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Cai H, Daneshvar Z, Miller K, Dash M, Jiang S. Exploring Campus Configuration and Patient Arrival Behaviors at Large Hospitals: An Integrated Post-Occupancy Evaluation (POE) Protocol. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241271432. [PMID: 39205446 DOI: 10.1177/19375867241271432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND This study addresses the challenges in hospital navigation, particularly focusing on the sequence of arrival experiences through foot traffic or driving within a medical campus. While previous research has emphasized wayfinding in interiors, this study recognizes the importance of transition from outdoor to indoor spaces in the hospital arrival zone. OBJECTIVES Twofold research efforts include: (1) Exploring vehicular and pedestrian behaviors in a hospital arrival zone using Space Syntax Analyses (SSA), and (2) Validating the SSA results using empirical data collected from onsite observations and behavior mapping. METHODS A series of axial map analyses were conducted on the hospital campus and building arrival zone regarding spatial connectivity and integration, depth of spaces, and wayfinding intelligibility based on vehicular and pedestrian movement paths. Systematic behavioral data collection includes vehicle shadowing (10 h) and pedestrian mapping (20 h) in the building arrival zone. RESULTS Space Syntax Analyses indicates high intelligibility scores for vehicles (R = .91) and pedestrian (R = .78) circulation patterns; traffic situations were visualized via axial maps. A dataset of 219 vehicles and 2,096 pedestrian behaviors was analyzed and visualized using diagrams and heatmaps, identifying different occupancy patterns within the space. Correlational analyses indicated strong correlations between the results: connectivity and integration scores are significantly correlated with both vehicular and pedestrian traffic volumes. CONCLUSION Preliminary findings of the study validated an integrated protocol to evaluate the impacts of campus configuration and building approach design on patient arrival and spatial navigation at large hospitals, serving as a POE protocol involving SSA.
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Affiliation(s)
- Hui Cai
- Department of Architecture, School of Architecture, University of Kansas, Lawrence, KS, USA
| | | | | | - Monalipa Dash
- School of Architecture and Planning, KIIT University, Bhubaneswar, India
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Quan X. Can Operating Room Design Make Orthopedic Surgeries Shorter, Safer, and More Efficient?: A Quasi-Experimental Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241254529. [PMID: 39090805 DOI: 10.1177/19375867241254529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVES The study aimed to fill the knowledge gap about how operating room (OR) design could reduce orthopedic surgery duration and contribute to surgical care safety and efficiency. BACKGROUND Long surgery duration may lead to delays and cancellations of surgeries, deteriorated patient experiences, postoperative complications, and waste of healthcare resources. The OR physical environment may contribute to the reduction of surgery duration by minimizing workflow disruptions and personnel movements during surgeries. METHODS Unobtrusive observations were conducted of 70 unilateral total knee or hip replacement surgeries in two differently designed ORs at a community hospital in the United States. A set of computer-based forms adapted from recent research was used to measure the surgery duration, environment-related disruptions, and ambulatory movements involving circulators. Potential confounding factors like surgery type were controlled in statistical analyses. RESULTS Significantly shorter surgery durations were recorded in the larger OR with more clearances on both sides of the operating table, a wider door located on the sidewall, more cabinets, and more clearance between the circulator workstation and the sterile field (p =.019). The better-designed OR was also associated with less frequent disruptions and fewer movements per case (p < .001). Significant correlations existed between surgery duration, the number of disruptions, and the number of movements (rs = .576-.700, ps < .001). CONCLUSIONS The study demonstrated the important role of OR physical environment in supporting the safe and efficient delivery of surgical care, which should be further enhanced through research and design innovations.
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Affiliation(s)
- Xiaobo Quan
- School of Architecture & Design, University of Kansas, Lawrence, KS, USA
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3
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Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 PMCID: PMC11268371 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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Heinke TL, Joseph A, Carroll D. Safety in Health Care: The Impact of Operating Room Design. Anesthesiol Clin 2023; 41:789-801. [PMID: 37838384 DOI: 10.1016/j.anclin.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
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.
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Affiliation(s)
- Timothy L Heinke
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA.
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, 2-141 Lee Hall, Clemson University, Clemson, SC 29631, USA
| | - David Carroll
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 25 Courtenay Drive, Suite 4200, MSC 240, Charleston, SC 29425, USA
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Kalantari R, Zamanian Z, Hasanshahi M, Jamali J, Faghihi A, Niakan MH, Gheysari S. An observational study to assess circulating nurses' non-technical skills. J Perioper Pract 2023; 33:296-301. [PMID: 36062532 DOI: 10.1177/17504589221117673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Non-technical skills are cognitive and social skills that are necessary for safe and efficient practices in operating theatre. These skills are inseparable parts of circulating nurses' duties and help them have a good performance during surgical processes. Circulating nurses' non-technical skills have not been closely measured, and much uncertainty still exists about the quality of their skills. This study aimed to assess circulating nurses' non-technical skills. METHODS A cross-sectional study was conducted on 300 circulating nurses who worked in four public hospitals in Iran, during 2020. The data of demographics of the studied population were collected using a demographic questionnaire. Kalantari et al's Circulating Practitioner's List of Non-Technical Skills was used to assess the circulating nurses' non-technical skills. RESULTS The situational awareness domain had the highest score, while leadership was the domain with the lowest mean score. There was a moderate positive relationship between the mean score of non-technical skills and the number of working years as a circulating nurse. CONCLUSION Although the circulating nurses had a moderate level of non-technical skills, they had low scores in several behaviours. However, they did well in some other behaviours. Educational interventions and policymaking solutions can help improve circulating nurses' non-technical skills.
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Affiliation(s)
- Reza Kalantari
- Department of Ergonomics, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zamanian
- Department of Ergonomics, Faculty of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Hasanshahi
- Department of Operating Room, School of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aliakbar Faghihi
- Clinical Educational Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Niakan
- Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Somayeh Gheysari
- Department of Operating Room, School of Nursing, Shiraz University of Medical Sciences, Shiraz, Iran
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Quan X. Improving Ambulatory Surgery Environments: The Effects on Patient Preoperative Anxiety, Perception, and Noise. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:73-88. [PMID: 36740908 DOI: 10.1177/19375867221149990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The study aimed to comparatively evaluate three types of preoperative care environment in terms of patient experience outcomes including patient preoperative anxiety, perceived environmental qualities, and noise level. BACKGROUND Preoperative anxiety is a major healthcare problem causing delays, complications, dissatisfaction, and rising healthcare costs. The design of preoperative spaces may play an important role in reducing preoperative anxiety and improving outcomes. METHODS Anonymous questionnaire surveys were conducted with 228 patients in the three types of preoperative bays that varied in terms of bay size and the amount of hard-wall partitions between bays to compare patient self-reported anxiety and perceived environmental qualities. Sound level measurements were conducted throughout the three preoperative care units. RESULTS Female patients in the preoperative unit with largest bays and full hard-wall partitions between bays reported significantly lower levels of subjective anxiety (p's = .002, <.001) and higher levels of perceived environmental qualities on privacy, cleanliness, noise, and pleasantness (p's from <.001 to .017) than patients in the units with smaller bays and no or partial hard-wall partitions. Similar but less clear pattern was found among male patients. The lowest average noise levels were recorded in the unit with largest bays and full hard-wall partitions between bays (2.3-6.1 decibels lower than the other units). CONCLUSIONS The design of preoperative care environment may contribute to the better management of preoperative anxiety. Further efforts in research and design are needed to maximize the benefits in clinical, experiential, and financial outcomes.
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Affiliation(s)
- Xiaobo Quan
- Christopher C. Gibbs College of Architecture, University of Oklahoma, Norman, OK, USA
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Taaffe K, Ferrand YB, Khoshkenar A, Fredendall L, San D, Rosopa P, Joseph A. Operating room design using agent-based simulation to reduce room obstructions. Health Care Manag Sci 2022:10.1007/s10729-022-09622-3. [PMID: 36529790 PMCID: PMC10369668 DOI: 10.1007/s10729-022-09622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
This study seeks to improve the safety of clinical care provided in operating rooms (OR) by examining how characteristics of both the physical environment and the procedure affect surgical team movement and contacts. We video recorded staff movements during a set of surgical procedures. Then we divided the OR into multiple zones and analyzed the frequency and duration of movement from origin to destination through zones. This data was abstracted into a generalized, agent-based, discrete event simulation model to study how OR size and OR equipment layout affected surgical staff movement and total number of surgical team contacts during a procedure. A full factorial experiment with seven input factors - OR size, OR shape, operating table orientation, circulating nurse (CN) workstation location, team size, number of doors, and procedure type - was conducted. Results were analyzed using multiple linear regression with surgical team contacts as the dependent variable. The OR size, the CN workstation location, and team size significantly affected surgical team contacts. Also, two- and three-way interactions between staff, procedure type, table orientation, and CN workstation location significantly affected contacts. We discuss implications of these findings for OR managers and for future research about designing future ORs.
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Joseph A, Neyens D, Taaffe K, Bayramzadeh S, Catchpole K. Understanding "Work as Done": Using a Structured Video-Based Observational Method to Understand and Model the Role of the Physical Environment in Complex Clinical Work Systems. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:13-27. [PMID: 35403456 DOI: 10.1177/19375867221089271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the planning, development, and implementation of a structured video-based observational method that can be used to systematically examine and model the role of the physical environment within healthcare systems. BACKGROUND Direct observation methods are often used in healthcare to study complex healthcare systems. However, these observations often occur in real time, which predisposes the collected data to shortcomings such as time lags in recording of activities, overlooking events, or limiting the scope of information than can be collected. Video observation approaches eliminate many of these challenges and provide opportunities for researchers to understand and model the role of the physical environment. METHODS An approach to developing and implementing a structured video-based observational method to study and model complex health systems is presented. RESULTS A structured observational approach can be highly effective for collecting multiple layers of data necessary for understanding interactions between the physical environment and other systems components in healthcare settings. The proposed video-based observation method is effective in settings that have clearly defined environmental boundaries, limited number of people, are complex and fast-paced such as the OR, ED trauma rooms, and ICU rooms. CONCLUSIONS Video-based observation is an effective complement to the traditional observational method for in-depth study of the built environment in health systems, enabling researchers to employ quantitative approaches to data collection and analysis, in addition to qualitative interpretations.
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Affiliation(s)
- Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA
| | - David Neyens
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Kevin Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Sara Bayramzadeh
- Health Care Design Program, Kent State University, Kent, OH, USA
| | - Ken Catchpole
- College of Medicine, Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
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- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA
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Lipson-Smith R, McLaughlan R. Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:351-374. [PMID: 35356828 DOI: 10.1177/19375867221089702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success. BACKGROUND Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations. METHODS The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors. RESULTS Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview. CONCLUSIONS The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.
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Affiliation(s)
- Ruby Lipson-Smith
- School of Architecture and the Built Environment, University of Newcastle, Australia
| | - Rebecca McLaughlan
- School of Architecture and the Built Environment, University of Newcastle, Australia.,Sydney School of Architecture, Design & Planning, The University of Sydney, Australia
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The impact of design on workflow: a comparative case study of level I trauma rooms. FACILITIES 2022. [DOI: 10.1108/f-11-2021-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to examine trauma room staff’s perception of factors that influence workflow in trauma care from a physical environment standpoint.
Design/methodology/approach
A semi-structured focus group method was used. Trauma team members, representative of various roles within a team, were recruited from five Level I trauma centers in the USA, through a convenience sampling method. A total of 53 participants were recruited to participate in online focus groups. The Systems Engineering Initiative for Patient Safety model was used to analyze the findings.
Findings
In addition to factors directly related to the physical environment, aspects of people and technology, such as crowding and access to technology, were found to be related to the physical environment. Examples of factors that improve or hinder workflow are layout design, appropriate room size, doors, sink locations, access to resources such as X-ray or blood and access to technology. Seamless and uninterrupted workflow is crucial in achieving efficient and safe care in the time-pressured environments of trauma rooms. To support workflow, the physical environment can offer solutions through effective layout design, thoughtful location of resources and technology and room size.
Originality/value
Trauma rooms are time-pressured and complex environments where seconds matter to save a patient’s life. Ensuring safe and efficient care requires seamless workflow. However, the literature on workflow in trauma rooms is limited.
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Liao X, Zhang P, Xu X, Zheng D, Wang J, Li Y, Xie L. Analysis of Factors Influencing Safety Attitudes of Operating Room Nurses and Their Cognition and Attitudes toward Adverse Event Reporting. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8315511. [PMID: 35178235 PMCID: PMC8844141 DOI: 10.1155/2022/8315511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Abstract
Operating room nurses play a critical role in patient safety. The evaluation of safety attitudes of operating room nurses reflects their awareness and belief of patient safety. Currently, however, the research on the safety attitudes of operating room nurses is hard to track in the existing literature in China. Therefore, this paper was conducted to explore the factors influencing the safety attitudes of operating room nurses and their cognition and attitudes toward adverse event reporting. A total of 711 operating room nurses from 16 tertiary hospitals in Sichuan Province from March 1, 2018, to 2019 were selected. The general information of operating room nurses, such as age, gender, and years of service in the operating room, was obtained through the basic information questionnaire. The Chinese version of the Safety Attitudes Questionnaire (C-SAQ) was used to evaluate the safety attitude of operating room nurses, and the cognition and attitude of the subjects to adverse event reports were assessed through the questionnaire of cognition and attitude toward adverse event reporting. The average score of safety attitudes of operating room nurses was 4.20 ± 0.49. The two dimensions with a lower positive reaction rate of the safety attitudes of operating room nurses were stress recognition and working conditions. The main factors affecting the safety attitude of operating room nurses were night shifts, as well as cognition and attitudes toward adverse event reporting. There was a positive correlation between the total score of C-SAQ and the total score of cognition and attitudes toward adverse event reporting (P < 0.01, r = 0.445). The safety attitude of operating room nurses is at the upper-middle level, but the stress recognition and working conditions need to be improved. Through the allocation of nursing human resources, the strengthening of hospital logistics support, and the establishment of nonpunitive nursing adverse event reporting system, the operating room safety can be significantly enhanced.
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Affiliation(s)
- Xin Liao
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Peijia Zhang
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Xiaofeng Xu
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Dan Zheng
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Jing Wang
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Yunfei Li
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Li Xie
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
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Obeidat B, Younis MB, Al-Shlool E. Investigations into the impact of nursing unit layout on critical care nurses. Heliyon 2022; 8:e08929. [PMID: 35198785 PMCID: PMC8850728 DOI: 10.1016/j.heliyon.2022.e08929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/06/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Nurses’ work environment has apparent implications for maximizing their productivity, satisfaction, and improving patient care. Objectives This study aimed to explore the influence of three nursing unit spatial layouts on critical care nurses’ satisfaction and walking behavior at a university hospital. Methods The research used a comparative design by administering a standardized questionnaire, recording walking steps and distances using pedometers, and tracking nurses’ walking behavior. Thirty-six critical care nurses working on the morning shift consented to participate in the research. Results The study results showed a relationship between the spatial layout of intensive care units (ICUs) and nurses' satisfaction and walking behavior. Questionnaire results indicated statistically significant variations in nurses' satisfaction with the location of the nursing station, the arrangement of patients' rooms, the availability of family space, and the unit's auditory privacy. Nurses in ICU1 were more satisfied with the nursing station's placement and the availability of family space inside patient rooms, while nurses in ICU2 were more satisfied with the patient bed arrangement and the unit's aural privacy than nurses in other units. The pedometer readings and movement maps revealed significant differences in nurses' walking patterns across the three ICUs. The steps, distances, and movement diagrams demonstrated that ICU1 with private rooms outperformed the other units owing to the nurse station's placement and accessibility to patients and support rooms. Conclusion This study concludes that the ICU design impacts nurses' satisfaction and behavior. The optimum placement of nursing stations, patients' beds, and supporting room reduces walking distance and thus increases nurses’ satisfaction and performance. Nurses' satisfaction with their work environment is critical for delivering high-quality healthcare services. Hospitals that want to improve the job performance of their nurses must establish a supportive work environment for them. Hospitals should encourage nurses to take an active role in making decisions about their work environment. The findings from this study will contribute to the existing literature from a cross-cultural perspective.
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Affiliation(s)
- Bushra Obeidat
- College of Architecture and Design, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Bani Younis
- Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
| | - Esra'a Al-Shlool
- College of Architecture and Design, Jordan University of Science and Technology, Irbid, Jordan
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Cohen TN, Wiegmann DA, Kanji FF, Alfred M, Anger JT, Catchpole KR. Using flow disruptions to understand healthcare system safety: A systematic review of observational studies. APPLIED ERGONOMICS 2022; 98:103559. [PMID: 34488190 PMCID: PMC11194701 DOI: 10.1016/j.apergo.2021.103559] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/12/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
This systematic review provides information on the methodologies, measurements and classification systems used in observational studies of flow disruptions in clinical environments. The PRISMA methodology was applied and authors searched two databases (PubMed and Web of Science) for studies meeting the following inclusion criteria: (a) were conducted in a healthcare setting, (b) explored systems-factors leading to deviations in care processes, (c) were prospective and observational, (d) classified observations, and (e) were original research studies published in peer-reviewed journals. Thirty studies were analyzed and a variety of methods were identified for observer training, data collection and observation classification. Although primarily applied in surgery, comparable research has been successfully conducted in other venues such as trauma care, and delivery rooms. The findings of this review were synthesized into a framework of considerations for conducting rigorous methodological studies aimed at understanding clinical systems.
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Affiliation(s)
- Tara N Cohen
- Cedars-Sinai Medical Center, Department of Surgery, 8687 Melrose Ave., Suite G-555, West Hollywood, CA, 90069, USA.
| | - Douglas A Wiegmann
- University of Wisconsin-Madison, College of Engineering, 1415 Engineering Drive, Madison, WI, 53706, USA
| | - Falisha F Kanji
- Cedars-Sinai Medical Center, Department of Surgery, 8687 Melrose Ave., Suite G-555, West Hollywood, CA, 90069, USA
| | - Myrtede Alfred
- University of Toronto, Department of Mechanical and Industrial Engineering, 5 King's College Road, M5S 3G8 (MB114) Toronto, Ontario, Canada
| | - Jennifer T Anger
- University of California San Diego, Department of Urology, 9400 Campus Point Drive, # 7897 La Jolla, CA 92037, USA
| | - Ken R Catchpole
- Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, Storm Eye Building, Ashley Avenue, Charleston, SC, 29425, USA
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14
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The Swedish version of the attitude towards pressure ulcer prevention instrument for use in an operating room context (APUP-OR): A nationwide psychometric evaluation. J Tissue Viability 2021; 31:46-51. [PMID: 34969580 DOI: 10.1016/j.jtv.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To assess operating room (OR) nurses' attitudes towards pressure ulcer prevention, the Attitude towards Pressure Ulcer Prevention (APuP) instrument was developed. AIM The aim of this study was to psychometrically evaluate the Attitude towards Pressure Ulcer Prevention (APuP) instrument in a Swedish OR context. MATERIALS AND METHODS A psychometric evaluation study was conducted, using a convenience sample, between February and August 2020. Validity (content, construct, discriminatory power) and reliability (stability and internal consistency) were evaluated. RESULTS The first survey (test) was completed by 284 Swedish OR nurses, of whom n = 50 (17.6%) completed the second survey (retest). A Principal Component Analysis was conducted for the 13-item instrument. The KMO value for this model was 0.62. Bartlett's test for sphericity was statistically significant (p 0.001). Five factors were identified which accounted for 56% of the variance in responses related to attitudes toward pressure ulcer prevention. The Cronbach's α for the instrument "attitude towards Pressure Ulcer Prevention" was 0.66. The intraclass correlation coefficient was 0.49 (95% CI = 0.25-0.67). CONCLUSION This Swedish version of the APuP- OR is the first step in the development of an instrument to measure OR nurses' attitudes towards PU prevention in a Swedish OR context. The reliability of the instrument was low and the validity moderate. A larger sample and the revision or addition of items related to the context of the operating room should be considered in order to confirm aspects of the psychometric properties.
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Mihandoust S, Joseph A, Madathil KC, Rogers H, Jafarifiroozabadi R, Ahmadshahi S, Holmstedt C, McElligott J. Comparing Sources of Disruptions to Telemedicine-Enabled Stroke Care in an Ambulance. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:96-115. [PMID: 34763545 PMCID: PMC10398637 DOI: 10.1177/19375867211054759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study is to understand the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. BACKGROUND Telemedicine is emerging as an efficient approach to provide timely remote assessment of patients experiencing acute stroke in an ambulance. These consults are facilitated by connecting the patient and paramedic with a remotely located neurologist and nurse using cameras, audio systems, and computers. However, ambulances are typically retrofitted to support telemedicine-enabled care, and the placement of these systems inside the ambulance might lead to spatial challenges and disruptions during patient evaluation. METHOD Video recordings of 13 simulated telemedicine-based stroke consults were coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. For each observed disruption-the type, severity or impact, location in the ambulance, and equipment involved in the disruption were recorded. RESULTS Seat size, arrangement of assessment equipment, location of telemedicine equipment (computer workstation), and design of telemedicine camera were among the factors that impacted telemedicine-related disruptions. The left ambulance seat zone and head of the patient bed were more involved in environmental hazard-related disruptions, while the right zone of the ambulance was more prone to interruptions and communication-related disruptions. CONCLUSION Adequate evaluation space for the paramedic, proper placement of evaluation equipment, and telemedicine computer location could facilitate the stroke care evaluation process and reduce FDs in the ambulance.
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Affiliation(s)
- Sahar Mihandoust
- Center for Health Facilities, Design and Testing, Clemson University, SC, USA
| | - Anjali Joseph
- Center for Health Facilities, Design and Testing, Clemson University, SC, USA
| | | | - Hunter Rogers
- Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, OH, USA
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The Role of the Physical Environment in Shaping Interruptions and Disruptions in Complex Health Care Settings: A Scoping Review. Am J Med Qual 2021; 36:449-458. [PMID: 34714780 DOI: 10.1097/jmq.0000000000000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interruptions and disruptions in complex healthcare environments, such as trauma rooms, can lead to compromised workflow and safety issues due to the physical environment's characteristics. This scoping review investigated the impact of the physical environment on interruptions and disruptions and the associated outcomes in complex environments, as they relate to the components of the Systems Engineering Initiative for Patient Safety. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to conduct the scoping review. CINAHL, Web of Science, and PubMed databases were searched. After removing duplicates and eligibility screening, quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Of 1,158 articles found, 20 were selected. Poor layout configurations, tripping hazards, and technology integration were common examples. More research must be conducted to unveil the impact of the physical environment on interruptions and disruptions.
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Kanji F, Cohen T, Alfred M, Caron A, Lawton S, Savage S, Shouhed D, Anger JT, Catchpole K. Room Size Influences Flow in Robotic-Assisted Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7984. [PMID: 34360275 PMCID: PMC8345669 DOI: 10.3390/ijerph18157984] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Abstract
The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of surgical flow disruptions (FDs) occurring during RAS. Fifty-six RAS procedures were observed at two academic hospitals between July 2019 and January 2021 across general, urologic, and gynecologic surgical specialties. A multiple regression analysis demonstrated significant effects of room size in the pre-docking phase (t = 2.170, df = 54, β = 0.017, p = 0.035) where the rate of FDs increased as room size increased, and docking phase (t = -2.488, df = 54, β = -0.017, p = 0.016) where the rate of FDs increased as room size decreased. Significant effects of site (pre-docking phase: p = 0.000 and docking phase: p = 0.000) were also demonstrated. Findings from this study demonstrate hitherto unrecognized spatial challenges involved with introducing surgical robots into the operating domain. While new technology may provide benefits towards patient safety, it is important to consider the needs of the technology prior to integration.
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Affiliation(s)
- Falisha Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; (M.A.); (S.L.); (K.C.)
| | - Ashley Caron
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Samuel Lawton
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; (M.A.); (S.L.); (K.C.)
| | - Stephen Savage
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Daniel Shouhed
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Jennifer T. Anger
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; (M.A.); (S.L.); (K.C.)
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Jurewicz KA, Neyens DM, Catchpole K, Joseph A, Reeves ST, Abernathy JH. Observational study of anaesthesia workflow to evaluate physical workspace design and layout. Br J Anaesth 2020; 126:633-641. [PMID: 33160603 DOI: 10.1016/j.bja.2020.08.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
| | - David M Neyens
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA.
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Anjali Joseph
- School of Architecture, Clemson University, Clemson, SC, USA
| | - Scott T Reeves
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins, Baltimore, MD, USA
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Rodrigues AL, Torres FBG, Gomes DC, Carvalho DR, Santos EAP, Cubas MR. Workflow and decision making of operating room nurses: integrative review. Rev Gaucha Enferm 2020; 41:e20190387. [PMID: 32813811 DOI: 10.1590/1983-1447.2020.20190387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Identify workflow factors in the operating room and their implications, which influence nurses' decision making. METHOD Integrative review of the literature conducted through searches in the databases: Latin American and Caribbean Literature in Health Sciences; Nursing Database; Pubmed; Scopus and Cumulative Index to Nursing and Allied Health Literature. The results were organized into factors related to positive, negative and positive and negative implications. RESULTS The sample of 18 articles included examples of factors with positive implications, such as preoperative data collection, negative outcomes, such as lack of human, material and structural resources, and positive and negative outcomes, as preparation for certification. CONCLUSIONS Factors that influence the decision-making process of nurses are associated to different conditions: client- related conditions and those conditions that go beyond the domain and organization of the surgical environment.
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Affiliation(s)
- Ana Luzia Rodrigues
- Programa de Pós-Graduação em Tecnologia em Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
| | | | - Denilsen Carvalho Gomes
- Programa de Pós-Graduação em Tecnologia em Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
| | - Deborah Ribeiro Carvalho
- Programa de Pós-Graduação em Tecnologia em Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
| | - Eduardo Alves Portela Santos
- Programa de Pós Graduação em Engenharia de Produção e Sistemas, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
| | - Marcia Regina Cubas
- Programa de Pós-Graduação em Tecnologia em Saúde, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brasil
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Neumann J, Angrick C, Höhn C, Zajonz D, Ghanem M, Roth A, Neumuth T. Surgical workflow simulation for the design and assessment of operating room setups in orthopedic surgery. BMC Med Inform Decis Mak 2020; 20:145. [PMID: 32616031 PMCID: PMC7333415 DOI: 10.1186/s12911-020-1086-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 03/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The design and internal layout of modern operating rooms (OR) are influencing the surgical team's collaboration and communication, ergonomics, as well as intraoperative hygiene substantially. Yet, there is no objective method for the assessment and design of operating room setups for different surgical disciplines and intervention types available. The aim of this work is to establish an improved OR setup for common procedures in arthroplasty. METHODS With the help of computer simulation, a method for the design and assessment of enhanced OR setups was developed. New OR setups were designed, analyzed in a computer simulation environment and evaluated in the actual intraoperative setting. Thereby, a 3D graphical simulation representation enabled the strong involvement of clinical stakeholders in all phases of the design and decision-making process of the new setup alternatives. RESULTS The implementation of improved OR setups reduces the instrument handover time between the surgeon and the scrub nurse, the travel paths of the OR team as well as shortens the procedure duration. Additionally, the ergonomics of the OR staff were improved. CONCLUSION The developed simulation method was evaluated in the actual intraoperative setting and proved its benefit for the design and optimization of OR setups for different surgical intervention types. As a clinical result, enhanced setups for total knee arthroplasty and total hip arthroplasty surgeries were established in daily clinical routine and the OR efficiency was improved.
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Affiliation(s)
- Juliane Neumann
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany.
| | - Christine Angrick
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
| | - Celina Höhn
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Endoprothetic Joint Surgery and General Orthopaedics, University of Leipzig Medical Center, Leipzig, Germany
| | - Dirk Zajonz
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Endoprothetic Joint Surgery and General Orthopaedics, University of Leipzig Medical Center, Leipzig, Germany
| | - Mohamed Ghanem
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Endoprothetic Joint Surgery and General Orthopaedics, University of Leipzig Medical Center, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic, Trauma and Plastic Surgery, Division of Endoprothetic Joint Surgery and General Orthopaedics, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), Leipzig University, Semmelweisstr. 14, 04103, Leipzig, Germany
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Advancing evidence-based healthcare facility design: a systematic literature review. Health Care Manag Sci 2020; 23:453-480. [PMID: 32447606 DOI: 10.1007/s10729-020-09506-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.
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