each presence of side tables, footrest, armrest, back support, variety, cleanliness, presence of workstation, appearance, color

ACCESSIBILITY TO

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18%

73% positive distractions 10% power outlets 7% outdoor spaces 3% each spaces in living rooms, rest rooms, exit doors

people in the space was the most important factor in me choosing where I was going to seat.”

SCENARIO 2

“ I wanted to be in a quieter corner for a

conference call.”

SCENARIO 3

“Definitely outlets and natural light, I’m

a big natural light fan- those are the best two.”

SCENARIO 4

“I just wanted some place that would just

help me see my patient the first time he just comes out of the door. “

“The ability to look at the reception desk

mattered because I dint know where I would be going.”

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ANALYSIS Feature participants would like to see changed in the waiting room Feature participants would like to see ADDED in the waiting room 19%

FURNITURE

workstation/desks, secluded seats/areas, recliner chairs, seats facing registration desk, play areas for children, trash cans, cafe table, seats with cup holders etc.

03

3%

not having their back to people

SOURCES OF POSITIVE DISTRACTIONS 50%

TV, reading material, plants, music, games, artwork, background noise, aquarium/fish tank, water features, more colors

29% ACCESSIBILITY Power outlet, restroom, food/cafe/vending machine, information display, spaces to relax, water fountain, Wi-Fi, thermostats, free head sets

Feature participants would like to see REMOVED from the waiting room

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

SIGNAGE

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25% PARTITIONS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

CONCLUSIONS 1

This study suggests what furniture type and quality seem most appealing to users while they are waiting in an outpatient waiting area, and therefore informs product development to enhance users’ waiting experience in outpatient clinic waiting areas.

2

The study also provides recommendations for designers regarding the optimal location of the furniture in outpatient waiting rooms.

3

Furthermore, the study compares users’ evaluation of the virtual versus real furniture to determine whether scenario-based simulations can be used during the design process to obtain end-users’ feedback regarding the space.

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

KEY TAKEAWAYS SEAT LOCATION

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The optimal seat location in the waiting area varies based on the type of task/activity patientsâ&#x20AC;&#x2122; family engage in during wait time:

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

The optimal seat location in the waiting area should allow sitting with the loved one and provide visibility to the registration desk, OR suite door/corridor, and window views simultaneously.

Private and secluded areas/seats should be considered in waiting rooms for conducting certain activities such as talking on the phone and private conversations.

Seats should be provided in the cafĂŠ areas adjacent to the waiting rooms.

SEAT TYPE

Furniture comfort is an important factor considered by users while selecting seats.

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The top-ranking feature of the real furniture used in this study (regardless of the type of task/activity) was stability of the furniture pieces such that they could not be easily tripped over.

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

Forum Room Breakout 1

Seminar 3 Breakout space Seminar 2 Breakout 4 Breakout space Breakout 2

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Breakout 3

#RIPCHDOR

n g i #CLEMSONARCHPLUSHEALTH s e SHARE YOUR IMAGES TO: y D t i s s r e i t e i l v SHARE YOUR IMAGES TO: i i c n a U F n h o t l ARE YOUR IMAGES TO: s a m e e H l #CLEMSONARCHPLUSHEALTH r C o f #RIPCHDOR r e t #CLEMSONARCHPLUSHEALTH n e C #RIPCHDOR FACULTY OFC 222

020

A+H STUDIO 221

DW

FACULTY OFC 223

SEMINAR 227

021

g n i t s

STORAGE 234A

FACULTY OFC 233A 030

FORUM 231

029A

MRUD STUDIO 224

019

SEMINAR 228

DW

SEMINAR 220

022

PF-B

PF-B

PF-B

PF-B

MICROSCOPY 234

026

KITCHEN 226

CRIT 229

PF-B

MSHP STUDIO 232

CONSERVATION 233

029

028

MSHP STUDIO 232

018

LOUNGE 230

FLEX SPACE 225

PF-C

017

STORAGE 207

PRINT 217

009

SEMINAR 218

009A

AV 208

STORAGE 216

ARCH STUDIO 219

016

IT 209

007

ADMIN 206A

006

ADMIN 206B

005

001

008

CONFERENCE DIRECT. OFC 215 214 015

014

DIRECT. OFC 213 013

DIRECT. OFC 212 012

027

025

PF-C

DIRECT. OFC 211 011

RECEPTION 201

DIRECT. OFC 210

004

010

STORAGE 205

004A

WORK ROOM 204

003

LIBRARY 203

ADMIN 202A

PF-C

002

ADMIN 202B

PF-C

USING THE HASHTAGS:

Mock-up

Breakfast, Lunch & Refreshments

BreakoutRoom 5 Conference Breakout space

USING THE HASHTAGS:

Restrooms

Stairs & Elevators

USING THE HASHTAGS:

LEMSONARCHPLUSHEALTH #RIPCHDOR

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSHOP AGENDA DAY 1 SEPTEMBER 12, 2019 08:30 – 09:00 09:00 – 10:00 10:00 – 11:00

Welcome & introductions Keynote: Innovations in surgical environments Case study exemplars

11:00 – 11:15

Morning break

11:15 – 12:00 12:00 – 12:30

Designing preoperative & postoperative workspaces Designing waiting areas

12:30 – 01:30

Lunch

01:30 – 01:45 01:45 – 02:30 02:30 – 03:15

RIPCHD.OR project introduction RIPCHD.OR research findings Safe OR prototype & “Safe OR Design Tool” preview

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03:30 – 03:45 03:45 – 04:00 04:00 – 05:15 05:15 – 05:45 05:45 – 07:00 07:00 – 09:00

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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Andrew Ibrahim Lynn Martin, Mark Gesinger; Cara Tubbs, Michael Folonis

Afternoon break

Design implementation Future state OR Panel discussion Recognition and closing remarks Evening Networking Reception Dinner (individual choice)

Becky Smith

William Berry, Alex Langerman, Bryan Langlands, Lynn Martin, David Ruthven

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

g n i t s

e T d n DESIGNING OPERATING ROOMS a n g i s (RIPCHD.OR PROJECT) e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f r e t n e C INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PROJECT BACKGROUND

OR is a highly complex riskprone area

World Alliance for Patient Safety, 2008

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5 out of every 1000 ambulatory surgical procedures results in a post surgical acute care visit for surgical site infections (SSI)

Distractions and errors contribute to medical errors leading to patient harm

Disruptive developments in medical technology and medical practice are impacting how surgeries are being performed today

OR design has lagged behind and OR environmental features are often latent conditions impacting patient safety in the OR

Owens et al., 2014

Wiegmann et al., 2007

Rostenberg & Barach, 2011

Weerakkody et al., 2013

There is a need for a systemic approach to OR design that examines the role of people, tasks, technology, equipment and the built environment on patient and staff safety outcomes in the OR

04

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

BRIDGING THE IDEAL WITH REALITY WORK AS

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IMAGINED

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

BRIDGING THE IDEAL WITH REALITY WORK AS

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

VISION To develop an evidence-based framework and methodology for the design and operation of operating rooms such that it impacts improved perioperative outcomes including surgical site infections, surgical errors and staff injuries.

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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To create a strong multidisciplinary network of people and places that together can effectively address patient safety issues in a range of different types of environments where there are key patient safety concerns.

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Clemson Team MUSC Team Industry Partners Advisory Committee Members

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

IN A SNAPSHOT

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$4M over 4 years. $1M/year

n g i s e y D t i s s r e i t e i l v i i c n a U F 01 02 03 n h o t l s a m e e H l r C o f

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Multi-disciplinary systems approach to improving patient safety in the OR

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2017

Literature review Case Studies OR observations

2016

2015

A P30 center core grant to develop a patient safety learning lab

Mockup design

Design development & implemenattaion at MUSC

04 2018

Funded by Agency for Healthcare Research and Quality (AHRQ)

g n i t s

Testing & evaluation

Three individual though integrated projects Focus on ambulatory surgery

Implementation of learning lab concepts into new MUSC surgery centers

04

Integration of research, teaching and practice INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PROJECT PARTNERS Dr. Scott Reeves (Principal Investigator)

Dr. Anjali Joseph (Principal Investigator)

RIPCHD.OR PSLL

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Industry partners

Anesthesiology Surgery Nursing

Medical University of South Carolina

Perioperative Services Quality and Safety

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Quality & safety experts

04

Anesthesiologists Surgeons Nurses

Operations management researchers

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g n i t s

Clemson University

Architecture+Health School of Architecture

Department of Industrial Engineering School of Nursing

College of Business

Technical advisory committee

College of Computing

Clinical & patient advisory committee

Administrative staff

Human factors experts

Healthcare architects

Design researchers

University faculty Graduate students Doctoral students

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PROJECT ACCOMPLISHMENTS October 2016 Tape on the floor mock-up

June 2016 Space acquired for mock-up

January-April 2016 Problem Analysis & coding protocol SeptemberDecember2016 Literature Review

RIPCHD.OR Workshop & OR design tool ideation session

June 2017 Construction of high fidelity mock-up begin

August 2016 Case studies & focus groups

November 2016 Cardboard mock-up

December 2016 Higher fidelity cardboard mock-up

PROBLEM ANALYSIS

DESIGN & DEVELOPMENT IMPLEMENTATION

October 2017 ACCelerate Creativity and Innovation Festival, held at the National Museum of American History in Washington, DC.

December 2018 Full team scenariobased simulations in high fidelity mock-up

September 2018 Workshop at Leo A Daly, FL

March 2018 Anesthesia task simulations in high fidelity mock-up May 2018 Nursing task simulations in high fidelity mock-up

March 2019 MUSC announces new surgery center September 2019 Post-move evaluations

April 2016 onward Data analysis of videos

YEAR 1

YEAR 3

YEAR 2

August 2015

August 2016

EVALUATION & DISSEMINATION

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January 2018 High fidelity mock-up unveiling

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

February-May 2016 Behavior observations of the OR system

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August 2017

September 2016 RIPCHD.OR Workshop & design charrette September 2016

November 2017 Evidence based design Touchstone award (silver category) November 2017 Healthcare Environments Award (conceptual design)

January 2018

YEAR 4 August 2018

May 2018 “The Operating Room of the Future” featured in The Wall Street Journal

August 2019

February 2019 Workshop with Emory at Charleston November 2018 Featured in the Healthcare Design Magazine Joseph, A. & Allison, D. (2018). Designing a Safer OR. Healthcare Design Magazine

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PROJECTS T1

PR

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UNMASKING OF ANESTHESIA-RELATED ALARMS AND COMMUNICATIONS

C OJE

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

g n i t s

This work extends what is known about alarms, interruptions, and distractions in the operating room by examining them from a systems perspective.

T2

PROJEC

TRAFFIC FLOW AND DOOR OPENINGS IN THE OR

This project will focus on understanding factors impacting traffic flow in the OR suite.

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INTEGRATED OR SUITE DESIGN

PRO

JECT

3

This project aims to develop an overall framework and methodology for designing an ergonomic and human-centered operating room that will improve patient and staff safety and outcomes in the OR.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PROJECTS RIPCHD.OR

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f PROJECT 1

YEAR 1

Anesthesia alarms

Problem analysis

Design development

3D Gestural input study

Tactile display study

YEAR 3 Design implementation

TASK SWITCHING

GESTURAL STUDY

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Circulating nurseâ&#x20AC;&#x2122;s workflow study

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CONTAMINATION OF ANESTHESIA WORK AREAS

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Flow analysis

Literature Review

OR FLOW MODELING

POST OCCUPANCY EVALUATIONS IN THE NEW MUSC ASC

OR DESIGN TOOLKIT

OR DESIGN TOOLKIT

OUTCOMES DATABASE

CAPACITY MODELING

ANALYSIS OF DOOR OPENINGS IN THE OR

PROJECT 1

Indepth case studies & international best practices

Procedure maps

Unmasking of anesthesiarelated alarms and communications

PROJECT 2 OR VR experiment

Design and traffic flow improvement simulation modeling

DISPLAYS & ALTERNATIVE INFORMATION PRESENTATIONS

YEAR 4 Evaluation and dissemination

Microbial load study

PROJECT 3

Discrete event simulation modeling

Video capture observation & coding

YEAR 2 Anesthesia workstation design

PROJECT 2

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BENEFITS OF A STERILE INSTRUMENT SETUP ROOM OR A SEPARATE INDUCTION ROOM ADJACENT TO THE OR

COMMUNICATION & TURNAROUND TIME

Development of OR prototype, mock-up & simulation

Traffic flow and door openings in the OR

HIGHER FIDELITY MOCK-UP, SIMULATION AND EVALUATION PROJECT 3

LIVE HIGH FIDELITY SIMULATIONS AND EVALUATIONS

Integrated OR suite design

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PREVIOUS TEAM MEMBERS

PROJECT 2

DAVID NEYENS

KEN CATCHPOLE

SCOTT REEVES

KATIE JUREWICZ

SARA RIGGS

KYLIE GOLMES

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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KEVIN TAAFFE

LAWRENCE FREDENDALL

DEE SAN

YANN FERRAND

ANJALI JOSEPH

AMIN KHOSHKENAR

SEYED AMIN SEYED HAERI

JAEYOUNG KIM

MARISA SHEHAN

RUTALI JOSHI

ROXANA JAFARI

EMILY HUFFER

ALEXIS FIORE

ERIC BOLIN

AMANDA REDDING

CASSANDRA SALGADO

DOTAN SHVORIN

JAMES ABERNATHY

SARA BAYRAMZADEH

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SCOTT BETZA

PROJECT 3

BRANDON LEE

MIRANDA MUS

LANSING DODD

DAVID ALLISON

WENZ TUTTLE

DEBORAH WINGLER

HANNAH SHULTZ

ZAHRA ZAMANI

RACHEL MATTHEWS

SUSAN Oâ&#x20AC;&#x2122;HARA

HEATHER HINTON

HERMINIA MACHRY

RAY TAN

BILL ROSTENBERG

LEAH BAUCH

YEAR 4 TEAM MEMBERS

YEAR 4 TEAM MEMBERS

PROJECT 1

g n i t s

PREVIOUS TEAM MEMBERS

PROJECT TEAMS

JAMES DOMINIC

CONSULTANTS

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

BILL ROSTENBERG Architecture for Advanced Medicine

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ELLEN TAYLOR The Center for Health Design

ROBIN CLARK QMT Group

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CHRISTOPHER PEMPSELL Pempsell Design

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

TECHNICAL ADVISORY COMMITTEE

BILL BERRY | M.D., MPA, MPH

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ELLEN TAYLOR | Ph.D., AIA, MBA, EDAC

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DAVID CULL | M.D.

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f EILEEN MALONE | RN, MSN, MS, EDAC

JAMES (JAKE) ABERNATHY | M.D., MPH

JOHN SCHAEFER | M.D.

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JONAS SHULTZ | MSc, EDAC

TIM BROOKSHIRE | MBA

KEITH ESSEN | Ph.D., MSN, BSN

WINDSOR SHERRILL | Ph.D

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

n g i s e y D t i s s r e i t e i l v i i c KERM HENRIKSEN | Ph.D. n a U F n h o t l s a m e e H l r C o f Thank you..

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Senior Advisor, Human Factors and Patient Safety Agency for Healthcare Research and Quality

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n Ageny for Healthcare Research and Quality (AHRQ) e C for your support !

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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n g i s e y D t i s s r e i RESEARCH FINDINGS t e i l v i i c n a U F n h o t l s a m e e H l r C o f

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS | YEAR 1 & 2 LITERATURE REVIEW EQUIPMENT &

TOOLS &

MATERIALS

SUITES

ROOM

INSTRUMENTS

TECHNOLOGY

198 Design & Spatial configuration

AIR

AUDITORY

THERMAL

VENTILATION

CONDITIONS

CONDITIONS

Articles

Equipment, technology & materials

STAFF PERFORMANCE

STAFF SAFETY

STAFF SATISFACTION

1

Pre-assessment survey & interview

2

Pre-assessment from plans

3

Physical assessment with photo protocol

45 minutes focus groups with three multidisciplinary teams working in different ORs – pediatric, orthopedic, general surgery

2

Focus on identifying key barriers and facilitators to performing work in the OR, storage issues, task coordination and flows

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Oberservations

PATIENT SAFETY

EFFICIENCY

Interviews

ERRORS

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1

3

SURGICAL FLOWS

PROCEDURE MAPS GASTROCUTANEOUS FISTULA CLOSURE

SURGICAL FLOW DISRUPTIONS

g n i t s

Final question on rank ordering key factors that have impact on work Space available in the OR Position of equipment Operating room doors Lighting Visibility to people and equipment

PEDIATRIC

VIDEO CAPTURE

PATIENT PREPARATION | 00:33:00

INTRAOPERATIVE | 00:29:31

POSTOPERATIVE | 00:14:38

DURATION | 1:17:09

This surgery was a gastrocutaneous fistula closure in a pediatric patient

LOCATION OF SURGICAL SITE

Usability Layout Environmental hazard Equipment failure Interruptions

DIAGRAM KEY

Above Equipment Sterile Zone Movable Furniture or Equipment Patient Circulating Nurse Scrub Nurse Surgeon Anesthesiologist

DOOR OPENINGS

OR | MAIN #5

Door to Sterile Core open Door 1 Corridor open Door 2 Corridor open

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LIGHTS ON/OFF OR General Light ON microphones

VISIBILITY

Environmental conditions

OBSERVATIONS

cameras mounted on poles

LIGHTING

remote

OPERATING

CASE STUDIES

onsite

SURGICAL

FOCUS GROUPS

C

SPAGHETTI DIAGRAMS

DISCRETE EVENT SIMULATION MODELING

ZONES KEY:

BACTERIAL LOAD SAMPLING

CIRCULATING NURSE WORK STATION ZONE

SURGEON'S WORK STATION ZONE

FOOT OF SURGICAL TABLE ZONE

SURGICAL TABLE ZONE 1 (right side of patient or head of patient) SURGICAL TABLE ZONE 2 (left side of patient or head of patient) DOOR TO STERILE CORE

cameras mounted on poles

base machine & computer screenmicrophones

04

base machine & computer screen connections - camera to computer

field of view

DOOR TO CORRIDOR

TRANSITIONAL ZONE

ANESTHESIA WORK STATION ZONE

connections - camera to computer

SUPPLY ZONE

field of view

SUPPORT ZONE

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

VIDEO CAPTURE

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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g n i t s

cameras mounted on poles microphones

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base machine & computer screen

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connections - camera to computer

cameras mounted on poles microphones base machine & computer screen

field of view

04

connections - camera to computer field of view

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OBSERVATIONS SURGERY PHASES

No Phase Turnaround Patient Preparation Intra-operative Post-operative

n g i s e SUBJECTS - 7 PRIMARY y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C OBJECTS - 7 o f r e t n e C Clean-up tech RN, circulating Scrub nurse/surgical tech/student Anesthesiologist/resident/tech/student MD, surgeon MD, student/resident Observer

04

Instrument Tray Instrument Table Main Instrument Table Secondary Instrument

Table Cart Trash Cans Room

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g n i t s ZONES KEY: CIRCULATING NURSE WORK STATION ZONE

SURGEON'S WORK STATION ZONE

FOOT OF SURGICAL TABLE ZONE

SURGICAL TABLE ZONE 1 (right side of patient or head of patient) SURGICAL TABLE ZONE 2 (left side of patient or head of patient) DOOR TO STERILE CORE

DOOR TO CORRIDOR

TRANSITIONAL ZONE

ANESTHESIA WORK STATION ZONE

SUPPLY ZONE

SUPPORT ZONE

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OBSERVATIONS FLOW DISRUPTIONS Usability Layout Environmental hazard Equipment failure Interruptions

DOOR OPENINGS Door to Sterile Core open Door 1 Corridor open Door 2 Corridor open

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

TRANSITIONAL ZONE 3

24'-6"

ANESTHESIA WORKSTATION ZONE

SURGICAL TABLE ZONE 1

SUPPLY ZONE 1

OPERATING ROOM A ZONE 2 SURGICAL TABLE

OPERATING ROOM SUPPLY B ZONE 2 SUPPORT ZONE 1

CIRCULATING NURSE WORKSTATION ZONE

OPERATING ROOM A

SURGEON’S WORKSTATION ZONE

SUPPORT ZONE 2

g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f FOOT OF SURGICAL TABLE ZONE

22'-4" SUPPORT ZONE 3

DOOR 2 TO CORRIDOR

SURGICAL TABLE ZONE 1

SURGICAL TABLE ZONE 2

TRANSITIONAL ZONE 1

DOOR TO STERILE CORE

SUPPLY ZONE 1

10'

TRANSITIONAL ZONE 3

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TRANSITIONAL ZONE 1

SURGICAL TABLE ZONE 2 24'-6"

TRANSITIONAL ZONE 2

DOOR 1 TO CORRIDOR

SUPPORT ZONE 1

FOOT OF SURGICAL TABLE ZONE

DOOR 2 TO CORRIDOR

OPERATING ROOM B SURGICAL TABLE ZONE 1

TRANSITIONAL ZONE 1

SUPPLY ZONE 2

SURGICAL TABLE ZONE 2

TRANSITIONAL ZONE 2

SUPPORT ZONE 1

DOOR TO STERILE CORE

TRANSITIONAL ZONE 3

SUPPORT ZONE 2

SURGEON’S WORKSTATION ZONE

DOOR 1 TO CORRIDOR

ANESTHESIA WORKSTATION ZONE

SUPPORT ZONE 3

FOOT OF SURGICAL TABLE ZONE

DOOR 2 TO CORRIDOR

SUPPLY ZONE 1

SUPPORT ZONE 4

SURGICAL TABLE ZONE 1

TRANSITIONAL ZONE 1

SUPPLY ZONE 2

SUPPORT ZONE 5

SURGICAL TABLE ZONE 2

TRANSITIONAL ZONE 2

SUPPORT ZONE 1

SUPPORT ZONE 6

DOOR TO STERILE CORE

TRANSITIONAL ZONE 3

SUPPORT ZONE 2 OPERATING ROOM A

DOOR 1 TO CORRIDOR

ANESTHESIA WORKSTATION ZONE

SUPPORT ZONE 3

OPERATING ROOM B ZONES KEY:

26'

SUPPORT ZONE 6

2'

5'

26'

CIRCULATING NURSE WORKSTATION ZONE

SUPPORT ZONE 5

8'-8"

SURGICAL TABLE ZONE 1

SURGEON’S WORKSTATION ZONE

SUPPORT ZONE 4

SUPPORT ZONE 6

DOOR 2 TO CORRIDOR

SUPPLY ZONE 2

OPERATING ROOM A

SUPPORT ZONE 5

FOOT OF SURGICAL TABLE ZONE

DOOR TO STERILE CORE CIRCULATING NURSE WORKSTATION ZONE

SUPPORT ZONE 3

22'-4"

ZONES KEY:

DOOR 1 TO CORRIDOR

SUPPLY ZONE 1

SUPPORT ZONE 2

SUPPORT ZONE 4

02 04

5'

10'

18'-8"

SUPPORT ZONE 1

C

2'

ANESTHESIA WORKSTATION ZONE

SUPPLY ZONE 2

en

TRANSITIONAL ZONE 2

SURGEON’S WORKSTATION ZONE

27'-11"

ANESTHESIA WORKSTATION ZONE

19'-10"

19'-10"

TRANSITIONAL ZONE 1

SURGEON’S WORKSTATION ZONE

CIRCULATING NURSE WORKSTATION ZONE DOOR TO STERILE CORE

27'-11"

TRANSITIONAL ZONE 3

CIRCULATING NURSE WORKSTATION ZONE

SURGICAL TABLE ZONE 2 24'-6"

ZONES KEY:

22'-4"

SUPPORT ZONE 6

ZONES KEY:

SURGICAL TABLE ZONE 1

OPERATING ROOM A

18'-8"

DOOR 2 TO CORRIDOR

OPERATING ROOM B

FOOT OF SURGICAL TABLE ZONE

DOOR 1 TO CORRIDOR

TRANSITIONAL ZONE 2

SUPPORT ZONE 3

26'

SUPPORT ZONE 4 SUPPORT ZONE 5

SUPPORT ZONE 2

463ft2 / 43.0m2 Pediatric 4 Surgeries

TRANSITIONAL ZONE 3 ANESTHESIA WORKSTATION ZONE

OPERATING ROOM C SUPPLY ZONE 1

OPERATING ROOM A

19'-10"

24'-6"

ZONES KEY:

27'-11"

DOOR 1 TO CORRIDOR

390ft2 / 32.2m2 Pediatric 8 Surgeries

g n i t OPERATING ROOM C s e T d n a n

22'-4"

SIMTIGRATE SYMPOSIUM | APRIL 2019

5' INNOVATIONS IN SURGICAL ENVIRONMENTS2'| SEPTEMBER 2019

OPERATING ROOM C

22'-4"

19'-10"

690ft2 / 64.1m2 DOOR TO STERILE CORE General Adult Procedure 13 Surgeries

27'-11"

FOOT OF SURGICAL TABLE ZONE

19'-10"

SETTING SETTING

27'-11"

ZONE

SURGEON’S WORKSTATION ZONE

10'

01 CIRCULATING NURSE WORK PATTERNS AND FLOW DISRUPTIONSg n SIGNIFICANCE

i t s e T d n a

• The circulating nurse (CN) has the responsibility of observing, monitoring and managing potential threats during surgical procedures, at and around the surgical field.

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

• This requires their constant movement to different zones of the OR to support team members.

• The layout of the OR, as well as a crowded and cluttered environment, may contribute to unnecessary movement or create barriers to movement inside the OR resulting in workflow disruptions.

STUDY AIMS

• To explore how the layout configuration and adjacencies of functionally different areas within the OR impacts movement patterns of the circulating nurse

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• To explore how the layout configuration and adjacencies of functionally different areas within the OR impact disruptions to the workflow of the circulating nurse

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

01 CIRCULATING NURSE WORK PATTERNS AND FLOW DISRUPTIONSg n WHAT WE FOUND?

Frequency of CN activities & duration of each activity Activity

Frequency

P atient related E quipment related M aterial and supply related I nformation related

07% 23% 35% 36%

Duration in hours (%)

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04 hr (13%) 06 hr (18%) 06 hr (18%) 18 hr (52%)

dis tr

fr

fr

M

equen

2200 total FDâ&#x20AC;&#x2122;s

cy

cy

I

E

FD on of across i t z ibu

es on

P

equen

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

ity

ion of each ac t a tiv r du

i t s e T d n a 26%

432 Layout

Frequency of visit to each zone and distribution of FD across zones

Location

Frequency

Surgical table zone 1 Surgical table zone 2 Supply zones

CN Workstation zone Transitional zones Door zones

08% 05% 03% 32% 25% 10%

Distribution of FD 28%

6.3% 4.1% 58.3% 3.4%

involved CN

152 Environmental hazard

Types of FDs Layout

Environmental hazards

adapt to inadequate space impeded visibility positioning of connectors, equipment, furniture and fixed structures in the OR

slipping, falling, tripping; interacting with sharp objects and contaminated needles; colliding with staff, equipment or furniture; excessively reaching to access patient, objects or equipment

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

01 CIRCULATING NURSE WORK PATTERNS AND FLOW DISRUPTIONSg n KEY TAKEAWAYS

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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• CN’s movement patterns, to a large degree, required crossing through multiple zones. The CN’s workstation acted as a main hub from which the CN made frequent trips to both sides of the surgical table, the foot of the OR table, supply zones, and support zones.

• The circulating nurse experiences most of the flow disruptions in transitional zones.

• Locating frequently traveled zones closer or where possible adjacent may reduce the involvement of the CN in an SFD while performing an activity.

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Bayramzadeh, S., Joseph, A., San, D., Khoshkenar, A., Taaffe, K., Jafarifiroozabadi, R., Neyens, D. M., & RIPCHD. OR Study Group. (2018, January). The Impact of Operating Room Layout on Circulating Nurse’s Work Patterns and Flow Disruptions: A Behavioral Mapping Study. HERD: Health Environments Research & Design Journal. DOI:https://doi. org/10.1177%2F1937586717751124 Neyens, D.M., Bayramzadeh, S., K. Catchpole, A. Joseph, K. Taaffe, K. Jurewicz, A. Khoshkenar, D. San & RIPCHD.OR Study Group (2018) Using a systems approach to evaluate a circulating nurse's work patterns and workflow disruptions. Applied Ergonomics. doi: 10.1016/j.apergo.2018.03.017 INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

02 CONTRIBUTION OF MINOR FLOW DISRUPTIONS TO MAJOR EVENTS g METHODS

SIGNIFICANCE • Disruptions in the natural flow of surgical procedures contribute to higher stress, higher perceived workload for surgical staff, increased surgery duration, surgical errors and increased patient mortality.

Video recordings of 28 surgeries in 3 ORs were coded using the following categorizations

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Staff activities Staff location

Types of FD layout, environmental hazards , usability, interruption and equipment failure Minor FD

Severity of FD (Palmer et al., 2013; Parker et al., 2010)

Major FD

• Studies in operating rooms show that minor disruptions, when grouped together, may contribute to major events. Though the impact of the OR built environment on minor or major disruptions and eventually patient safety has been acknowledged, it has rarely been studied as a source of FD in the OR.

STUDY AIMS

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1—no impact/minor disruption-no response; 2—momentary disruption (acknowledgment of disruption, no pause in task); 3—momentary distraction (short pause <10 s); 4—primary task interrupted (task cessation >10 s); 5—primary task disruption (secondary task engaged) 6—repeat task

• Explore how minor and major flow disruptions are related in terms of the people involved, tasks performed and OR traffic, as well as the location of FDs and other environmental characteristics of the OR that may contribute to these disruptions.

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• Understand how layout and traffic affects the occurrences of bothminor and major flow disruptions during surgery

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

02 CONTRIBUTION OF MINOR FLOW DISRUPTIONS TO MAJOR EVENTS g WHAT WE FOUND?

n i t s e T d n a 2504 n74% 26% g i s e y D 98% t i s s 73% r e i t e i l v i i 2% c n a U F n h o t l s a 30% m e e H l r C o f 30%

Staff activities during major FDs

major FD’s

21%

Patient

total FD’s

minor FD’s

In

21%

Equipment tasks

31%

Material & supply

27%

Information

C

en

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of major FDs, a surgical staff member(s) either was momentarily distracted or had a pause or interruption in her/his task.

of minor FDs did not result in behavior change

In of the cases they engaged in secondary activity or repeated surgical task

occurred due to interruptions such as non-essential staff entering the OR, spilling or dropping of equipment and searching activities because of missing items in the OR

more than 50%

30%

of all the FDs originated from

of minor FDs originated from

layout issues

of those occur in the

environmental hazards

anesthesia zone

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

02 CONTRIBUTION OF MINOR FLOW DISRUPTIONS TO MAJOR EVENTS g KEY TAKEAWAYS

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

n i t s e T d n a

• Minor flow disruptions that occurred while performing equipment related activities were related to increases in major flow disruptions.

• An increase in minor disruptions in the transitional zone that connects the CN workstation zone with the foot of the surgical table was slightly related to an increase in the rate of major flow disruptions.

• The number of transitions between OR zones and the overall density or crowdedness in the OR significantly impacted the occurrence of any type of flow disruption.

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Joseph, A., Khoshkenar, A., Taaffe, K. Catchpole, K., Machry, H., & Bayramzadeh, S. (2018, August 29). Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room. BMJ Quality & Safety, 0:1-8. http://dx.doi.org/10.1136/bmjqs-2018-007957 INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

03 FACTORS IMPACTING MICROBIAL LOADS IN THE OR • In previous research, surgical site infections (SSIs) have been associated with patient safety outcomes. The OR team, the number of people, their movement in the OR, door openings, surgical practices, scrub attire, etc. are some of the external risk factors that can lead to the development of SSI.

27 surgeries were video recorded and analyzed using Noldus Observer XT (version 12.5) to determine high and low transit areas

PHASE 2

Data was collected in 4 ORs across 21 procedures using air samplers and settle plates placed at identified locations

PHASE 3

Data was analyzed using hierarchical regression modeling

Door 1

• Understand how the movement of the patient, equipment, materials, staff and OR door openings affects OR microbial loads at various locations

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PHASE 1

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

• One potential contributing factor to increased risk of SSI is microbial contamination in the OR. However, the relationship between staff movement patterns and microbial load levels hasn’t been examined closely.

STUDY AIMS

METHODS

• Offer evidence-based guidelines for OR workflow design.

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D B A

Door 2

SIGNIFICANCE

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Traffic flow by all of the staff in OR1 during surgery 1

Location of air samplers & settle plates A B C D E

near door 1, high traffic area near door 2, high traffic area transition location, high traffic area low traffic area near door 2, high traffic area INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

03 FACTORS IMPACTING MICROBIAL LOADS IN THE OR WHAT WE FOUND?

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

*

NUMBER OF PEOPLE did not contribute significantly to the microbial load

Though the NUMBER OF DOOR OPENINGS was not a significant factor, proximity to a door impacted bacterial counts.

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Higher TRAFFIC AREAS in the OR have a higher microbial load than the lower traffic areas.

Analysis of the air sampling data did not demonstrate differences by LOCATION in the bacterial load.

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TEMPERATURE and HUMIDITY were not significant

g n i t s The study produced mixed findings for average microbial load for the orthopedic and pediatric PROCEDURES due to difference in nature of procedures.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

03 FACTORS IMPACTING MICROBIAL LOADS IN THE OR KEY TAKEAWAYS

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g n i t s

• Analysis of the air sampling data did not demonstrate differences by location in the bacterial load.

• Higher traffic areas in the OR have a higher microbial load than the lower traffic areas.

• The number of door openings did not have a significant impact.

• All hierarchical regression models of the settle plate CFU identified the sampling timeframe as significant

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Taaffe, K., B. Lee, Y. Ferrand, L. Fredendall, D. San, C. Salgado, D. Shvorin, A. Khoshkenar, and S. Reeves. “The influence of traffic, area location, and other factors on operating room microbial load,” in review with Infection Control and Hospital Epidemiology.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

INTUITIVE? 05 IMPACT OF LAYOUT ON TASKS PERFORMED IN ANESTHESIA WORKSPACE g SIGNIFICANCE

n i t s e METHODS T d n a n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

• The anesthesia workspace is a small area for anesthesia providers, often with cluttered work surfaces and several pieces of fixed and/or movable equipment like anesthesia machine, electronic medical record (EMR) computer, infusion pumps, and drug storage and preparation areas.

• Anesthesia providers frequently switch between tasks, which means that the spatial arrangement of different devices can be critical for maintaining monitoring and patient awareness.

Video Analysis. Video data from 6 surgeries was first used to analyze the time spent on different tasks by anesthesia providers during the maintenance phase of anesthetic care.

Task Analysis. Tasks were paired to explore the frequency and direction of task switching. Each task pair was plotted as a line connecting the locations of where the tasks were performed.

For example, if the anesthesia provider performed a series of tasks such as “patient visual displays - EMR - patient”, then the task pairs would be “patient-visual displays”, ”visual-displays-EMR”, then “EMR-patient.”

Workspace Layout Assessment. Data from 6 surgeries were used to test theoretical configurations of different workspaces (layout A,B,C & D) to assess the relationship between anesthesia workspace layout and workflow.

STUDY AIMS

• Understand how anesthesia providers switch between tasks during maintenance phase.

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• Simulate task-switching to proactively analyze different layouts

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Layout A (original layout)

Layout B

Layout C

Layout D

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

INTUITIVE? 05 IMPACT OF LAYOUT ON TASKS PERFORMED IN ANESTHESIA WORKSPACE g WHAT WE FOUND?

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Task switching analysis Example of analysis for layout D based on data from surgery 2 & 3

Time spent on tasks (during maintenance phase)

n i t s e T d n a

Workspace Layout Assessment

8.2 %

7.0 % 4.7 %

30 %

4.4 %

18.6 %

26.6 %

Patient EMR Visual display tasks

The anesthesia provider is facing the patient for about half of the duration of the maintenance phase

Layout B

The anesthesia provider has to look away from the patient when preparing and retrieving supplies

Layout C

Layout C further improved the centering of tasks towards the patient

Layout D

Layout D allows for the anesthesia provider to continually monitor the patient and patient displays while interacting with the EMR computer

Surgery 2

Retrieving supplies Infusion pumps Preparing supplies Non-medical tasks

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Layout A

Surgery 3

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

INTUITIVE? 05 IMPACT OF LAYOUT ON TASKS PERFORMED IN ANESTHESIA WORKSPACE g KEY TAKEAWAYS • Patient and EMR tasks consumed the highest proportions of surgery time

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

n i t s e T d n a

• On average across all surgeries, a task switch occurs every 6.39 seconds.

• Layout D theoretically improves the centering of tasks around the patient, and by reducing the time spent with their back to the patient, enables increased awareness, when compared to the original layout and the other alternatives.

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Jurewicz, K., Neyens, D., Catchpole, K., Joseph, A., Reeves, S., Abernathy, J. (under review) Using anesthesia workflow to evaluate physical workspace design and layout Betza, S. M., Jurewicz, K. A., Neyens, D. M., Riggs, S. L., Abernathy, J. H., Reeves, S. T. (2016). Anesthesia maintenance and vigilance: Examining Task Switching. In Proceedings of the Human Factors and Ergonomics Society Annual Meeting (pp. 608–612). Santa Monica, CA: Human Factors and Ergonomics Society.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

06 SIMULATION MODELING TO EVALUATE AN IDEAL OR LAYOUT SIGNIFICANCE

• There is a pressing need to improve safety and efficiency in the operating room. Post-surgical adverse events such as surgical site infections and surgical flow disruption occur at a significant rate and may result in mortality.

METHODS PHASE 1

n g i s e y D t i s s r e i t 3 e i l v i i c Un a F n h o t l s a 5 7 m e e H l 2 r C fo

e T d n a

g n i t s

23 surgical procedures were video recorded and analyzed for surgical flow data to create a dataset

PHASE 2

A simulation-based modeling tool was developed in order to test OR prototypes using

STUDY AIMS

• The aim of this study is to identify an ideal room design using risk and safety performance measures in a simulation model with the goal of improving the flow of staff members.

• This study uses a simulation modeling approach to analytically evaluate and compare alternative design layouts with regard to:

metrics TNC TDT NTS

Total number of contacts as a measure of congestion Total distance traveled Number of transitions near the surgical area as a measure of infection risk and safety

subjects

1. Surgical table orientation

and

2. OR size

different locations of mobile CN workstation - Wall - Foot of the table

3. OR shape

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SURGICAL TABLE ZONE 2 (left side of patient or head of patient) FOOT OF SURGICAL TABLE ZONE DOOR 1 SURGICAL TABLE ZONE 1 (right side of patient or head of patient) DOOR 2

TRANSITIONAL ZONE DOOR 1

06 SIMULATION MODELING TO EVALUATE AN IDEAL OR LAYOUT

g n i t s

SUPPORT ZONE 2B. MediumMISCELLANEOUS OR (prototype size) - 1 door

e T d n a

SUGGESTED STAFF LOCATION TASKS ZONE INSTRUMENT TABLE + CASE DURING CART SUPPORT

Base prototype 1C. OR table angled (as it is now) - 1 door CASE 2 MISCELLANEOUS SUPPORT ZONE

SUGGESTED STAFF LOCATION DURING TASKS

SUGGESTED STAFF LOCATION DURING TASKS

2A. Smaller OR (72% from prototype OR size) - 1 door

LOCATION ZONE KEY:

CIRCULATING NURSE WORK STATION ZONE

CASE 3

LOCATION ZONE KEY:

CIRCULATING NURSE WORK STATION ZONE LOCATION ZONE KEY:

CIRCULATING NURSE WORK STATION ZONE SURGEON'S WORK STATION ZONE

SURGEON'S WORK STATION ZONE

POSITION of the OR table

SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

TDT

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

DOOR 2

3A. Square OR (24'x24') / 1 door LOCATION ZONE KEY: TRANSITIONAL ZONE

CIRCULATING NURSE WORK STATION ZONE ANESTHESIA WORK STATION ZONE

DOOR 2

DOOR 2

SUPPLY ZONE 1 CIRCULATING NURSE WORK STATION ZONE

ANESTHESIA WORK STATION ZONE

Angled OR table

SUGGESTED STAFF LOCATION DURING TASKS DOOR 2

SUPPLY ZONE 2

SUGGESTED STAFF LOCATION DURING TASKS

DOOR 2

TRANSITIONAL ZONE

2B. Medium OR (prototype size) - 1 door ANESTHESIA WORK STATION ZONE

1B.

SUPPLY ZONE 1 LOCATION ZONE KEY:

LOCATION ZONE KEY:

ANESTHESIA WORK STATION ZONE

OR table perpendicular to the longer wall - 1 door

CIRCULATING NURSE WORK STATION ZONE SUPPLY ZONE 1

SIZE of the OR

CIRCULATING NURSE WORK STATION ZONE

SURGEON'S WORK STATION ZONE SUPPLY ZONE 2

SURGEON'S WORK STATION ZONE

FOOT OF SURGICAL TABLE ZONE INSTRUMENT TABLE + CASE CART SUPPORT ZONE SURGICAL TABLE ZONE 1 MISCELLANEOUS SUPPORT (right side of patient ZONE or head of patient) SURGICAL TABLE ZONE 2 SUGGESTED DURING TASKS (leftSTAFF side of LOCATION patient or head of patient)

SURGICAL TABLE ZONE 1 2 SURGICAL TABLE ZONE (left side patient head patient) (right side of of patient or or head of of patient)

DOOR 1

TRANSITIONAL ZONE ANESTHESIA WORK STATION ZONE

SUPPLY ZONE 1

SUPPLY ZONE 2

SUPPLY ZONE 2 INSTRUMENT TABLE + CASE CART SUPPORT ZONE

INSTRUMENT TABLE + CASE CART SUPPORT ZONE MISCELLANEOUS SUPPORT ZONE

MISCELLANEOUS SUPPORT ZONE

580 sq ft

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

3B. Rectangular OR (as prototype) / 1 door SUGGESTED STAFF LOCATION DURING TASKS

739 sq ft

3A. Square OR (24'x24') / 1 door SUGGESTED STAFF LOCATION DURING TASKS

LOCATION ZONE KEY:

SHAPE of the OR

CIRCULATING NURSE WORK STATION ZONE

C

1C. OR table angled (as it is now) - 1 door

2C. Larger OR (27% more than prototype OR size)

SURGEON'S WORK STATION ZONE SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

SURGICAL TABLE ZONE 2 (left side of patient or head of patient) DOOR 1

LOCATION ZONE KEY:

FOOT OF SURGICAL TABLE ZONE

DOOR 1

DOOR 2

DOOR 2

SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

TRANSITIONAL ZONE

SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

CIRCULATING NURSE WORK STATION ZONE

TRANSITIONAL ZONE SURGEON'S WORK STATION ZONE ANESTHESIA WORK STATION ZONE FOOT OF SURGICAL TABLE ZONE

DOOR 1

ANESTHESIA WORK STATION ZONE

SUPPLY ZONE 1 SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

DOOR 2

SUPPLY ZONE 1

SUPPLY ZONE 2 SURGICAL TABLE ZONE 2

TRANSITIONAL ZONE

(left side of patient or head of patient)

SUPPLY ZONE 2

INSTRUMENT TABLE DOOR 1 + CASE CART SUPPORT ZONE

ANESTHESIA WORK STATION ZONE

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

SUPPLY ZONE 2

SUPPLY ZONE 1

SUPPLY ZONE 2 SUGGESTED STAFF LOCATION DURING TASKS

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

LOCATION ZONE KEY: MISCELLANEOUS SUPPORT ZONE

CIRCULATING NURSE WORK STATION ZONE

SUGGESTED STAFF LOCATION DURING TASKS

FOOT OF SURGICAL TABLE ZONE

SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

CIRCULATING NURSE WORK STATION ZONE SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

Square & small (20’ X20’)

ANESTHESIA WORK STATION ZONE

FOOT OF SURGICAL TABLE ZONE

LOCATION ZONE KEY:

FOOT OF SURGICAL TABLE ZONE

SUPPLY ZONE 1

SUPPLY ZONE 1 ZONE TRANSITIONAL

SURGEON'S WORK STATION ZONE

SURGEON'S WORK STATION ZONE

MISCELLANEOUS SUPPORT ZONE

ANESTHESIA WORK STATION ZONE DOOR 2

SURGEON'S WORK STATION ZONE

CIRCULATING NURSE WORK STATION ZONE

Performed best in Case 2

SURGICAL TABLE ZONE 1

MISCELLANEOUS SUPPORT ZONE

SUPPLY ZONE 2

LOCATION ZONESUGGESTED KEY: STAFF LOCATION DURING TASKS

en

FOOT OF SURGICAL TABLE ZONE SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

SUPPLY ZONE 1

MISCELLANEOUS SUPPORT ZONE

NTS

SURGEON'S WORK STATION ZONE SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

SUPPLY ZONE 2

ANESTHESIA WORK STATION ZONE

r te

CIRCULATING NURSE WORK STATION ZONE

DOOR 1 TRANSITIONAL ZONE

DOOR 2

Performed best in Case 1

SURGEON'S WORK STATION ZONE

TRANSITIONAL ZONE

SUPPLY ZONE 1

TDT

CIRCULATING NURSE WORK STATION ZONE

LOCATION ZONE KEY:

SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

DOOR 2

ANESTHESIA WORK STATION ZONE

Performed best in Case 3

LOCATION ZONE KEY:

DOOR 2

DOOR 2

TRANSITIONAL ZONE

TNC

SUGGESTED STAFF LOCATION DURING TASKS

DOOR 1 of patient or head of patient) (right side

DOOR 1

2B. Medium OR (prototype size) - 1 door

MISCELLANEOUS SUPPORT ZONE

FOOT OF SURGICAL TABLE ZONE

SUGGESTED STAFForLOCATION DURING TASKS (right side of patient head of patient)

421 sq ft

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

TRANSITIONAL ZONE

FOOT OF SURGICAL TABLE ZONE SURGICAL TABLE ZONE 1

Square and small OR (20'x20') / 1 door

ANESTHESIA WORK STATION ZONE

DOOR 1

FOOT OF SURGICAL TABLE ZONE MISCELLANEOUS SUPPORT ZONE

4.

SUGGESTED STAFF LOCATION DURING TASKS

SUPPLY ZONE 1

OR table perpendicular to 2C. Largershorter OR (27% morewall than prototype OR size)

SURGEON'S WORK STATION ZONE INSTRUMENT TABLE + CASE CART SUPPORT ZONE

Performed best in Case 3

MISCELLANEOUS SUPPORT ZONE TRANSITIONAL ZONE

SUPPLY ZONE 2

INSTRUMENT TABLE + CASE CART SUPPORT ZONE SUGGESTED STAFF LOCATION DURING TASKS SURGICAL TABLE ZONE 2 (left side of patient or head of patient) MISCELLANEOUS SUPPORT ZONE

DOOR 1TABLE ZONE 2 SURGICAL (left side of patient or head of patient)

NTS

DOOR 2 INSTRUMENT TABLE + CASE CART SUPPORT ZONE

SUPPLY ZONE 1

MISCELLANEOUS SUPPORT ZONE SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

DOOR 1

Performed best in Case 1

SURGICAL TABLE ZONE 2

INSTRUMENT TABLE + CASE CART SUPPORT ZONE FOOT OF SURGICAL TABLE ZONE

SUPPLY ZONE 2

TDT

SURGICAL TABLE ZONE 1

SUPPLY 1 or head of patient) (left sideZONE of patient

ANESTHESIA WORK STATION ZONE

LOCATION TRANSITIONAL ZONE KEY: ZONE

SURGICAL TABLE ZONE 1 (right side of patient or head of patient) INSTRUMENT TABLE + CASE CART SUPPORT ZONE

(diminishing benefit with increasing size)

FOOT OF SURGICAL TABLE ZONE

SUPPLY ZONE 2 SURGEON'S WORK STATION ZONE

LOCATION ZONE CIRCULATING NURSE KEY: WORK STATION ZONE

TNC

SURGEON'S WORK STATION ZONE DOOR 2

SUPPLY ZONE 2

TRANSITIONAL ZONE

SUPPLY ZONE 2

Performed well in Case 3 & Case 2

SURGICAL TABLE ZONE 2 (left side of patientNURSE or headWORK of patient) CIRCULATING STATION ZONE

DOOR 1

DOOR 1

FOOT OF SURGICAL TABLE ZONE

2A. Smaller OR (72% from prototype OR size) - 1 door

SURGICAL TABLE ZONE 1 (right side of patient or head of patient)

LOCATION ZONE KEY:

ANESTHESIA WORKor STATION ZONE (right side of patient head of patient)

SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

SUPPLY ZONE 1

1C. OR table angled (as it is now) - 1 door

FOOT OF SURGICAL TABLE ZONE

SURGICAL TABLE ZONE 2 SURGICAL TABLE ZONEof1patient) (left side of patient or head DOOR 1

SURGICAL TABLE ZONE 2 (left side of patient or head of patient) MISCELLANEOUS SUPPORT ZONE

NTS

SURGEON'S WORK STATION ZONE

TRANSITIONAL ZONE

SURGEON'S WORK STATION ZONE

OR table perpendicular to longer wall

CIRCULATING NURSE WORK STATION ZONE

SURGICAL ZONETABLE 1 FOOT OFTABLE SURGICAL ZONE (right side of patient or head of patient)

(right side of patient or head of patient)

SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

3B. Rectangular OR (as prototype) / 1 door

LOCATION ZONE KEY:

DOOR 1 FOOT OF SURGICAL ZONE SURGEON'S WORKTABLE STATION ZONE

FOOT OF SURGICAL TABLE ZONE

No clear patterns were observed in terms of performance metrics though the TNC appear to be fewest in CASE 1

SUGGESTED STAFF LOCATION DURING TASKS

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

MISCELLANEOUS SUPPLY ZONE 2SUPPORT ZONE

TNC

MISCELLANEOUS SUPPORT ZONE

SUPPLY ZONE 2

INSTRUMENT TABLE + CASE CART SUPPORT ZONE SUPPLY ZONE 1

DOOR 1

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

SUPPLY ZONE 1

SUPPLY ZONE 2 ANESTHESIA WORK STATION ZONE

WHAT WE FOUND?

SUPPLY ZONE 2

ANESTHESIA WORK STATION ZONE

SUPPLY ZONE 1 TRANSITIONAL ZONE

CASE 1

SUPPLY ZONE 1

TRANSITIONAL ZONE

ANESTHESIA WORK STATION ZONE DOOR 2

OR table perpendicular to the longer wall - 1 door

ANESTHESIA WORK STATION ZONE

DOOR 1

DOOR 2

SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

1B.

SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

Rectangular

SUGGESTED STAFF LOCATION DURING TASKS INSTRUMENT TABLE + CASE CART SUPPORT ZONE

Square (24’ X24’)

SURGICAL TABLE ZONE 1 (right side of patient or head of patient) SURGICAL TABLE ZONE 2 (left side of patient or head of patient)

LOCATION ZONE KEY: DOOR 1

CIRCULATING NURSE WORK STATION ZONE DOOR 2

SURGEON'S WORK STATION ZONE TRANSITIONAL ZONE FOOT OF SURGICAL TABLE ZONE ANESTHESIA WORK STATION ZONE SURGICAL TABLE ZONE 1 SUPPLY (right side of ZONE patient 1or head of patient) SURGICAL TABLE ZONE 2 ZONEor2 head of patient) (leftSUPPLY side of patient DOOR 1 INSTRUMENT TABLE + CASE CART SUPPORT ZONE DOOR 2 MISCELLANEOUS SUPPORT ZONE

MISCELLANEOUS DOOR 2SUPPORT ZONE

TRANSITIONAL SUGGESTEDZONE STAFF LOCATION DURING TASKS

TRANSITIONAL ZONE DURING TASKS SUGGESTED STAFF LOCATION

ANESTHESIA WORK STATION ZONE

ANESTHESIA WORK STATION ZONE

SUPPLY ZONE 1

SUPPLY ZONE 1

MISCELLANEOUS SUPPORT ZONE

SUPPLY ZONE 2 SUPPLY ZONE 2

SUGGESTED STAFF LOCATION DURING TASKS

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

MISCELLANEOUS SUPPORT ZONE

SUGGESTED STAFF LOCATION DURING TASKS

2C. Larger OR (27% more than prototype OR size)

4.

INSTRUMENT TABLE + CASE CART SUPPORT ZONE

MISCELLANEOUS SUPPORT ZONE

SUGGESTED STAFF LOCATION DURING TASKS

Rectangular OR (as prototype) / 1 door INNOVATIONS IN3B.SURGICAL ENVIRONMENTS | SEPTEMBER 2019

LOCATION ZONE KEY:

Square and small OR (20'x20') / 1 door

CIRCULATING NURSE WORK STATION ZONE

LOCATION ZONE KEY: CIRCULATING NURSE WORK STATION ZONE

LOCATION ZONE KEY:

SURGEON'S WORK STATION ZONE

06 SIMULATION MODELING TO EVALUATE AN IDEAL OR LAYOUT KEY TAKEAWAYS • As number of people in the OR increased, all outcomes deteriorated.

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

g n i t s

• Though distance walked was less when the CN workstation was closer to the OR table, number of transitions near surgical area were found to be higher.

• Distance walked was least in the small ORs though number of contacts and transitions near surgical area were higher.

• Diminishing returns of increasing area were observed on NTS and TNC. Overall, the prototype appeared to be effective for the measures tested.

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Taaffe, K.,Joseph, A., Khoshkenar, A., Machry, H., Allison, D., Reeves, Scott, R. (under review) Proactive Design of a Safe and Efficient Operating Room: A Simulation-Based Modeling Approach INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

e T d n a

g n i t s

n g i s e y D t i s s ENGAGING MULTIDISCIPLINARY r e i t e i l v i i c n a U F DESIGN TEAMS INthTHE PROCESS n o l s a m e e H l r C o f r te

n e C

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

STUDIO DESIGN PROJECT PHYSICAL OR MOCK-UP | CHARLESTON DESIGN CENTER (CDC), DOWNTOWN DAVID ALLISON, FAIA, FACHA DIRECTOR OF GRADUATE STUDIES IN ARCHITECTURE + HEALTH

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04

n e C

e T d n a

g n i t s

n g i s The OR room experience for the patient and staff e Defining and redefining OR design guidelines and concepts y D t i s s r e i t e i l v i i c Un a F n h o t l s a m e e H l r C o f

MASTER OF ARCHITECTURE

RACHEL MATTHEWS

YINGCE HUANG

LEAH BAUCH

ZHIQIN (JANE) LIU

SHIRUI (MAX) LIN

LINDSEY HOFSTRA

QIAN (KENNETH) DONG

AUSTIN FERGUSON

+ HEALTH STUDENTS

THIRD SEMESTER OF PROGRAM INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

DESIGN GUIDELINES QUALITY IN THE OR

PROJECT VISION

n g i s e y D t i s s r e i t e DESIGN OBJECTIVES i l v i i c n a U F n h o t l s a m e e H l r C o f r GUIDELINESte n e C OPTIMIZE EFFICIENCY & EFFECTIVENESS

PLAN THE OR. TO OPTIMIZE MOVEMENT AND FLOW

MAXIMIZE VISUAL AWARENESS IN THE OR.

PROVIDE INTEGRATED DIGITAL INFORMATION DISPLAYS IN MULTIPLE

LOCATIONS

04

OPTIMIZE CLINICAL OUTCOMES AND HEALTH & SAFETY

MINIMIZE INSTITUTIONAL CLUTTER

OPTIMIZE POSITIVE EXPERIENCE FOR ALL USERS

PROVIDE APPROPRIATE & CONTROLLED ACCESS TO DAYLIGHT

e T d n a

OPTIMIZE SUSTAINABLE STRATEGIES

PROVIDE FLEXIBLE & CONTROLLABLE ARTIFICIAL LIGHTING

g n i t s

OPTIMIZE THE ABILITY TO CHANGE OVER TIME

DESIGN FEATURES THAT MINIMIZE SURFACE AND AIRBORNE CONTAMINATION

INCORPORATE PLUG & PLAY SYSTEMS

EMPLOY A FLEXIBLE ROOM /SUITE CHASSIS

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ITERATIVE DESIGN PROCESS

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f Build

Understand

Ideate

Interpret

Design

Evaluate

e T d n a Test Disseminate

Implement

Define

g n i t s

Synthesize

Refine

Translate

Literature review & Observations

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Data collection & Data analysis

Dissemination

Design Charette

YEAR 1

Development of Design guidelines

Iterative design process

YEAR 2

Construction of ASCs

YEAR 3

Post occupancy research

Develop design toolkit

YEAR 4

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 3

04 n e C

Higher fidelity cardboard mock-up

Initial cardboard mock-up

PHASE 2

Tape on the floor mock-up

PHASE 1

r te Nursing simulations

PHASE 5

PHASE 6

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T d n a

Systems evaluations

ITERATIVE DESIGN PROCESS PHASE 4

Anesthesia evaluations

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 1 | TAPE ON THE FLOOR MOCK-UP OCTOBER 12-14, 2016

n g i ROOM SIZE s e y D t i CHASSIS CONFIGURATION (CLEAN CORE, WORK s s r e i CORE, SINGLE CORRIDOR) t e i l v i i c n a DOOR LOCATION U F n h o t l EQUIPMENT PLACEMENT AND ORIENTATION s a m e e H l r C o f r e t n e C

SIMULATION TESTING OF DESIGN FEATURES 1 2

3 4

e T d n a

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

DN

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 1

2

26’-0” 24’-0”

26’-0” 24’-0”

22’-0”

22’-0”

DOOR

A

DOOR

DOOR

A

2

DOOR

1

i t s e T d n a

DOOR

B

r te

04

Flex Studio

26’-0”

30’-0”

DOOR

26’-0”

30’-0”

Flex Studio

n e C

DN

UP

DN

PHASE 1 | TAPE ON THE FLOOR MOCK-UP TESTING CONFIGURATIONS ng

CACC Studio

B

DOOR

Seminar

DOOR

Seminar

CACC Studio

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 2 | INITIAL CARDBOARD MOCK-UP SIMULATION TESTING OF DESIGN FEATURES

n g i s e y D LOCATION OF DIGITAL DISPLAYS, STORAGE, STAFF t i s s WORK AREAS AND SCRUB SINK r e i t e i l v i i c n CONCEPTS FOR ANCILLARY INDUCTION AND a U F PREPARATION ROOMS n h o t l s a m e e H l r C o f r e t n e C

1 POSITION OF SURGICAL TABLE 2

3

04

e T d n a

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

C GB&A

PHASE 2 | INITIAL CARDBOARD MOCK-UP TESTING CONFIGURATIONS ng C GB&A

GB&A

C.Z.

S.Z.

S.Z.

OPTION A

A.Z.

13' - 0"

26' - 0"

C GB&A

11' - 0"

24' - 6"

13' - 0"

14' - 0"

C GB&A

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n e OPTION A | FLOOR C PLAN 11' - 0"

C.Z.

C.Z.

C.Z.

15' - 0"

A.Z.

GB&A

C

A.Z.

C

A.Z.

S.Z.

OPTION D

3

A

B

S.Z.

S.Z.

S.Z.

OPTION A | PATIENT MOVING IN

GB&A

2

22' - 0"

S.Z.

C.Z.

OPTION A | INTRA OPERATIVE

C

1

C.Z.

14' - 0"

n g i s e y D t i s s r e i t OPTION B OPTIONv Ce i l i i c n a U F n h o t l s a m e e H l r C o f C

C.Z.

A.Z.

A.Z.

GB&A C

A.Z.

GB&A C

A.Z.

i t s e T d n a

C.Z. S.Z. 1

OPTION A | PATIENT MOVING OUT INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 3 | HIGH FIDELITY CARDBOARD MOCK-UP

n g i ENTRANCE AND EXIT SEQUENCING s e y D t i LOCATION OF INDUCTION AND PREP ROOM IN s s r e i RELATION TO THE FOOT OF THE BED AND SCRUB t e i l v i i SINK c n a U F n CONTENT AND LOCATION OF DIGITAL DISPLAYS h o t l s a m NUMBER AND LOCATION OF DOORSeIN RELATION e l TO STERILE AND CN ZONES r H C o f r e t n e C

SIMULATION TESTING OF DESIGN FEATURES 1 2

3 4

04

e T d n a

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 3 | FINAL CARDBOARD MOCK-UP TESTING CONFIGURATIONS ng

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f FGI MIN | 400 SF SC a MIN DIMENSION | 20 FT

CC

OR

OR

A

OR

SINGLE CORRIDOR

CLEAN CORE

OR

OR

SC b

OR

S.Z.

OR

A.Z.

OR

OR

14' - 3"

14' - 3"

OR

C

A.Z.

A.Z.

595 NSF

GB&A

SINGLE CORRIDOR

12' - 3 1/2"

12' - 3 1/2"

Anesthesia Zone Scrub Nurse Zone Circulating Zone

12' - 3 1/2"

12' - 3 1/2"

13' - 0"

C.Z. S.Z. C GB&A

C

12' - 3 1/2"

15' - 0"

12' - 3 1/2"

584 NSF

OR

OR

SC b

FGI MIN | 400 SF SC a MIN DIMENSION | 20 FT

OR

OR

OR

SINGLE CORRIDOR

OR

OR

SINGLE CORRIDOR

OR

04

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A.Z.

12' - 3 1/2"

58

FG MI

15' - 0"

Anesthesia Zone Scrub Nurse Zone Circulating Zone

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Anesthesia Zone Scrub Nurse Zone Circulating Zone

12' - 3 1/2"

3

C

C

13' - 11"

C.Z.

C

S.Z.

S.Z.

13' - 0"

S.Z.

C.Z.

2

C GB&A

26' - 0"

B

13' - 0"

13' - 0"

C.Z.

B

B

OR

26' - 0"

26' - 0"

OR

22' - 0"

1

14' - 3"

A

14' - 3"

3

22' - 0"

2

C GB&A

22' - 0" 595 NSF

FGI MIN | 400 SF MIN DIMENSION | 20 FT

A

A

1

2

2

1

22' - 0"

1

OPTION C

26' - 0"

FLOOROPTION PLAN | B1+2

FLOOR PLAN | 3+4

OPTION OOR PLAN |1 A

i t s e T OPTION D|5 FLOOR PLAN d n a

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OR PROTOTYPE AND PHYSICAL MOCK-UP Anesthesia Workstation

Located in the corner away from the OR entry with ample space to minimize interruptions

Anesthesia Storage

Located within anesthesia work area and across the monitor to provide quick access for the anesthesia team with minimal obstruction.

Angled OR table position

OR table angled to accommodate sidedness of surgery and ample space for the scrub nurseâ&#x20AC;&#x2122;s maneuver

22' - 0"

1

Scrub Sink Window

15' - 0"

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Flexible room/suite chassis

Scrub sink strategically located and equipped with a window to provide view into the OR

Flexibility, adaptibility and expandibility to accomodate changing needs and future expansion

2

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

g n i t s

A

C GB&A

C.Z.

13' - 9" 13' - 9"

INDUCTION 206 SF

C GB&A

S.Z.

Parallel processing

Integrated Digital Information Displays

Wall mounted screens to maximize visual awareness

General Storage Located near CNâ&#x20AC;&#x2122;s workstation to accommodate quick access to supplies and material by the CN

O.R. 580 SF

Provision of sufficient circulation S.Z. area Optimize movement and flow in the operating room

Circulating Nurse Workstation

Dedicating an induction room to process two patients simultaneously inside and outside of the OR can increase patient and parent satisfaction and patient throughput

ALCOVE 206 SF

Mobile CN workstation provided flexibility with rotation and move of the workstation as needed.

Integrated Digital Information Displays 13' - 9"

A.Z.

C GB&A

C

14' - 3"

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ALCOVE 206 SF

26' - 0"

S.Z.

14' - 3"

B

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6' - 0"

14' - 3"

A.Z.

Conveniently provide information needed on vitals and patient information with INNOVATIONS minimal body movement and adjustment

IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SCENARIO DEVELOPMENT AND ANALYSIS STRATEGY

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g n i t s

e T SCENARIOS WERE UTILIZED TO EVALUATE DESIGN FEATURES BY ENGAGING THE CLINICIANS THROUGH ENACTMENTS d n a n g Identifying tasks performed by each role si e y D t i s s r e i t e i l v Developing task-based scenarios i i c n a U F n h o t l s a Refining the scenarios in collaboration with research team’s clinical experts m e e H l r C o f r e t TOOLKIT COMPRISED OF MOCK-UP SCENARIO PROTOCOL, SIMULATION DIRECTOR’S GUIDE AND NOTE TAKERS TEMPLATE n e C Bayramzadeh, S., Joseph, A., Allison, D., Shultz, J., & Abernathy, J. (2018, July). Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes. Applied Ergonomics, 70, 288-299. DOI:https://doi.org/10.1016/j.apergo.2018.03.011 INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

HIGH FIDELITY MOCKUP EVALUATIONS PHASE 4 | ANESTHESIA WORKSTATION TESTING CONFIGURATIONS HIGH FIDELITY MOCKUP EVALUATIONS ng PEDIATRIC | CONFIGURATION 1

PEDIATRIC | CONFIGURATION 1

PLAN

PEDIATRIC | CONFIGURATION 2

PEDIATRIC | CONFIGURATION 2

g i s e y D t i HIGH FIDELITY MOCKUP EVALUATIONSies s r t e i l v ORTHO | CONFIGURATION 1 ORTHO | CONFIGURATION 2 ORTHO | CONFIGURATION 3 i i c Un a F n h o t l s a m e e H l r C o f r e t n e C PLAN

PHYSICAL MOCK-UP PHYSICAL MOCK-UP

PLAN PLAN

PHYSICALMOCK-UP MOCK-UP PHYSICAL

Facilitators Challenges Facilitators Challenges gloves andon phone on the wall the Pyxis -Sharps container floor besidethe thecart cartisiseasier easier to to -Location -Location of gloves of and phone the wall next tonext the to Pyxis -Sharps container on on thethe floor beside was convenient. access. was convenient. access.

-Booms blocking the view to the wall-mounted displays -Booms blocking the view to the wall-mounted displays that are installed on the shorter wall.

Challenges that-Wall-mounted are installed on the shorter wall.

Challenges displays cannot contain all the information -EHR and IV pole were in the way. displays cannot contain all theinfo. information -EHR and -Booms IV pole were in the that anesthesiologists need, e.g. ventilation blocking theway. view to the wall-mounted displays -Wall-mounted that anesthesiologists need, e.g. ventilation info.

-Booms blocking the viewontothe the wall-mounted displays that are installed shorter wall. that are installed on the shorter wall.

-Cables need to reach from the machine to the table.

-Cables need to reach themove machine the table.

-IV pole may from need to whentosurgeon shifts sides for ear need tube. to move when surgeon shifts sides for -IV pole may -It is better to have sharps closer to the work surface.

PHYSICAL MOCK-UP PLAN PHYSICAL MOCK-UP ear tube.PLAN -It is better to have sharps closer to the work surface.

Other notes Challenges -Surgeries are typically done on the stretcher.

Other notes OR bed typically turn 90 degrees; however, -Surgeries-The are typically done onhas theto stretcher.

04

i t PEDIATRIC | CONFIGURATION 3 s PEDIATRIC | CONFIGURATION 3 e T d n a n

here it worked best with 45 degree turn.

-The anesthesia providers preferred the Pyxis machine to move farther away from the anesthesia zone.

Challenges

-EHR and IV pole were in the way when patient was transported to the OR table side.

-EHR and IV pole were in the way of anesthesiologist entering the anesthesia area.

-In case of an emergency, dropping the bed and pushing the equipment away can be a challenge.

PLAN PLAN

PHYSICAL MOCK-UP PHYSICAL MOCK-UP

Facilitators Facilitators -Everything was onon thethe same sideside andand compact.

-Everything was same compact.

-All equipment and supplies were easily accessible.

-All equipment and supplies were easily accessible.

-There were less physical obstruction.

-There were less physical obstruction.

-There is much more space.

-There is much more space.

Challenges Challenges -Plugs for the microscope and headlights should be -Plugs for the microscope and headlights should be considered.

considered.

PLAN

PHYSICAL MOCK-UP

Notes

Configuration 3 supported increased visibility, -EHR incorporated with the monitor allowing providers to see all the equipment in ADVISORY COMMITTEE UPDATEworks | MAYwell.

15, 2018 -Surgery on both left and right of the patient front of them, as well as more unobstructed ADVISORY COMMITTEE UPDATE | MAY 15, 2018 views to the wall-mounted displays.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 5 | NURSING EVALUATIONS MAY, 2018 SIMULATION TESTING OF DESIGN FEATURES

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

1 LAYOUT- ANGLED BED , 1 DOOR VS. 2 DOOR

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2 LOCATION OF EQUIPMENT

3 PLACEMENT OF CIRCULATING NURSE AND SURGEON WORKSTATION

4 INFORMATION DISPLAYS

5 CHANGE IN WORK FLOW DUE TO INDUCTION ROOM AND

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 5 | NURSING EVALUATIONS TESTING CONFIGURATIONS OPTION A

OR with 1 door

OPTION B

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H OR with induction room l r C o f Using an induction is most beneficial for pediatric cases where parents participate in the induction process and some adult spinal cases.

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OPTION C

g n i t s

OR with instrument pre room

Using an instrument preparation room is most beneficial for longer surgeries, creating the potential for having one instrument preparation room serve multiple ORs. However, this type of arrangement would impact staffing models.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

PHASE 6 | SYSTEM EVALUATIONS OBJECTIVE

To examine how the system components within the OR prototype function holistically during highfidelity scenario-based simulation testing

PARTICIPANTS

Full orthopedic and pediatric surgical teams consisting of a scrub nurse, circulating nurse, surgeon, and two anesthesia personnel

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

SURGICAL PROCEDURES

Full simulations will be conducted for the following procedures • Orthopedic Arthroscopy • Pediatric Laparoscopic hernia repair • Pediatric Ear tubes and tonsillectomy

EVALUATION STRATEGY

A multi-layered data collection approach will be implemented to evaluate the effectiveness of alternative design options in addressing the following EDB goals

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• Improve movement and flow

• Improve visual and information awareness • Reduce disruptions in the OR • Reduce contamination in the OR • Improve workplace ergonomics

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SYSTEMS DATA COLLECTION PROTOCOL

g n ORTHOPEDIC - ARTHROSCOPY WITH BREAKDOWN t SIMULATION i s e T PATH OF TRAVEL AND SFD d n a POST-ENACTMENT FOCUS GROUPS n g i s e y D t i s 9s r e i t e i l v i i VISUAL AWARENESS INTERVIEWS c n a U F n h o t l s a VISUAL CONTENT SURVEY S m e e H l r C $ o f r e ;< t n e C 0 - 10 Minutes | Pre-Operative

PRE-OPERATIVE

TURNOVER

POST-OPERATIVE

Graphic Lege Notetakers

Path of Travel

Provide insight into how well the OR mock-up supports overall flow of people and equipment

Scrub

Solidify the placement of storage, equipment, and workstations

Anes

Provide insight into the impact of the wall-mounted displays on surgical team membersâ&#x20AC;&#x2122; work practices

if

Anes

Surge Equipment

Prima

1

Interm

C GB&A

Identify what types of information are needed during each phase of surgery for the respective surgical team members

Circu

d

2

04

INTRA-OPERATIVE

,

Actual: 0:00-6:30

Initia

3

Simu

Simul

Tape on the Floor W

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ANALYSIS | PATH OF TRAVEL ORTHOPEDIC - ARTHROSCOPY WITHOUT BREAKDOWN SIMULATION

ANESTHESIOLOGIST 1

ANESTHESIOLOGIST 2

CIRCULATING NURSE

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

PRE-OPERATIVE PHASE

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SURGEON

0-10 Minutes

PRE-OPERATIVE/ INTRA-OPERATIVE PHASE 10-20 Minutes

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INTRA-OPERATIVE PHASE

04

20-30 Minutes

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS | FLOW DISRUPTIONS TYPES OF FDs-ORTHOPEDIC SURGERY SIMULATIONS

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g n i t s

Within each simulation, the majority of FDs were related to Layout, with furniture and equipment being the most prevalent in Simulation 1 in addition to cluttered pathways in Simulation 2.

n g i s SIMULATION 1 SIMULATION 2 De y t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f r e t n e C 57%

43%

7%

82%

18%

18%

15%

7%

50%

7%

35%

14%

04

29%

18%

TYPES OF FDs LAYOUT Wire Infractions Furniture/Equipment Conflicts Obstacles (route change) Cluttered Pathway (posture change) Impeded view (posture change)

ENVIRONMENTAL Bumps Slips Trips Excessive Reach Falls

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS | FLOW DISRUPTIONS FD LOCATIONS - ORTHOPEDIC SURGERY SIMULATIONS FD LOCATIONS-ORTHOPEDIC SURGERY SIMULATIONS FD LOCATIONS - ORTHOPEDIC SURGERY SIMULATIONS Transitional zone

Surgical table zone 2 (left of patient)

Surgical table zone 1 (right of patient)

e T d n a

g n i t s

Across simulations, FDs located around the surgical table, in addition to the anesthesia workstation zone in Simulation 1.

Transitional Surgeonwere workstat ion zone Surgical table zone 2 (left of patient) Suppo rt zo ne Surgical table zone 1Transitional (right of patient) Supply zone zone2 Transitional zone Surgeon Transitional zone1 Supply zone Surgical table zone workstat 2 (left of ion patient) Surgical table table zone zone 2 (left (left of patient) Suppo rt zone zo ne Surgical of patient) Instrument table Surgical table zone 1 2(right of patient) Surgical table zone 1workstat (right of patient) Transitional zone Supply zone Surgical table zone 1 (right of patient) Foot of surgical table Surgeon ion zone2 Surgeon workstat ion zone Surgical table zone workstat 2 (left of ion patient) Supply zone Surgeon zone Door Suppo rt zo ne21 Suppo rt zo ne1 Surgical table zone 1Transitional (right of patient) zone Suppo rt zo ne Instrument table Door Supply zone 2 Supply zone Surgeon workstat ion Transitional zone2 Surgical table zone 2 (left of patient) Foot of table Supply zone 2 CNsurgical workstation zone 1 Supply zone Suppo rt zo ne21 Surgicaltable tablezone zone 2(right (left of patient) Door Surgical 1work Supply zone 1 Anesthesia station zone Instrument table zone Instrument table zone Supply zone Surgical table zone 1workstat (right of patient) Surgeon ion Door 12 Instrument zone Anccilary room Foot of surgical table

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

Foot of table Supply zone Surgeon workstat ion zone Suppo rt zo ne210.0% CNsurgical workstation Foot of surgical table Door Door Suppo rt zo ne2 Instrument table zone Anesthesia work station Supply zone Door 2 Door 1 Door 1 Foot of table zone Supply zone Anccilary room Door 12 CNsurgical workstation zone

CN workstation zone Door 210.0% Supply zone Instrument table zone CN work workstation Anesthesia station zone

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Anesthesia work station zone Door 1 zone FootInstrument of surgical table Anesthesia work station Anccilary room

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FD LOCATIONS - ORTHOPEDIC SURGERY SIMULATIONS FD LOCATIONS - ORTHOPEDIC SURGERY SIMULATIONS FD LOCATIONS - ORTHOPEDIC SURGERY SIMULATIONS

10.0%

10.0%

40.0%

50.0%

60.0%

40.0%

50.0%

60.0%

30.0%

40.0%

50.0%

60.0%

20.0%ion 1 Simulat 20.0%

Simulat ion 30.0% 2 30.0%

40.0% 40.0%

50.0% 50.0%

60.0% 60.0%

Simulat Simulat ion ion 1 1

Simulat Simulat ion ion 2 2 40.0%

50.0%

60.0%

30.0%

40.0%

50.0%

60.0%

Simulat 20.0%ion 1

Simulat ion 30.0% 2

40.0%

50.0%

60.0%

Simulat ion 1

Simulat ion 2

20.0%

Simulat ion 1

10.0%

Anesthesia work station zone Door 2 0.0% 10.0%

10.0% 10.0%

AnccilaryDoor room 1 CN workstation zone

CN work workstation Anesthesia station zone0.0%

20.0%

Simulat ion 1

Anccilary room CNsurgical workstation zone Foot of table Door 2 Anccilary room 0.0%

en

C

FD LOCATIONS - ORTHOPEDIC SURGERY SIMULATIONS FD LOCATIONS - ORTHOPEDIC SURGERY SIMULATIONS

10.0%

20.0%

20.0% Simulat ion 1

Anesthesia work stationroom zone Anccilary Anccilary room0.0%

10.0%

0.0%

10.0%

20.0%

30.0%

Simulat ion 2

30.0%

Simulat ion 2

30.0% Simulat ion 2

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS | FLOW DISRUPTIONS

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TYPES OF STAFF INVOLVED IN FDS ACROSS ORTHOPEDIC SIMULATIONS Across both simulations, the majority of FDs involved an anesthesiologist, followed by circulating nurse.

n SIMULATION 2 g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f SIMULATION 1 58.8%

44.4%

29.4%

33.3%

5.9%

11.1%

Anesthesiologist

Circulating Nurse

Scrub Nurse

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5.9%

Surgeon

Anesthesiologist

Circulating Nurse

Scrub Nurse

11.1%

Surgeon

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS | FOCUS GROUP & SYSTEMS OBSERVATIONS DECEMBER, 2018 Orthopedic Simulation 1

2

3

4

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

THE ABILITY FOR THE BOOM TO BE POSITIONED ON EITHER SIDE OF THE FOOT OF THE BED REDUCED ENCROACHMENT INTO THE ANESTHESIA ZONE.

2

3

4

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1

3

2

3

4

DISPLAYS IN THREE LOCATIONS WERE KEY TO FACILITATING INFORMATION ACCESS TO ALL SURGICAL TEAM MEMBERS.

3

THE DISPLAY OF MULTIPLE TYPES OF INFORMATION SIMULTANEOUSLY WAS KEY TO SUPPORTING SURGICAL TEAM MEMBERS INDIVIDUAL AND COLLECTIVE TASKS.

5

THE HEIGHT OF THE DISPLAYS WAS CONSIDERED TO BE TOO HIGH. MODIFICATIONS

TO HEIGHT SHOULD TAKE INTO CONSIDERATION PLACING THE SCREENS AT A HEIGHT WHERE MOVABLE EQUIPMENT WILL NOT BUMP INTO THEM.

5

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ECCENTRICALLY POSITIONING THE SURGICAL TABLE WAS KEY IN SUPPORTING THE

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ABILITY TO PERFORM SURGERY ON EITHER SIDE OF THE PATIENT, AND PROVIDING MORE SPACE FOR THE ANESTHESIA ZONE.

04

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

FINDINGS | FOCUS GROUP & SYSTEMS OBSERVATIONS DECEMBER, 2018 Orthopedic Simulation 6

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

PLACING THE PRIMARY ENTRANCE DOOR AT THE FOOT OF THE SURGICAL TABLE SUPPORTS EASE OF PATIENT ENTRY AND EXIT.

7

THE USE OF THE MOBILE WORKSTATION WAS KEY TO SUPPORTING SYNERGISTIC

TEAM WORK, AND SHOULD BE CONSIDERED FOR BOTH THE CIRCULATING NURSE AND SURGEON.

8

7

THE PLACEMENT OF THE EMR IN THE ANESTHESIA ZONE CONTINUES TO BE A BARRIER DUE TO REQUIRING THE ANESTHESIOLOGIST TO TURN THEIR BACK TO USE THE EMR, BREAKING THEIR ROUTINE SURVEILLANCE TRIANGLE PATTERN.

9

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8

10

6

THE COLORS IN THE FLOORING TO DEMARCATE THE DIFFERENT ZONES WAS KEY TO

HAVING A VISUAL REFERENCE TO REDUCE ENCROACHMENT INTO THE STERILE ZONE AND

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10

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CONSIDERATION SHOULD BE GIVEN TO PLACING THE PRIMARY LOCATION FOR GLOVES, HAND SANITIZER, AND SHARPS IN A CENTRAL LOCATION NEAR THE PRIMARY ENTRANCE TO REDUCE ENCROACHMENT INTO CIRCULATING NURSE, STERILE, AND ANESTHESIA ZONES UPON ENTRY. INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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n g i s e y D t i s s r e i SAFE ORcDESIGN li it nive TOOL a U F n h o t l s a m e e H l r C o f

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OR DESIGN TOOL DEVELOPMENT PURPOSE

GOAL

To help designers, architects, clinicians, and healthcare administrators better understand how to design a safer more ergonomic operating room (OR) environment

Support users in considering the impact of facility design on the underlying (latent) conditions that can lead to harm on the OR environment

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INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OR DESIGN TOOL DEVELOPMENT

01

04

02

n g i s e y D t i s s r e i t e BUILDING DESIGN STRATEGY i l v i i c n CONSENSUS DEVELOPMENT a U F n h o t l s a m e e H l r C o f r e t n e C

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03

INTERFACE DEVELOPMENT

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

STEPS

29 Design elements

EXAMPLES

Element Identification

CONTENT

DESIGN STRATEGY DEVELOPMENT

04

n g i s e y D t i s s r e 28 04 i t e i l v i i c Un a F n h o t l s a m e e H l r C o f Desired Outcomes Identification

Design elements

layout-overall

Improve movement and flow, reduce risk of contamination, reduce disruptions)

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Design strategy

Actionable design statement

Provide clearly defined circulation, anesthesia, and sterile zones.

Strategy description

Why the strategy is important

Clearly defined circulation, anesthesia, and sterile zones support movement within the OR without disruption and interference between surgical team members.

Types of evidence

Types of evidence

Peer-reviewed (best practices, design guidelines, or literature review report)

g n i t s Type of Strategy

05 Types of strategies e.g. built environment, task

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

BUILDING CONSENSUS

g n i t s

Modified Delphi Process

PHASE 2

PHASE 1 Internal Review

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

January 22 – February 5, 2019

123 design strategies

Conducted with team leaders to solidify design strategies for first round of Delphi process

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First round Delphi

April 15 – 30, 2019

91 design strategies evaluated

e T PHASE 3 d n a Second round Delphi

June 10 – 24, 2019

44 design strategies evaluated (41 strategies were passed on first round with more than 80% agreement for inclusion and importance)

Panel of 7 clinicians and 8 architects

Panel of 7 clinicians and 8 architects

Qualtrics on-line survey

Qualtrics on-line survey

Recommendation for inclusion

Comments or suggestions to clarify/reword Level of importance for inclusion Missing strategies

Remote on-line polling Remaining design strategies that did not reach an 80% consensus for both inclusion and importance as originally written Design strategies that required rephrasing

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

INTERFACE DEVELOPMENT 2

1

Information capture Identify functional requirements Develop administrative workflow Develop data capture strategy for data base

Interface Design Create wire frames to support conceptual design Design the process and information flow of the interface Design the user experience based on user scenarios Create graphics to support the user experience Develop written content to support the user experience

n g i s e y D t i s s r e i 3 it e l v i i c n a U F n h o t l s a m e e H l r C o f

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October 2018

Implementation

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December 2018

January 2019

4

Testing Usability testing with clinical and design users Platform testing with varying technologies (e.g. tablet, phone, and computer)

Build out the interface

August 2018

g n i t s

June 2019

July 2019

August 2019

ordesign.clemson.edu

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SAFE OR DESIGN TOOL The Safe OR Design Tool contains the following components:

TECHNOLOGY

STRUCTURAL SYSTEM

DESIGN STRATEGIES

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CIRCULATION ZONE

DESIGN ELEMENTS A series of 14 design elements provide a focused platform for accessing design strategies and desired outcomes for commonly found features within the OR environment.

g n i t s

WORKSTATION

BOOMS

ANCILLARY SPACES

WINDOWS

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f DOORS

These actionable statements provide guidance on how to implement a design strategy into the OR environment to support a desired outcome.

RATIONALE

An associated description is provided for each design strategy addressing why that specific strategy is important to consider based on current literature or PSLL findings.

DESIRED OUTCOMES

Desired outcomes that have been linked with evidence to the associated design strategy are provided to address how the design strategy can improve safety and quality in the OR.

TYPE OF EVIDENCE

The type of evidence, broken into 4 distinct categories, and full citation for each combination of design strategy and desired outcome is provided for usersâ&#x20AC;&#x2122; reference.

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TYPE OF STRATEGY

Each design strategy is tagged to provide insight into which OR work system component is impacted by the associated design strategy.

ANESTHESIA ZONE

ordesign.clemson.edu STORAGE

FURNITURE & EQUIPMENT SURGICAL TABLE

STERILE ZONE

INTERIOR SURFACES

LAYOUT

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

OR LAYOUT

INTERIOR SURFACES ng

Provide expansion opportunities to accommodate future technologies and equipment.

Size the OR to accommodate all surgical team members and their associated tasks and equipment.

Provide clearly defined circulation, anesthesia, and sterile zones.

Locate movable equipment in close proximity to surgical team membersâ&#x20AC;&#x2122; related tasks.

During planning phases, locate and clearly identify circulation, anesthesia and sterile zones according to surgical team members related tasks.

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Provide standardized room layout across ORs within the same facility and service line.

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

i t s e T d n a

Provide easily cleanable transitions between walls and floors (skirting)

Provide interior surfaces that minimize joints, crevices and articulations.

Consider modular wall systems.

Provide flush flooring transitions at entry and exit points of the OR

Provide flooring that does not require waxing to maintain its functional integrity Provide easily cleanable interior surfaces.

Consider flooring to support staff ergonomic needs such as underfoot comfort, while at the same time evaluating alignments and tradeoffs with other criteria (e.g., equipment movement and cleaning).

Provide standardized room layout across ORs within the same facility and service line.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

DOORS

TECHNOLOGY ng

Provide clearly visible signage to discourage door openings.

Provide doors with mechanisms that control the duration of door openings.

Provide doors with sufficient width.

r te

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Provide a designated area outside the OR to store movable furniture and equipment when not in use.

FURNTURE & EQUIPMENT

i t s e T d n a

Locate visual information displays so they are easily seen by all surgical team members.

Provide visual information displays with height and viewing angle adjustment.

Provide multiple types of visual information displays.

Provide docking capacity within the OR for mobile and wireless technologies.

Provide staff-controlled visual information displays.

Provide doors with mechanisms that control the duration of door openings.

Utilize wireless technologies.

Utilize wireless technologies.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

ANESTHESIA ZONE Position EMR computer to facilitate integration of EMR tasks into anesthesia maintenance workflow.

Provide space within the anesthesia zone to accommodate all anesthesia equipment, as well as staff movement.

Discuss space requirements for supporting information handoffs between anesthesia team members during the procedure.

Locate anesthesia zone to avoid encroachment of unrelated circulation into the anesthesia zone.

Position anesthesia equipment in the anesthesia zone to minimize the amount of time that the anesthesia provider has their back turned away from the patient and visual displays.

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CIRCULATION ZONE g n

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Provide sufficient circulation area to accommodate the flow of all surgical team members, equipment, and supplies.

Provide unobstructed circulation pathways.

Locate the circulation zone to support entry and exit into the OR without encroaching on anesthesia and sterile zones.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSTATION

Provide computer workstations that allow surgical team members to face the sterile field irrespective of the OR table position.

Provide height and monitor angle adjustable mobile workstations.

Provide easily cleanable workstation surfaces.

Position circulating nurse workstation for visual access to both the OR table and traffic entering and exiting the OR.

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t s e T d n a

BOOMS g in

Position overhead booms to minimize entanglement between boom components.

Provide ceiling mounted booms with integrated power, data, and medical gas outlets.

Evaluate boom mount locations for impact on airflow disturbances over the OR table.

Provide booms with adjustable features.

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

NEXT STEPS ONE

TWO

04

POST OCCUPANCY EVALUATION

THREE

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EXTENDING CURRENT RESEARCH

Video observations similar to those in year 1 will be conducted at the new pediatric surgery center open at MUSC Childrenâ&#x20AC;&#x2122;s Health R. Keith Summey Medical Pavilion,, and the results from the post-occupancy evaluations will be compared with data collected in years 1 and 2.

Work from this research project has been extended into another AHRQ grant funded research study focused on reducing errors in perioperative anesthesia medication delivery. This new research project is a collaboration between Medical University of South Carolina, Clemson University, and Johns Hopkins University, and will continue through 2020.

The high-fidelity mock-up will remain at the Clemson Design Center in Charleston through the remainder of 2019 and Spring of 2020, and will continue to serve as a learning lab for students and other interested groups to use as a learning and demonstration resource

The research and prototype design framework and methods that were developed, employed, and refined on this project are envisioned to be applicable to other healthcare spaces where critical patient care and treatment is delivered and in settings that are replicated over and over again in the design of healthcare facilities.

n g i s e y D t i s s FOUR CONTINUED LEARNING APPLICATION TO OTHER ENVIRONMENTS r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f r e t n e C

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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e T d n a

g n i t s

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

WORKSHOP AGENDA DAY 1 SEPTEMBER 12, 2019 08:30 – 09:00 09:00 – 10:00 10:00 – 11:00

Welcome & introductions Keynote: Innovations in surgical environments Case study exemplars

11:00 – 11:15

Morning break

11:15 – 12:00 12:00 – 12:30

Designing preoperative & postoperative workspaces Designing waiting areas

12:30 – 01:30

Lunch

01:30 – 01:45 01:45 – 02:30 02:30 – 03:15

RIPCHD.OR project introduction RIPCHD.OR research findings Safe OR prototype & “Safe OR Design Tool” preview

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03:30 – 03:45 03:45 – 04:00 04:00 – 05:15 05:15 – 05:45 05:45 – 07:00 07:00 – 09:00

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g n i t s

Andrew Ibrahim Lynn Martin, Mark Gesinger; Cara Tubbs, Michael Folonis

Afternoon break

Design implementation Future state OR Panel discussion Recognition and closing remarks Evening Networking Reception Dinner (individual choice)

Becky Smith

William Berry, Alex Langerman, Bryan Langlands, Lynn Martin, David Ruthven

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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g n i t s

n g i s e y D t i s s r e i DESIGN IMPLEMENTATION t e i l v i i c n a U F Becky Smith n h o t l s a m e e H l r C o f r te

n e C

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

MUSC CHILDRENâ&#x20AC;&#x2122;S HEALTH: SUMMEY HEALTH PAVILION- ASC COMPONENT

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

AGENDA:

1) TIMELINE

2) OVERVIEW

3) AMBULATORY SURGERY & OR DESIGN 4) NEXT STEPS

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n i t s

n i t s

TIMELINE d n

a n

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TIMELINE d n

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e T

NATURAL LIGHT

COLORFUL

a n

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e T

OVERVIEW

SUPPORTIVE

PLAYFUL

TECHNOLOGY

nd

n i t s

PATIENT CENTRIC

IMPROVE WAYFINDING

MODULAR

UNIVERSAL ROOMS

r e t

REDUCE TRAVEL

STANDARDIZATION

n e

FUTURE GROWTH

EDUCATIONAL

PROJECT STATS and n

g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

e T

99,000 SF Ambulatory Campus

Program: 1st Floor – ASC (4 OR Rooms/2 Procedure Spaces/4 induction rooms/23 flexible pre/Post op rooms), Imaging, Diagnostics, Urgent Care, Phlebotomy, Infusion, Retail Rx, & Café 2nd Floor - 84 exam/treatment areas including 5 Audiology, 6 Ophthalmology, 6 Cardio Diagnostics

Schedule - to be designed and completed before SJCH opens.

Design: May – December 2017, Construction: November 2017 – Feb 2019 Opened: April 2019 for patients

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Construction Costs: $36.7 M

n i t s

n i t s

MAIN ENTRY

SECONDARY ENTRANCE

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e T FIRST

DIAGNOSTICS CLINIC

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SURGERY/ PROCEDURE AREA

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PRE/POST AREA ASC FAMILY

n i t s

e T FIRST

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d FLOOR n a

SURERY/ PROCEDURE AREA PRE/POST AREA ASC FAMILY

n i t s

a n

e T SECOND nd FLOOR

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g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

n i t s

a n

e T SECOND nd FLOOR

e

r e nt

g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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r e nt

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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n i t s

ASC PATIENT FLOW

n i t s

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e T SURGICAL nd AREA

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g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

n i t s

a n

e T SURGICAL nd AREA

e

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a n

nd

e

r e nt

g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

n i t s

e T OR

a n

nd

e

r e nt

g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

n i t s

e T OR

Wins:  Room size/space  Storage cabs  Nurse workstation  Parallel processing Losses (Budget):  Walls  Graphic displays  Windows  Fixed ceiling system

n i t s

e T NEXT

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f  INTERIM INTERVIEWS WITH SURGICAL STAFF  FORMAL POST OCCUPANCY EVALUATION  PATIENTS  SURGICAL STAFF  MAINTENANCE

 PROCESS IMPROVEMENTS  FACILITY IMPROVEMENTS

 MUSC CITADEL MALL MUSCULOSKELETAL TO OPEN FALL 2019

e

r e nt

d STEPS n a

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n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l Q & A r C fo

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n g i s e y D t i s s r e i t e i l v i i c n a FUTURE STATE OR U F n h o t l s a m e e H l r C o f Image credits: https://www.pinterest.com/pin/441634307199797771

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

THE MARCH TOWARD INCREASING AMBULATORY SURGERY

Number of ASC’s

Types of outpatient procedures performed in ASC’s

06

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42

77

1,000

ASC’s

ASC’s

ASC’s

200

types of procedures

2011

2010

1990’s

1988

1982

1980’s

(Banapour et al, 2019)

5,300 ASC’s

2000

types of procedures

Almost half of mastectomies were performed as outpatient surgeries (Appleby, 2016). At least 8 ambulatory surgery centers also had Robotic Surgery Systems (Pallardy and Vaidya, 2014)

Elective outpatient total joint arthroplasty including knee and hip TJAs grew 47% between 2012 and 2015, and projected to grow 77% over the subsequent decade

(Bert, Hooper & Moen, 2017)

The most common procedures performed in ambulatory surgical settings (excluding cosmetic surgery) as of 2017 included various forms of eye surgery, esophageal procedures, colonoscopies (both diagnostic and lesion removal), spinal/nerve blocks and subcutaneous injections, ENT, knee and shoulder arthroscopy/ surgery

2017

(Burden, 2005)

23 million surgeries were performed across ASCs in the United States

2015

Outpatient Robot-Assisted Radical Prostatectomy (RARP) had been reported by 2010

2013

The Society for Ambulatory Anesthesia was formed in 1984 and has rapidly expanded

(Burden, 2005)

1976

(Hedley-Whyte and Milamed, 2005)

The first freestanding ambulatory surgery center opened in Phoenix, Arizona with a focus on gastroenterology, pain management, gynecology and orthopedic cases

1970’s

The first disposable anesthesia system meeting ANSI and ISO standards was employed for outpatient surgery in 1968

1960’s

1910’s

1890’s

1960s saw early forms of hospital-based outpatient surgery

1975

The first reported ambulatory surgeries were performed in the US employing general anesthesia in 1918

The earliest outpatient surgery was performed in Glasgow, Scotland

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f

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g n i t s

5,400

6,100

ASC’s

ASC’s

3500

types of procedures

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

RIPCHD.OR AS A FLEXIBLE CHASSIS

4'- 0"

PRIMARY CHASSIS

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OR

OR

PREP

PREP

PREP

OR OR

OR

INDUCTION

ALCOVE

OR

INDUCTION

Prep

INDUCTION

ALCOVE

INDUCTION

ALCOVE

OR OR

Induction Room 4

OR

TERTIARY CHASSIS

OR

ALCOVE

SECONDARY CHASSIS

BREAKDOWN

C

OR

No Ancillary Rooms

C.Z.

S.Z.

PREP

SINGLE CORRIDOR

OR OR

4'- 0"

14' - 3"

S.Z.

4'- 0"

14' - 3"

4'- 0"

26' - 0"

B

A.Z.

4'- 0"

4'- 0"

A

4'- 0"

OR

ALCOVE

BREAKDOWN

ALCOVE

EQUIPMENT

ALCOVE

BREAKDOWN

ALCOVE

BREAKDOWN

OR

OR

CONTROL

EQUIPMENT

OR

Breakdown Room

OR

CONTROL

EQUIPMENT CONTROL

OR

OR

EQUIPMENT

EQUIPMENT CONTROL

Control Room

OR

OR

CONTROL

SINGLE CORRIDOR

4'- 0"

SINGLE CORRIDOR

4'- 0"

SINGLE CORRIDOR

4'- 0"

SINGLE CORRIDOR

22' - 0" 4'- 0"

e OPTIONS FOR ADJACENT SUPPORT SPACES T 1 d n a n g i s e y D t i s s r e i t e i l v i 2ni c 3 a U F n h o t l s a m e e H l r C o f 2

24' - 0"

SINGLE CORRIDOR

1

g n i t s

CONTROL

OR EQUIPMENT

OR

Control Room

A.Z. Anesthesia zone | C.Z. Circulation zone | S.Z. Scrub Zone

06

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

SUITE OPTIONS

26' - 0"

26' - 0"

10' - 0"

A.Z. S.Z.

S.Z.

C.Z.

14' - 3"

A.Z. S.Z.

14' - 3"

26' - 0"

14' - 3" 14' - 3"

SUPPORT SPACES

S.Z.

S.Z.

C.Z.

S.Z.

C.Z.

SURGICAL SUPPLY STORAGE

A.Z. S.Z.

S.Z.

C.Z.

6' - 0"

14' - 3"

F

26' - 0"

14' - 3"

n e C

34' - 0" 24' - 0"

E

G

G

S.Z.

H

C.Z.

S.Z.

S.Z.

C.Z.

6' - 0"

S.Z.

A.Z.

26' - 0"

14' - 3"

r te

C.Z.

34' - 0"

6' - 0"

SUPPORT SPACE SUPPORT SPACE

C.Z.

A.Z.

I

06

S.Z.

E

H

S.Z.

D

14' - 3"

14' - 3" 14' - 3"

26' - 0"

S.Z.

SUPPORT SPACE

C.Z.

A.Z.

S.Z.

A.Z.

SUPPORT SPACE

14' - 3"

S.Z.

2

C

C

F

G

H

SUPPORT SPACE

S.Z.

26' - 0"

14' - 3"

A.Z.

34' - 0" 24' - 0" 22' - 0"

C.Z.

A.Z.

C.Z.

E

F

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f S.Z.

D

S.Z.

10' - 0"

B

26' - 0"

26' - 0"

14' - 3"

D

S.Z.

24' - 0" 22' - 0" A

26' - 0"

14' - 3"

A.Z.

SUPPORT SPACE

C.Z.

C

10' - 0"

1

S.Z.

B

S.Z.

10' - 0"

34' - 0"

A.Z.

SUPPORT SPACE

14' - 3"

26' - 0"

S.Z.

4

A

6' - 0"

14' - 3"

A.Z.

24' - 0"

3

SUPPORT SPACE

A

B

24' - 0"

2

e T d n a

CLEAN CORE 34' - 0"

34' - 0" 24' - 0" 22' - 0"

26' - 0"

24' - 0" 22' - 0"

1

WORK CORE

6' - 0"

SINGLE CORRIDOR

g n i t s

I

I

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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g n i t s

n g i s e y D t i s s r e i t e i l v i i c n a IMAGE GUIDANCE U F n h o t l s a m e e H l r C o f

Image credits: https://www.childrenscolorado.org/doctors-and-departments/departments/heart/programs-and-clinics/cardiac-catheterization/ INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

of overhead bridge

Cath/Angio eqipment with overhead bridge

movement of patient bed

IMAGE GUIDED PROCEDURES

LEGEND

t s e T d n a C-arm

g n i

range and movement of C-arm

Anesthesia workstation

Cath/Angio eqipment with overhead bridge

range and movement of overhead bridge movement of patient bed

Mobile Circulating Nursesâ&#x20AC;&#x2122; workstation Instrument prep table

24'-0" 1

4'-0"

4'-0"

1'-0" 1'-0" 1'-0" 1'-0"

2'-0"

2

4'-0"

4'-0"

4'-0"

4'-0"

4'-0"

12'-0"

9'-0" 2'-0"

4'-0"

4'-0"

B

CATHETER / SUPPLY STORAGE

1'-0" 1'-0" 1'-0"

B

662 SF

120 SF

CONTROL ROOM 141 SF

CORRIDOR SCRUB

CRASH CART CATHETER

CATHETER

CATHETER

CATHETER

SUPPLY

SUPPLY CRASH CART

O.R. 686 SF

4'-0"

A

4'-0"

4'-0"

4'-0"

4'-0"

4'-0"

1'-0"

2'-0"

1'-0" 1'-0"

22'-0"

4'-0"

4'-0"

4'-0"

17'-0"

26'-0" 1

4'-0"

4'-0" 10'-0"

4'-0"

4'-0"

4'-0"

4'-0"

4'-0"

22'-0"

1'-0"

4'-0"

1'-0" 1'-0" 1'-0"

5'-0"

1

4'-0" 9'-0"

4'-0"

APRONS

4'-0"

10'-2" 8'-0 1/2"

4'-0" 9'-0"

2'-0"

4'-0"

4'-0"

4'-0"

1

4'-0"

22'-0"

28'-0" 3

EQUIPMENT ROOM 120 SF

SUPPLY

1'-0" 1'-0"

10'-0" 28'-0"

2

26'-0"

28'-0" A

4'-0"

CONTROL ROOM

4'-0"

109 SF

28'-0" 3

4'-0"

10'-2"

2'-0"

26'-0" 2

EQUIPMENT ROOM

SUPPLY

1'-0" 1'-0" 1'-0"

2'-0"

CORRIDOR

141 SF

4'-0"

8'-2" 2'-0"

2

132 SF

SUPPLY

1'-0" 1'-0" 1'-0"

1'-0" 1'-0"

12'-0"

APRONS

2'-0"

A

EQUIPMENT ROOM

CORRIDOR

110 SF

4'-0"

SCRUB

1'-0" 1'-0" 1'-0"

CORRIDOR

8'-0 1/2"

150 SF

4'-0"

686 SF

4'-0"

CRASH CART

CONTROL ROOM

9'-0" 4'-0"

EQUIPMENT ROOM

APRONS

4'-0" 1'-0" 1'-0" 1'-0"

CRASH CART

CATHETER / SUPPLY STORAGE

26'-0"

10'-0"

CONTROL ROOM

4'-0"

4'-0"

10'-0"

4'-0"

O.R.

4'-0"

9'-0"

662 SF

2'-0"

APRONS

4'-0"

26'-0"

28'-0"

SCRUB

4'-0"

SUPPLY

4'-0"

SCRUB

4'-0"

4'-0"

10'-2"

28'-0"

CORRIDOR

O.R.

O.R.

4'-0"

4'-0"

APRONS

110 SF

7'-0" 4'-0"

4'-0"

109 SF

CONTROL ROOM

4'-0"

4'-0"

EQUIPMENT ROOM

4'-0"

8'-0 1/2"

A

22'-0" 4'-0"

4'-0"

9'-0"

700 SF

1'-0" 1'-0"

SUPPLY

4'-0"

15'-5 1/2"

2'-0"

9'-0"

4'-0"

9'-0"

4'-0"

30'-0"

9'-0"

10'-0"

4'-0"

1'-0" 1'-0" 1'-0"

3

30'-0"

2'-0"

4'-0"

1'-0" 1'-0" 1'-0"

1'-0"

2

4

28'-0"

26'-0"

4'-0"

4'-0"

28'-0"

B

CRASH CART

O.R.

9'-0"

5'-0"

4'-0"

4'-0"

15'-5 1/2"

1

3

2'-0"

4'-0"

4'-0"

10'-0"

APRONS

SCRUB

9'-0"

2'-0"

1'-0" 1'-0" 1'-0"

4'-0"

4'-0"

4'-0"

4'-0" 22'-0"

10'-0"

CATHETER / SUPPLY

4'-0"

2'-0"

4'-0"

150 SF

B

4'-0"

SUPPLY

4'-0"

n e C SUPPLY

4'-0"

CONTROL ROOM

CATHETER / SUPPLY

2'-0"

r te

4'-0"

Option D SCENARIO 4

SCRUB

CORRIDOR

2'-0"

132 SF

CRASH CART

4'-0"

613 SF

1'-0" 1'-0" 1'-0"

CATHETER

26'-0"

O.R.

22'-0"

2'-0"

1'-0" 1'-0" 1'-0"

700 SF

4'-0"

CRASH CART

4'-0"

4'-0"

B

2'-0"

4'-0"

EQUIPMENT ROOM

4'-0"

1'-0" 1'-0" 1'-0"

APRONS

SCRUB

1'-0" 1'-0" 1'-0"

4'-0"

A

26'-0"

28'-0"

15'-0" 2'-0"

270 SF

4'-0" 4'-0"

4'-0" 4'-0"

CONTROL ROOM

4'-0"

28'-0"

B

APRONS

4'-0" 1'-0" 1'-0" 1'-0"

A

4'-0"

O.R.

2'-0"

SCRUB

1'-0" 1'-0" 1'-0"

4'-0" 1'-0" 1'-0" 1'-0"

CRASH CART

4'-0"

B

4'-0"

CORRIDOR

4'-0"

613 SF

152 SF

10'-0"

4'-0"

SUPPLY

4'-0"

SUPPLY

4'-0"

CATHETER

O.R.

EQUIPMENT ROOM

4'-0"

4'-0"

4'-0" 4'-0" 26'-0" 4'-0"

28'-0"

CORRIDOR

4'-0" 4'-0"

B

1'-0" 1'-0"

8'-0 1/2"

2'-0"

10'-2"

1'-0"

movement of patient bed

9'-0"

4'-0"

2'-0"

17'-0"

4'-0"

1'-0" 1'-0" 1'-0"

4'-0"

2'-0"

4'-0"

26'-0"

4'-0"

4'-0"

A

22'-0"

2'-0"

1'-0" 1'-0" 1'-0"

2'-0"

2'-0"

1'-0" 1'-0"

1'-0" 1'-0" 1'-0"

4'-0"

1'-0" 1'-0" 1'-0"

4'-0"

SCENARIO 4

range and movement of overhead bridge

4'-0"

2'-0"

28'-0"

4'-0"

4'-0"

4'-0"

4'-0"

1'-0" 1'-0" 1'-0" 1'-0"

range and movement of C-arm

28'-0"

4'-0"

4'-0"

SUPPLY

2

28'-0"

1'-0" 1'-0" 1'-0"

4'-0"

1

26'-0"

8'-2"

4'-0"

SCENARIO 3

3

26'-0"

2'-0"

4'-0"

12'-0"

4'-0"

1'-0" 1'-0" 1'-0"

4'-0"

2'-0"

2

SUPPORT ROOMS

22'-0"

1'-0" 1'-0" 1'-0"

A

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 1

1'-0" 1'-0" 1'-0"

2'-0"

SCENARIO 2

2

24'-0"

4'-0"

2

1

SCENARIO 3

2'-0"

SCENARIO 2

SUPPORT ROOMS

SCENARIO 1 SCENARIO 1

4

4'-0"

4'-0"

4'-0"

2'-0"

7'-0"

4'-0" 9'-0"

30'-0"

4'-0"

4'-0"

4'-0" 12'-0"

4'-0"

4'-0"

4'-0" 9'-0"

30'-0" 2

3

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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n g i s e y D t i s s r e i t e i l v i i c n a ROBOTICS U F n h o t l s a m e e H l r C o f

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Image credits: https://www.umassmed.edu/otolaryngology/specialties/robotic-surgery/

g n i t s

Circulating Nurses’ workstation

of overhead bridge movement of patient bed

LEGEND EQUIPMENT

t s e T d n a Surgeon

Anesthesia workstation

Circulating Nurse

Scrub Tech

1'-0" 1'-0" 1'-0"

1'-0" 1'-0" 1'-0"

1'-0"

2'-0"

1'-0" 1'-0"

4'-0"

4'-0"

10'-0" 4'-0"

4'-0"

4'-0"

2'-0" 4'-0"

SUPPLY

2'-0"

EQUIPMENT ROOM

Surgeon Console

8'-2"

1'-0" 1'-0" 1'-0"

4'-0"

4'-0"

4'-0"

CONTROL ROOM 10'-0" SCRUB

O.R. 700 SF

613 SF

B

2

9'-0"

O.R.

1

SUPPORT ROOMS

CORRIDOR

Robotic Equipment

10'-0"

4'-0"

1

4'-0"

26'-0"

28'-0"

4'-0"

1

3

4'-0"

4'-0"

4

4'-0"

26'-0"

28'-0"

4'-0" 4'-0"

4'-0"

4'-0"

26'-0"

28'-0"

4'-0"

3

4'-0"

2

4'-0"

17'-0" 4'-0"

4

1'-0" 1'-0" 1'-0"

4'-0"

3

n e C

4'-0"

2

613 SF

A

SUPPLY

2

22'-0" 4'-0"

1

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Option 01: Robot Equipment on patient side

06

1

B

O.R.

1'-0" 1'-0" 1'-0"

4

4

613 SF

4'-0"

3

3

O.R.

1'-0" 1'-0" 1'-0" 1'-0"

3

2

4'-0"

4

1

4'-0"

26'-0"

4'-0"

26'-0"

15'-5 1/2" CRASH CART

2'-0"

A

4'-0"

3

26'-0"

2'-0"

2'-0"

22'-0"

4'-0"

28'-0"

1'-0" 1'-0" 1'-0"

4'-0"

SUPPLY

4'-0"

4'-0"

1'-0" 1'-0" 1'-0" 1'-0"

4'-0"

4'-0"

1'-0" 1'-0" 1'-0"

4'-0"

2

Instrument prep table

2

4'-0"

4'-0"

2'-0"

A

4'-0"

4

1

2

2'-0"

2'-0"

22'-0"

4'-0"

1'-0" 1'-0" 1'-0"

SUPPLY

1'-0" 1'-0" 1'-0"

4'-0"

4'-0"

4'-0"

1'-0" 1'-0" 1'-0" 1'-0"

2'-0"

4'-0"

1'-0" 1'-0" 1'-0"

4'-0"

4'-0"

4'-0"

4'-0"

2'-0"

1'-0" 1'-0" 1'-0"

4'-0"

4'-0"

A

4'-0"

2'-0"

Option A

Circulating Nurses’ SCENARIO workstation

24'-0"

24'-0"

2'-0"

22'-0"

Robotic Equipment

Anesthesia workstation

4

2'-0" 1'-0" 1'-0" 1'-0"

n g i s e y D t i s s r e i t e i l v i i c n a U F n h o t l s a m e e H l r C o f 1

2

1

24'-0"

Instrument prep table

3

2

1

SCENARIO 3

1 2

Patient

SCENARIO 2

Surgeon Console

Mobile Circulating Nurses’ workstation

Anesthesiologist

SCENARIO 1

g n i

ROBOTIC SURGERY EQUIPMENT

4

ROBOTIC SURGERY

MEDICAL PERSONNEL

Instrument prep table

Option 02: Robot Equipment at foot of the patient bed

INNOVATIONS IN SURGICAL ENVIRONMENTS | SEPTEMBER 2019

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n g i s e y D t i s s r e i t e i l v i i c n a OPTIMUS OR U F n h o t l s a m e e H l r C o f

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g n i t s

Image credits: https://www.ecnmag.com/article/2017/09/2017-esp-award-nominee-optimus-services-integrated-surgical-environment

e T d n a

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g n i t s

n g i s e y D t i s s r e i t e i l v i i c n a NBBJh FCONCEPT OR U n o t l s a m e e H l r C o f

Image credits: http://www.nbbj.com/news/2015/1/26/nbbj-in-fast-company-how-to-design-a-safer-operating-room/