Layout (Strategies)

Locate computer workstations in close proximity to surgical team members' related tasks.

Computers and monitors that are located in close proximity to surgical team member's related tasks support better access to supplies and improved workflow by reducing travel distance.

DESIRED OUTCOMES/CITATIONS

Improve movement and flow

Peer-reviewed (empirical study)

Ahmad et al., 2016
Ahmad, N., Hussein, A. A., Cavuoto, L., Sharif, M., Allers, J. C., Hinata, N., ... & Guru, K. A. (2016). Ambulatory movements, team dynamics and interactions during robot‐assisted surgery. BJU international, 118(1), 132-139.

TYPE OF STRATEGY

Task Technology Built Environment

Locate doors adjacent, or in direct access, to primary circulation area to direct flow away from sterile and anesthesia zones.

Doors that are located adjacent, or in direct access, to the primary circulation area to direct flow away from the sterile and anesthesia zones support material and instrument set up without disruption and unnecessary traffic, as well as support patient transfer to the OR table.

DESIRED OUTCOMES/CITATIONS

Improve movement and flow

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

Rostenberg & Barach, 2011
Rostenberg, B., & Barach, P. R. (2011). Design of cardiovascular operating rooms for tomorrow's technology and clinical practice—Part one. Progress in Pediatric Cardiology, 32(2), 121-128.

Peer-reviewed (empirical study)

Bayramzadeh et al., 2018a
Bayramzadeh, S., Joseph, A., San, D., Khoshkenar, A., Taaffe, K., Jafarifiroozabadi, R., ... & RIPCHD. OR Study Group. (2018). 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, 11(3), 124-138.

Peer-reviewed (empirical study)

Bayramzadeh et al., 2018b
Bayramzadeh, S., Joseph, A., San, D., Khoshkenar, A., Taaffe, K., Jafarifiroozabadi, R., ... & RIPCHD. OR Study Group. (2018). 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, 11(3), 124-138.

Reduce disruptions

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

Rostenberg & Barach, 2011
Rostenberg, B., & Barach, P. R. (2011). Design of cardiovascular operating rooms for tomorrow's technology and clinical practice—Part one. Progress in Pediatric Cardiology, 32(2), 121-128.

Peer-reviewed (empirical study)

Bayramzadeh et al., 2018a
Bayramzadeh, S., Joseph, A., San, D., Khoshkenar, A., Taaffe, K., Jafarifiroozabadi, R., ... & RIPCHD. OR Study Group. (2018). 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, 11(3), 124-138.

Reduce risk of contamination

Peer-reviewed (empirical study)

Bayramzadeh et al., 2018b
Bayramzadeh, S., Joseph, A., Allison, D., Shultz, J., Abernathy, J., & Group, R. O. S. (2018). Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes. Applied ergonomics, 70, 288-299.

TYPE OF STRATEGY

Task Built Environment

Provide clearly defined circulation, anesthesia, and sterile zones.

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

DESIRED OUTCOMES/CITATIONS

Reduce disruptions

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

Rostenberg & Barach, 2011
Rostenberg, B., & Barach, P. R. (2011). Design of cardiovascular operating rooms for tomorrow's technology and clinical practice—Part one. Progress in Pediatric Cardiology, 32(2), 121-128.

Reduce risk of contamination

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

Rostenberg & Barach, 2011
Rostenberg, B., & Barach, P. R. (2011). Design of cardiovascular operating rooms for tomorrow's technology and clinical practice—Part one. Progress in Pediatric Cardiology, 32(2), 121-128.

Improve movement and flow

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

Rostenberg & Barach, 2012
Rostenberg, B., & Barach, P. R. (2012). Design of cardiovascular operating rooms for tomorrow's technology and clinical practice—Part 2. Progress in Pediatric Cardiology, 33(1), 57-65.

TYPE OF STRATEGY

Task Built Environment

Locate the primary power source for movable equipment to minimize hazards.

Appropriately locating primary power sources related to movable equipment reduces the potential for pathway obstructions caused by wires and cords.

DESIRED OUTCOMES/CITATIONS

Reduce slips, trips, and falls

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

Brogmus et al., 2007
Brogmus, G., Leone, W., Butler, L., & Hernandez, E. (2007). Best practices in OR suite layout and equipment choices to reduce slips, trips, and falls. AORN journal, 86(3), 384-398.

Peer-reviewed (empirical study)

Bell et al., 2008
Bell, J. L., Collins, J. W., Wolf, L., Grönqvist, R., Chiou, S., Chang, W. R., ... & Evanoff, B. (2008). Evaluation of a comprehensive slip, trip and fall prevention programme for hospital employees. Ergonomics, 51(12), 1906-1925.

TYPE OF STRATEGY

Technology Built Environment

Locate doors to minimize collisions during entry into the OR.

Doors that are located to minimize collisions with furniture, team members, and equipment during entry into the OR support reduced disruptions.

DESIRED OUTCOMES/CITATIONS

Reduce disruptions

PSLL (case studies, RIPCHD.OR books)

PSLL High Fidelity Mock-up Simulations, December 2018
PSLL High Fidelity Mock-up Simulations (December 2018). Orthopedic High Fidelity Mock-up Simulations Focus Group. Charleston, SC.

TYPE OF STRATEGY

Task Built Environment

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

Appropriate OR sizing and layout design can minimize walking distances, without negatively impacting congestion and clutter.

DESIRED OUTCOMES/CITATIONS

Improve movement and flow

Peer-reviewed (empirical study)

Joseph et al., 2019
Joseph A., Machry H., Khoshkenar A., Taaffe K.. OR Proactive Design with Simulation Modeling.

TYPE OF STRATEGY

People Task Technology Built Environment

Locate movable equipment in close proximity to surgical team members' related tasks.

Movable equipment that is located near surgical team members' related tasks supports improved workflow by reducing travel distance.

DESIRED OUTCOMES/CITATIONS

Improve movement and flow

Peer-reviewed (empirical study)

Ahmad et al., 2016
Ahmad, N., Hussein, A. A., Cavuoto, L., Sharif, M., Allers, J. C., Hinata, N., ... & Guru, K. A. (2016). Ambulatory movements, team dynamics and interactions during robot‐assisted surgery. BJU international, 118(1), 132-139.

Best Practice report (non peer-reviewed)

Joseph & Allison, 2018
Joseph, A. & Allison, D. (2018). Designing A Safer OR. Healthcare Design Magazine. Available at https://www.healthcaredesignmagazine.com/trends/research-theory/designing-a-safer-or/

TYPE OF STRATEGY

Task Built Environment

Provide expansion opportunities to accommodate future technologies and equipment.

Space and infrastructure for the expansion of future technologies and equipment supports the ability to integrate new technologies and equipment easily into the OR.

DESIRED OUTCOMES/CITATIONS

Improve ability to adapt over time

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

Brogmus et al., 2007
Brogmus, G., Leone, W., Butler, L., & Hernandez, E. (2007). Best practices in OR suite layout and equipment choices to reduce slips, trips, and falls. AORN journal, 86(3), 384-398.

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

Rostenberg & Barach, 2011
Rostenberg, B., & Barach, P. R. (2011). Design of cardiovascular operating rooms for tomorrow's technology and clinical practice—Part one. Progress in Pediatric Cardiology, 32(2), 121-128.

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

FGI Guidelines, Hospitals, 2018
Facility Guidelines Institute. (2018). 2018 FGI Guidelines for Design and Construction of Outpatient Facilities Washington, D.C.: Facility Guidelines Institute.

TYPE OF STRATEGY

Technology Built Environment

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

Locating and clearly identifying circulation, anesthesia, and sterile zones during planning phases according to surgical team members related tasks supports improved workflow by reducing travel distance and discouraging unnecessary movement during procedures.

DESIRED OUTCOMES/CITATIONS

Improve movement and flow

Peer-reviewed (empirical study)

Joseph et al., 2019
Joseph A., Machry H., Khoshkenar A., Taaffe K.. OR Proactive Design with Simulation Modeling.

Reduce bacterial load

Peer-reviewed (empirical study)

Taaffe et al., 2018
Taaffe, K., Lee, B., Ferrand, Y., Fredendall, L., San, D., Salgado, C., Shvorin, D., Khoshkenar, A. and Reeves, S. (2018). The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load. Infection Control & Hospital Epidemiology, 39(4), pp.391-397.

TYPE OF STRATEGY

Task Built Environment

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

Standardized room layout of supply and equipment storage, information technologies, and zone distribution supports reduced time spent on non-patient care activities.

DESIRED OUTCOMES/CITATIONS

Improve efficiency

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

Brogmus et al., 2007
Brogmus, G., Leone, W., Butler, L., & Hernandez, E. (2007). Best practices in OR suite layout and equipment choices to reduce slips, trips, and falls. AORN journal, 86(3), 384-398.

Improve workplace ergonomics

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

Brogmus et al., 2007
Brogmus, G., Leone, W., Butler, L., & Hernandez, E. (2007). Best practices in OR suite layout and equipment choices to reduce slips, trips, and falls. AORN journal, 86(3), 384-398.

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

Rostenberg & Barach, 2012
Rostenberg, B., & Barach, P. R. (2012). Design of cardiovascular operating rooms for tomorrow's technology and clinical practice—Part 2. Progress in Pediatric Cardiology, 33(1), 57-65.

TYPE OF STRATEGY

Task Organization Technology Built Environment

Locate hand hygiene supplies such as hand sanitizer and personal protective equipment to enable effective hand hygiene practices for all surgical team members.

Locating hand hygiene supplies such as hand sanitizer and personal protective equipment to enable effective hand hygiene practices supports reduced contamination of equipment and surfaces.

DESIRED OUTCOMES/CITATIONS

Reduce risk of contamination

Peer-reviewed (empirical study)

Birnbach, Rosen, Fitzpatrick, Carling, Arheart, et al., 2015
Birnbach, D. J., Rosen, L. F., Fitzpatrick, M., Carling, P., Arheart, K. L., & Munoz-Price, L. S. (2015). Double Gloves: A Randomized Trial to Evaluate a Simple Strategy to Reduce Contamination in the Operating Room. Anesthesia & Analgesia, 120(4). Retrieved from http://journals.lww.com/anesthesia-analgesia/Fulltext/2015/04000/Double_Gloves___A_Randomized_Trial_to_Evaluate_a.23.aspx

Best Practice report (non peer-reviewed)

Stackhouse et al., 2011
Stackhouse, R. A., Beers, R., Brown, D., Brown, M., Greene, E., McCann, M. E., & Tompkins, B. M. (2011). Recommendations for Infection Control for the Practice of Anesthesiology. American Society of Anesthesiologists (3rd ed.). Park Ridge, IL.

TYPE OF STRATEGY

Task Built Environment

OR Design Toolkit

LAYOUT

Layout

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