Safety in Health Care: The Impact of Operating Room Design

The science of operating room design has grown over the past 20 years due to the realization that the physical environment influences health care provider performance and patient outcomes. Medical errors occur when the normal workflow in an operating room is disrupted as providers must overcome sub-optimal conditions. All aspects of the physical environment can impact operating room flow. Studying the layout, contents, ergonomics, and environmental parameters of the operating can lead improved work conditions resulting improved patient and provider safety. At the forefront of operating room design science is the use of simulation and the evaluation of new technologies.

Using Virtual Reality (VR) Mock-Ups for Evidence-Based Healthcare Facility Design Decisions

(1) Background: There are many complexities and trade-offs that design teams consider when designing or renovating a built environment for healthcare. Virtual reality (VR) mock-ups can allow design teams to evaluate the planned design. This study aimed to examine the overall value of using VR mock-ups to conduct a simulation-based mock-up evaluation. (2) Methods: Data collected from scenario enactments within a VR mock-up was compared to data collected from an existing medication room with the same design to assess predictive validity. Outcomes regarding quality and patient safety were also examined as a result of design modifications to the VR mock-up which were identified through a post-occupancy evaluation (POE) of the existing medication room. Survey data from participants, hospital design stakeholders, and POE recommendation recipients captured perceptions regarding the evaluation process. Specifically, this included perceptions regarding mock-up and scenario realism as well as utility of the evaluation process. (3) Results: Evidence-based data collected using the VR mock-up accurately assessed workflow (link analysis), bumps, impediments, interruptions, and task completion times. Collecting data pertaining to selection errors and equipment placement were identified after procuring the VR software and therefore the accuracy of these measures was not assessed. Searching behaviours were not possible to capture using the VR software. A 506% return on investment was achieved through the VR mock-up evaluations. (4) Conclusion: Organizations should consider what evaluation objectives are planned and how they will be measured for a mock-up evaluation to determine if VR is appropriate.

Observational study of anaesthesia workflow to evaluate physical workspace design and layout

BACKGROUND

The safety and efficiency of anaesthesia care depend on the design of the physical workspace. However, little is known about the influence that workspace design has on the ability to perform complex operating theatre (OT) work. The aim of this study was to observe the relationship between task switching and physical layout, and then use the data collected to design and assess different anaesthesia workspace layouts.

METHODS

In this observational study, six videos of anaesthesia providers were analysed from a single centre in the United States. A task analysis of workflow during the maintenance phase of anaesthesia was performed by categorising tasks. The data supported evaluations of alternative workspace designs.

RESULTS

An anaesthesia provider's time was occupied primarily by three tasks: patient (mean: 30.0% of total maintenance duration), electronic medical record (26.6%), and visual display tasks (18.6%). The mean time between task switches was 6.39 s. With the current workspace layout, the anaesthesia provider was centred toward the patient for approximately half of the maintenance duration. Evaluating the alternative layout designs showed how equipment arrangements could improve task switching and increase the provider's focus towards the patient and visual displays.

CONCLUSIONS

Our study showed that current operating theatre layouts do not fit work demands. We report a simple method that facilitates a quick layout design assessment and showed that the anaesthesia workspace can be improved to better suit workflow and patient care. Overall, this arrangement could reduce anaesthesia workload while improving task flow efficiency and potentially the safety of care.

Mock-Ups: Using Experiential Simulation Models in the Healthcare Design Process

PURPOSE

The purpose of this article was to explore how different types of mock-ups are being used in the healthcare design process and present a methodology framework for the process.

BACKGROUND

Historically, physical mock-ups have been used in healthcare design primarily to test construction techniques. Although this historic use of mock-ups assisted the design team in decision-making, newer forms of mock-ups have evolved that expand the input provided into decision-making. These newer techniques, rapid prototyping, early build-out, virtual reality, and enhancements to the traditional physical mock-up focus more on challenging the functionality of the space, testing new operational concepts, and increasing user input.

METHOD

This methodology article utilized five case studies in which different types and combinations of mock-ups were used in the design process and then, the methodology compares the realism, immersion, and testability of each mock-up technique.

RESULTS

For each mock-up type, the case studies described the purpose of the technique, the advantages and disadvantages, the most appropriate phase for its use in the design process, the estimated cost, and the process logistics. These components are compared to assist in developing a methodology for a variety of design situations.

CONCLUSIONS

The findings related to different mock-up techniques are a valuable tool for healthcare design teams to use in selecting the most appropriate mock-up technique and the proposed methodology will assist in executing the mock-up process.

Safety, Performance, and Satisfaction Outcomes in the Operating Room: A Literature Review

OBJECTIVE

This review of empirical literature focuses on the design of operating rooms (ORs) by investigating the physical environmental features of ORs associated with patient and staff outcomes.

BACKGROUND

Many ORs built more than 30 years ago remain operational today. However, most are inadequately designed to handle the equipment, processes, and people that a contemporary OR needs to accommodate. However, the evidence base for designing ORs has been sorely lacking, and little guidance exists on how OR design can improve safety and performance outcomes.

METHOD

A literature search was conducted using PubMed and the university's linked databases. The inclusion criteria included peer-reviewed journal articles that reported some aspect of the physical environment of ORs along with outcomes. The study included empirical studies as well as nonempirical best practice papers.

RESULTS

This literature review uncovered 211 articles. The main themes that emerged include OR design-related factors, ventilation, temperature and humidity, acoustical environment, lighting, and materials. Some environmental threats to patient safety in the OR include frequent door openings, clutter, poor air quality, surface contamination, and noise. Further, staff performance and satisfaction were impacted by factors such as the OR layout and equipment and furniture ergonomics.

CONCLUSION

This literature review provides an overview of the research organized into design-focused topic areas to support decision-making by architects and designers. This article highlights gaps in the research and identifies areas where best practice and design assumptions need to be evaluated using rigorous design research.

User Evaluation of Neonatology Ward Design

Objective:

The object of this article is to identify the set of affective and emotional factors behind users’ assessments of a space in a neonatology unit and to propose design guidelines based on these.

Background:

The importance of the neonatology service and the variety of users place great demands on the space at all levels. Despite the repercussions, the emotional aspects of the environment have received less attention.

Methods:

To avoid incurring limitations in the user mental scheme, this study uses two complementary methodologies: focus group and semantic differential. The (qualitative) focus group methodology provides exploratory information and concepts. The (quantitative) semantic differential methodology then uses these concepts to extract the conceptual structures that users employ in their assessment of the space. Of the total 175 subjects, 31 took part in focus groups and 144 in semantic differential.

Results:

Five independent concepts were identified: privacy, functionality and professional nature, spaciousness, lighting, and cleanliness. In relation to the importance of the overall positive assessment of the space, the perception of privacy and sensations of dominance and pleasure are fundamental. Six relevant design aspects were also identified: provide spacious surroundings, facilitate sufficient separation between the different posts or cots, use different colors from those usually found in health-care centers, as some aversion was found to white and especially green, design areas with childhood themes, use warm artificial light, and choose user-friendly equipment.

Conclusions:

Results provide design recommendations of interest and show the possibilities offered by combining both systems to analyze user response.

An Evaluation of Operating Room Safety and Efficiency: Pilot Utilization of a Structured Focus Group Format and Three-Dimensional Video Mock-Up to Inform Design Decision Making

Objective:

The purpose of this investigation was to identify safety and efficiency-related design features for inclusion in operating room (OR) construction documents.

Background:

Organizations are confronted with an array of challenges when planning an OR, including inefficiencies in operations, adverse events, and a variety of innovations to choose from. Currently, techniques that can be used in design practice and to inform design decision making for implementable OR solutions are limited.

Methods:

The project team used a structured focus group format with mixed methods to solicit 19 varying surgical team members' reactions to a three-dimensional video mock-up of a proposed OR. Data from the 19 participants were analyzed using stepwise multiple regression and content analysis of open-ended responses.

Results and Discussion:

Results demonstrate that several features of the proposed OR design predict meaningful outcomes, including flexibility and satisfaction with the OR setup, adverse event prevention, team performance, and distractions and interruptions. Participants' suggested solutions include universal booms to support anesthetic and perfusion capabilities, a fixed circulating nursing workstation that faces the patient and is at the foot of the operating room table, a wall-mounted monitor across from the surgeon, and wiring to support a touch-screen control arm in OR surgical fields.

Conclusions:

Findings from structured focus groups with mixed methods lead to implementable design solutions for construction documentation. The expeditious qualities and objectivity of the format are value-adds to the design decision-making process. Future research should use various techniques such as virtual technologies and building information modeling.