RIPCHD.OR Volume 2 by Clemson Center for Health Facilities Design & Testing

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CARE THROUGH HUMAN-CENTERED DESIGN IN THE OPERATING ROOM RIPCHD.OR

VOLUME 2 | 2016-2017

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This project was supported by grant number P30HS0O24380 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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EDITORS: Anjali Joseph, Rutali Joshi & David Allison EDITORIAL ASSISTANTS: Deborah Wingler, Sara Bayramzadeh & James Lyndon McCracken GRAPHIC DESIGNERS: Rutali Joshi

TABLE OF CONTENTS

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Project Overview

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Design Charrette and Visioning Workshop

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Year 2 Projects

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Dissemination

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Next steps

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Advisory Committee

102 -109

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01 litie i c a F PROJECT OVERVIEW h lt e t n e C

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The Realizing Improved Patient Care through Human Centered Design in the OR (RIPCHD.OR) patient safety learning lab (PSLL) uses a multidisciplinary human-centered approach to incorporate evidence-based design, human factors and systems engineering principles to design a safer, more ergonomic operating room (OR). A range of different core team members, advisory committee members and user groups have been actively involved throughout the project to support the goal of designing an OR that addresses patient and staff safety issues in this high risk-prone environment. Year 1 of the project focused on structuring the learning lab, formalizing the vision and goals for the project, as well as establishing infrastructure and management. An extensive literature review was followed by data collection through video observations and analysis of the data. To conclude the first year of the project and transition from problem analysis to conceptual design, a design charrette and project visioning session was held with all project team members, Medical University of South Carolina (MUSC) clinicians, design professionals, advisory committee members, and Clemson Architecture + Health graduate students. The purpose of this meeting was to share first year findings, and kick off year 2 of the project. . The focus of year 2 of the learning lab was primarily on moving from problem analysis to design and development in the three interrelated integrated subprojects within the larger project. The team also worked to prioritize the design and development activities undertaken by the RIPCHD.OR learning lab in year 3.

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PROJECT AIMS

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While this learning lab focuses on the design of a safer OR, the goal is to create a strong multidisciplinary network of people and places that together can effectively address patient safety concerns in a range of different environments where there are key patient safety concerns. The design, process and technology solutions that emerge from the three projects involved with the learning lab will be implemented and tested in two new MUSC ambulatory surgery centers (ASCs) in Charleston, SC dedicated to pediatric and orthopedic surgical procedures. The project also aims to develop a range of tools and solutions that can help healthcare design teams evaluate proposed design solutions proactively and design changes based on their potential impacts on patient safety and staff safety outcomes.

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PROJECT PHASES

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Literature review Case Studies OR observations

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02 Mockup design

Design development & implementation at MUSC

04 Testing & evaluation

PROJECT PARTNERS Research

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MUSC

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2 Design projects

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LS3P

Mock-up

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PROJECT STRUCTURE

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The core research and design team includes university faculty, design researchers, healthcare architects, human factors engineers, operations management researchers, anesthesiologists, surgeons and nurses. The team also receives guidance from an advisory committee comprised of patient safety and industry experts from diverse organizations, including Greenville Health System, the Veterans Administration and Health Quality Council of Alberta. Additionally, a diverse group of stakeholders from MUSC including staff from strategic planning, perioperative services and surgery (nurses, anesthesiology personnel and surgeons from Orthopedics and Pediatrics) were engaged throughout and participated as part of a clinical advisory committee. Three distinct, yet highly interrelated and integrated patient safety focused subprojects related to key aspects of the OR suite constitute the learning lab. The coordination and collaboration between the three project teams is managed under the leadership of Dr. Anjali Joseph from Clemson University and Dr. Scott Reeves from MUSC. Each of the three project teams is led by two project leaders- a professor from one department of Clemson Universityâ&#x20AC;&#x2122;s graduate school and a member from MUSC, to ensure efforts between the two key collaborators are closely coordinated.

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David Neyens & Scott Reeves Key Personnel

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PROJECT 2

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( OVERALL & ADMINISTRATIVE )

MUSC PROJECT TEAM CLINICAL & PATIENT ADVISORY COMMITTEE

Kevin Taaffe & Danielle Scheurer

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David Allison & Jake Abernathy Key Personnel

AIM 1

INDUSTRY PARTNERS TECHNICAL ADVISORY COMMITTEE

CORE TEAM

ANJALI JOSEPH | PH.D., EDAC CLEMSON UNIVERSITY

CHRISTINE TURLEY | M.D.

HEALTH SCIENCES SOUTH CAROLINA

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DAVID NEYENS | PH.D., MPH CLEMSON UNIVERSITY

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DANIELLE SCHEURER| M.D.

MEDICAL UNIVERSITY SOUTH CAROLINA

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MARK SCHEURER | M.D.

MEDICAL UNIVERSITY SOUTH CAROLINA

DAVID ALLISON | FAIA, FACHA

JAMES ABERNATHY | M.D.

CLEMSON UNIVERSITY

MEDICAL UNIVERSITY SOUTH CAROLINA

KEN CATCHPOLE | PH.D.

SARA BAYRAMZADEH | PH.D.

CLEMSON UNIVERSITY

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CLEMSON UNIVERSITY

SCOTT REEVES | M.D., MBA, FACC, FASE MEDICAL UNIVERSITY SOUTH CAROLINA

KEVIN TAAFFE | PH.D. CLEMSON UNIVERSITY

JAMES McCRACKEN

CLEMSON UNIVERSITY

PROJECT 1

UNMASKING OF ANESTHESIA-RELATED ALARMS & COMMUNICATIONS

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Team 1 is working from a systems perspective to extend what is known about alarms, interruptions and distractions for anesthesiologists in the operating room. This project has the goal of developing and evaluating systems design methods that account for masking and exploring interface design as a means to mitigate the effect of masking.

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YEAR 1 FINDINGS By observing and analyzing the recorded surgery videos, we identified the tasks associated with anesthesia maintenance and developed operationalized definitions for those tasks to facilitate future analysis.

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Surgery video analysis emphasized the importance of accounting for provider vigilance limitations and mitigation of vigilance decrement when designing technology and its associated layout and configuration within the OR environment.

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Physical environment, especially the configuration of display layout in conjunction with or within the workspace, is a critical component of analyzing the problem space.

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To identify work-practice and technology implications for the anesthesia workstation, a focus group was conducted with MUSC anesthesia providers. The focus group revealed three themes: setting and using alarms, tasks and work, and work environment.

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YEAR 2 AIMS AND OBJECTIVES

Conducting further analysis of surgery video data for specific analyses of activities and task switching in the anesthesia workstation

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Constructing an anesthesia workstation prototype to simulate the tasks, sounds and environment and to evaluate factors such as mental workload and presentation modality

Further refinement of the tactile displays, smart watches and gestural input as they can be incorporated into the anesthesia workstation prototype

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DAVID NEYENS

SARA RIGGS

KEN CATCHPOLE

KATIE JUREWICZ

SCOTT BETZA

KYLIE GOMES

Further evaluation of different display means, display modality for human-technology communication, and dynamic environmental characteristics for the anesthesiologist

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PROJECT 2

TRAFFIC FLOW & DOOR OPENINGS IN THE OR

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The objective of team 2 is to develop measures to analyze the risks to both patient and staff safety that exist within the PEMSI flows, that is, (P)atients, (E)quipment, (M)aterials, (S)taff and (I)nformation. To date, there are no clear measures of how these PEMSI workflows interact within the OR. Given this fact, it is difficult for OR designers and managers to reliably predict how changes to one part of their system (e.g. one workflow) will affect the other parts of the system. Reliable performance of surgical procedures requires all PEMSI flows to be coordinated to occur within the constraints of the OR.

YEAR 1 FINDINGS Based on the in-person observations of several ORs with different types of surgeries, several processes and flow opportunities were identified in workflow/process design, OR clutter, and bio-contamination.

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As part of our larger project spanning all three teams, we created a robust coding scheme to identify subject locations, PEMSI activities, and surgical flow disruptions, for each videotaped surgery.

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We are currently completing the coding of the PEMSI flows and locations for each of these surgeries (based on the recorded videos).

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To determine if number of door openings and other PEMSIrelated flows (like number of people in the OR) have any measureable effect on the microbial load, we observed 15 surgeries for microbial load both near the doors and near the surgical field.

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We developed a prototype discrete-event simulation model to analyze the PEMSI flows that occurred in the videotaped surgeries and to identify the density of occupancy within each region or zone and the frequency of common paths used within the OR.

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PROJECT TEAM

YEAR 2 AIMS AND OBJECTIVES

Using the prototype simulation from Year 1, we enhanced the decision-making capability in the model to allow each person in the OR to react to changes in his/her surroundings. In other words, we can test new design layouts and flow ideas without having to rmake changes to the actual system.

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KEVIN TAAFFE

LAWRENCE FREDENDALL

YANN FERRAND

CASSANDRA SALGADO

DEE SAN

BRANDON LEE

MIRANDA MUS

AMIN KHOSHKENAR

Investigate the value of team consistency in the ability to achieve consistent OR performance.

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Use existing surgical data collected in Year 1, as well as supplemental survey data from individuals on the teams, and to determine which factors of team dynamics are important in delivering surgical care.

Develop the platform for providing user interaction with a simulation model that represents a surgical procedure.

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PROJECT 3

INTEGRATED OR SUITE DESIGN

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This projects works towards developing a better understanding of how various aspects of the operating room built environment impact patient and staff safety outcomes. Taking into account system factors like people, equipment, tools and processes, the aim is to understand how OR design can support optimal and efficient workflows, minimize surgical flow disruptions and improve performance. The integration of research, teaching and design is exemplified by involving Clemson Architecture + Health graduate students in the development and design of the OR prototype.

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YEAR 1 FINDINGS

The problem analysis phase of the project focused on in-depth understanding of OR environment using a range of different methods. A framework was developed to observe and code behaviors in the operating room. 12 surgeries were observed in person and 35 surgeries were video recorded and coded. The literature review identified that surgical suites and operating room configuration, equipment positioning and orientation, technology integration, material selection, ventilation and air quality in the OR, temperature, noise levels, lighting type and quality, and visibility affected staff and patient outcomes in the OR. Different types of flows (people, equipment, materials, supplies and instruments as well as information) were examined at multiple sites to understand the variations due to physical design, technology or processes. Two in-depth case studies identified the need for modularity and flexibility in the OR, strategic integration of technology, and connectivity and adjacencies as being critical to staff safety and flow optimization respectively. They also highlighted the significance of parallel processing and single direction flow to increase efficiency and reduce travel distance. Two sets of focus groups were conducted with surgical team members at MUSC to obtain input regarding barriers and facilitators to shed light on the observed behaviors and to highlight key areas for future study and development. The nature and configuration of events and activities during a surgery were documented for different types of surgeries based on video observations. The purpose of this was to compare the degree of variation between surgical setup and space use between different surgeries.

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MONITOR

STERILE INSTRUMENT TABLE

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EPIC EMR

ANESTHESIA MACHINE

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YEAR 2 AIMS AND OBJECTIVES

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Development of design guidelines

Develop OR design concepts using an iterative scenario based simulation approach

Build mock-ups of increasing levels of fidelity and conduct evaluation to support design refinement Iterative testing and design improvements

Data analysis and dissemination

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DAVID ALLISON

BILL ROSTENBERG

SUSAN Oâ&#x20AC;&#x2122;HARA

DEBORAH WINGLER

HERMINIA MACHRY

MICHELLE EICHINGER

RUTALI JOSHI

ROXANA JAFARI

JAMES DOMINIC

RACHEL MATTEWS

LEAH BAUCH

LANSING DODD

WENZ TUTTLE

HANNAH SCHULTZ

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ANJALI JOSEPH

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SARA BAYRAMZADEH

PROJECT ACCOMPLISHMENTS YEAR 1 & 2 | SEPT ’15- SEPT ‘17

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A major focus of year 2 was collecting complementary data to support initial and emerging research questions, developing analysis techniques and applying findings from the first year to develop an iterative OR design prototype in three phases. Each phase was followed by the construction of a physical mock-up with increasing levels of fidelity. The evaluation results from the last mock-up informed the development of the final design concept. The prototype was also developed in virtual reality to elicit feedback from the users. Journal publications, conference presentations and poster presentations have been utilized as an outlet for disseminating project findings.

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Bacterial Load Sampling

Problem Analysis & Coding Protocol

IRB Approval

JUNE ‘16 ONWARDS

Data Analysis

Coder Training

Behavior Observations of the OR System

AUG ‘16

ONWARDS

Focus Groups

Case Studies

JULY ‘16

APR ‘16

APR ‘16 MAY ‘16

MAR - MAY ’16 MAR ‘16

YEAR 1

Literature Review

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LITERATURE & REVIEW

DATA COLLECTION

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Development of Anesthesia Workstation Simulator

Operating Room Mock-Up

EDRA 47 Conference Presentation Advisory Committee

Discrete Event Simulation Model

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RIPCHD.OR Workshop & Design Charrette

Cardboard Mock up

Virtual Reality Experiment

Presentation at Healthcare Design conference

Gestural input study

AUG ‘17

Analysis of anesthesia maintenance task pairs and anesthesia workstation layout

AUG ‘17

JULY ‘17

EDRA 48 Conference Presentation

MAY ‘17

Virtual Reality Development

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JAN ‘17 - APRIL ’17

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DEC ‘16

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SEPT ‘16 OCT ‘16

YEAR 2

Gestural input study with 30 students at Clemson

Design Reﬁnement

High Fidelity Mockup

Tape on the Floor Mock up

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Presentation at ACE-ODAM, Banff

Presented at International Conference on Applied Human Factors & Ergonomics

with 16 anesthesiologists

PROJECT INNOVATION Build

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Ideate

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Design

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Dissemination

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DeďŹ ne ReďŹ ne

Literature review & Observations

Design Charette

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Development of Design guidelines

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Evaluate

Iterative design process

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Synthesize

Construction of ASCs

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Post occupancy research

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Develop design toolkit

YEAR 4

ITERATIVE DESIGN PROCESS

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Iterative OR prototype design development took place throughout the second year in three phases: conceptual design, design development and design refinement. Each design phase was followed by the construction of a physical mock-up with increasing levels of fidelity. Simultaneously, a mock-up evaluation toolkit was developed to evaluate alternative design solutions in terms of their effectiveness in achieving the goals set out via the design objectives and design guidelines. . Design refinements for each phase were based on feedback from evaluations of the mock-up that were conducted with MUSC surgical teams, designers and researchers.

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TIME design & development

implementation

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i c a AND VISIONING DESIGN CHARRETTE F hWORKSHOP t l a e H r o f r e t n Ce

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The project has been a highly interdisciplinary and collaborative enterprise since its inception. The full RIPCHD.OR research team, advisory board, second year masterâ&#x20AC;&#x2122;s students from Clemson Universityâ&#x20AC;&#x2122;s Architecture + Health program, designers from the architecture firm LS3P, clinicians from MUSC, and experts in the field of surgery were invited to be a part of a two-day workshop to share findings from year 1 and kick-off year 2 design and research projects. The workshop involved brainstorming exercises to determine the project vision, design objectives and guidelines for the design and development of an OR prototype and identify potential outcomes of interest for prototype evaluation.

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BRAINSTORMING AND VISIONING WORKSHOP OBJECTIVES 1

Understand key issues around ambulatory surgery that may impact the development and direction of RIPCHD.OR learning lab

Communicate a comprehensive body of knowledge to the research and design teams - including research, future trends, policies and guidelines that may support the development of new ideas around OR design

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Advisory committee meeting and workshop

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Prioritize key areas of focus for design development in year 2 of the RIPCHD.OR learning lab

Kick start design ideation for the integrated OR suite design through a design charrette

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Development of design guidelines

Student presentations

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Brainstorming session

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Scale model of the operating room

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The data collected in year 1 provided a robust foundation for the next phase of RIPCHD.OR. A major focus during Year 2 was the application of the first-year findings to develop concepts for creating a safer OR. Several different designs and process interventions were developed into an OR prototype that was systematically evaluated. With the research studies developed in year 1 as the basis, each of the teams worked on sub-projects individually or as a collaboration between the teams.

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PROJECTS RIPCHD.OR

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PROJECT 1

Anesthesia alarms

YEAR 1 problem analysis

YEAR 2 design development

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design implementation

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3D GESTURAL INPUT STUDY

Gestural study

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ANESTHESIA TACTILE DISPLAY WORKSTATION STUDY DESIGN

Task switching

Displays & alternative information presentations

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Video capture Observation & coding

MICROBIAL LOAD SUDY

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CIRCULATING NURSEâ&#x20AC;&#x2122;S WORKFLOW STUDY

Smart watch study

Discrete event simulation modeling

DESIGN AND TRAFFIC FLOW IMPROVEMENT SIMULATION MODELING

ASC Operational flow & simulation modeling

Design and traffic flow improvement simulation modeling

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PROJECT 3

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Flow analysis

Literature Review

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Safety Risk Assessment Toolkit

Outcomes database

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Benefits of a sterile instrument setup room or a separate induction room adjacent to the OR

Indepth case studies & international best practices

OR VR EXPERIMENT

Procedure maps

Unmasking of anesthesiarelated alarms and communications

PROJECT 2 Traffic flow and door openings in the OR

DEVELOPMENT OF OR PROTOTYPE, MOCK-UP & SIMULATION PROJECT 3 Integrated OR suite design

Analysis of door openings in the OR

Higher fidelity mockup, simulation and evaluation

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2017 Graduate students in the second year of the Architecture + Health masterâ&#x20AC;&#x2122;s program were assigned to develop an OR prototype as part of a semester long studio design project. The design team continually utilized the research done previously by the RIPCHD.OR research team, while also seeking case studies, potential products, systems and materials that could be used in the operating room setting as well as items and technologies already being used in the OR. The design challenge for the students was to think and create beyond the conventional ways in which healthcare settings are typically conceived and built. Students were charged to think about room configurations, materials, systems, details, and construction methods, or how to use conventional elements in unconventional and innovative ways. In the end the goal was to optimize usability, comfort and control for the surgical team as well as the patient.

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Architecture + Health Studio

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FACULTY IN ARCHITECTURE + HEALTH | 2017

DAVID ALLISON, FAIA, FACHA DIRECTOR OF GRADUATE STUDIES IN ARCHITECTURE + HEALTH

STUDENTS IN ARCHITECTURE + HEALTH | 2017 GRADUATES

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RACHEL MATTHEWS

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

LEAH BAUCH

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YINGCE HUANG

SHIRUI (MAX) LIN

ZHIQIN (JANE) LIU

LINDSEY HOFSTRA

AUSTIN FERGUSON

QIAN (KENNETH) DONG

DESIGN STUDY ASHLEY RIVER TOWER CHARLESTON, SC

CASE STUDIES DGSF 42,9000

OWNER/FACILITY Medical University of South Carolina (MUSC)

ARCHITECT(S) NBBJ & LS3P

SEATTLE CHILDREN’S BELLEVUE CLINIC AND SURGERY CENTER BELLEVUE, WA OWNER/FACILITY Seattle Children’s Hospital

TYPE OF FACILITY DGSF Inpatient tower with 17,400 ambulatory services & surgery

TYPE OF FACILITY Pediatric Surgery Center & Ambulatory Care Clinic

ARCHITECT(S) NBBJ

O.R. OF THE FUTURE (O.R.F.) FLOWS & TYPES PATIENT

BRANDENBURG UNIVERSITY HOSPITAL BRANDENBURG AN DER HAVEL, GERMANY DGSF 22,874

OWNER/FACILITY Städtisches Klinikum Brandenburg GmbH

ADVANCED MULTI-MODALITY IMAGE GUIDED OPERATING (AMIGO) SUITE | BOSTON, MA

Ashley River Tower

ARCHITECT(S) Heinle Wischer und Partner, Stuttgart

http://www.nbbj.com/work/medical-university-of-south-carolina-ashley-river-tower/

ESCONDIDO, CA

OWNER/FACILITY Brigham and Women’s Hospital

OWNER/FACILITY Palomar Health

ARCHITECT(S) Payette

Bellevue Clinic & Surgery Center

TYPE OF FACILITY Teaching Hospital of Harvard Medical School

SPARTANBURG REGIONAL MEDICAL CENTER

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SPARTANBURG, SC ARCHITECT(S) CO Architects

TYPE OF FACILITY General Medical and DGSF Surgical 68,192

Brandenburg University Hospital

TYPE OF FACILITY GSFCenter & Surgery 5,400 Ambulatory Care Clinic

1. 2. 3. 4. 5. 6. 7.

Change Clothes Pre-Op Assessment Anesthesia Induction Time-Out Monitoring during surgery Anesthesia Emergence Post Anesthesia hand-off

3. 4. 5. 6. 7.

ARCHITECT(S) McMillan Smith & Partners Architects, PLLC

Brigham & Women’s Hospital

http://www.suffolk.com/projects/healthcare/boston-massachusetts-brigham-and-womens-hospital-amigo-suite.html

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O.R. OF THE FUTURE (O.R.F.)

OWNER/FACILITY Spartanburg Regional Health System

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1. 2. 3. TYPE OF FACILITY 4. Emergency services 5. 6. 7. 8. 9. 10.

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Change Clothes Pre-Op Assessment Check other patients Scrub Time-Out Surgery Dictating Report to Family Post TO Anesthesia CLEAN CORE Check otherCORE patients TO CLEAN

1-2

4-6

7-10

1-3

6-7

9-10

+ The patient is brought in from the registration area.

7-10

up in the operating room, the patient is induced and prepared in the induction room.

6a + After anesthesia wears off, the patient is transferred into the early recovery room were surgeon communicates with the family.

6-7 + After spending 15 minutes in the early recovery room, the patient is transferred to the PACU.

4-6 4-5 + Anesthetized patient is brought into O.R. and placed onto surgery table for the procedure.

EQUIPMENTININTHE THEO.R. O.R. EQUIPMENT

IN THE O.R. EQUIPMENTEQUIPMENT IN THE O.R. TO CLEAN CORE TO CLEAN CORE

4-5

3 + While instruments are being set

5-6

ANESTHESIOLOGIST

http://www.nbbj.com/work/seattle-childrens-hospital-bellevue-clinic-and-surgery-center/

PALOMAR MEDICAL CENTER ESCONDIDO DGSF 70,062

BRIGHAM AND WOMEN’S HOSPITAL

Admission B. Waiting Pre-Op Assessment Induction Surgery Emergence Post Anesthesia Recovery A. Step-down Recovery Discharge

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CENTER FOR INTEGRATION OF MEDICINE AND INNOVATIVE TECHNOLOGY | BOSTON, MA GSF 1,925

OWNER/FACILITY Massachusetts General Hospital

ARCHITECT(S) Harvey Kirk and Team

Palomar Medical Center Escondido

http://www.palomarhealth.org/media/image/Mayo%20Clinic%20Care%20Network/_DSC0453_4_5_6_7_8.jpg

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TYPE OF FACILITY Teaching Hospital

Spartanburg Regional Medical Center https://plus.google.com/+Spartanburgregional/photos

+ View into an induction room from inside the O.R.

+ View into an induction room from

https://s-media-cache-ak0.pinimg.com/736x/f2/52/ef/f252ef8d3500a36d33868f5e1ac98a0c.jpg

inside the O.R. room from + View into an induction inside the O.R.

http://www.enr.com/ext/resources/archives/images2/2013/02/enr02112013_botb_health_ ss.jpg Tiny one image

OR of the future, Center for Intergration of Medicine and Innovative Technology

+ Green floor finish denotes the sterile field where the procedure takes place.

+ View into an induction room from inside the O.R.

TO MAIN CORRIDOR TO MAIN CORRIDOR

http://van.h10staging.com/portfolio.php?p=hospitals&project=119

TO MAIN CORRIDOR

+ Green floor finish denotes the sterile field where the procedure takes place.

+ Green floor finish denotes the sterile field where the procedure

takes place. + Green floor finish denotes the sterile field where the procedure takes place.

Circulating Nurse Work Station Circulating Nurse Work Station Surgeon’s Work Station Surgeon’s Foot of Surgical TableWork Station Foot of Surgical Table Sterile Zone Sterile Zone Circulating Nurse Work Station Anesthesia Work Station Circulating Nurse Work Station Anesthesia Work Station Surgeon’s Work Station Supply Items Surgeon’s Work Station Supply Items Foot of Surgical Table Support Items Support Items Foot of Surgical Table Sterile FamilyZone Seating Family Seating Sterile Zone Anesthesia Work Station Anesthesia Work Station + Hall providing access intothe all the induction rooms. + Hall providing access into all induction rooms. Supply Items + Frosted glass, break-away doors, allow natural daylightinto intothe the + Frosted glass, break-away doors, allow natural daylight Diagram Adapted Supply Items Support Items induction Diagram Adapted From NBBJFrom NBBJ induction rooms.rooms. by Rachel Matthews by Rachel Matthews Family Seating Support Items

Family Seating Diagram Adapted From NBBJ by Rachel Matthews

Diagram Adapted From NBBJ by Rachel Matthews

+ Hall providing access into all the induction rooms. 21 + Frosted glass, break-away doors, allow natural daylight into the induction rooms. + Hall providing access into all the induction rooms.

+ Frosted glass, break-away doors, allow natural daylight into the induction rooms.

CODE REVIEW MINIMUM REQUIREMENTSBAYS

CUBICLES

SINGLE PATIENT ROOMS

60 SF BAYS

80 SF CUBICLES

100 SF ROOMS SINGLE PATIENT

FACILITY FGI 2014GUIDELINES INSTITUTE (FGI) 2014BAYS 3.7-3.3.1.1 OPERATING ROOM 5ft 15’

3ft

5ft 15’ 15’ 250 SF

15’

3ft

25015’ SF

250 SF

BAYS 3.7-3.4 PREPOSTOPERATIVE 60 SF 60 SFANDbetween minimum clearance the sides BAYS 4ft of patient on sides of patient beds 60 SF walls beds and adjacant

3.7-3.3.1.2 OPERATING ROOM FOR SURGICAL PROCEDURES THAT REQUIRE ADDITIONAL PERSONNEL AND/OR LARGE20’EQUIPMENT 20’ 5ft 20’ 60020’ SF 5ft

SC.DHEC

CUBICLES PATIENT80CARE AREAS 80 SF SF the between sides 3ft and foot ofCUBICLES lounge

SF chairs and80 adjacent

SINGLE PATIENT ROOMS

SINGLE PATIENT ROOMS 100100 SFSF between the sides

SINGLE PATIENT ROOMS 3ft and foot of lounge

100 SF adjacent chairs and walls between the sides SF between the 3ft and100 foot of sides lounge chairs andlounge adjacent 3ft andbetween foot of the sides walls chairs and adjacent 3ft and foot of lounge walls chairs and adjacent between the sides

minimum clearance between the sides walls between the sides 60the SF sides SFof lounge between the foot minimum clearance between between the80 sides 4ft 3ft and of patient beds foot 5ftofon sides of patient beds chairs and adjacent beds andofthe cubicle on sides patient of patient bedsand adjacant walls and foot of lounge minimum clearance between the sides between the sides walls curtain beds and chairs adjacent between footadjacant of 4ft walls 3ftand sides ofthe patient of patient beds and foot of lounge 5ft on beds and the cubicle and adjacant walls chairs and adjacent minimum clearance between the sides walls between the sides 3ft beds between the foot ofcurtain 4ft of patient beds 3ftwalls on sides of patient and foot of lounge 5ftbetween beds and the cubicle beds the foot of and adjacant walls chairs and adjacent beds and the cubicle 3ft walls curtain curtain between the foot of 3ft beds and the cubicle BAYS OR CUBICLES curtain

250 SF

20’ 600 SF

CUBICLES

600 SF

4ft

3ft

BAYS OR CUBICLES

CUBICLES 80CUBICLES SFBAYS OR BAYS OR 80 SF BAYS OR CUBICLES 80 SF

of80 SF the sides between the sides from the foot of from the footbetween between paient 80 SFbeds between paient 4ft of patient the bed to the 3ft stretchers or beds the bed to the5ft closed4ft of patient beds 3ft curtain wall and adjacant wallsstretchers or beds closed curtain wallfrom the footand walls the sides of adjacant between between paient

closed3.7-3.4.3.2 curtain wall

4ft 3ft adjacant wallsAREA PHASEand II RECOVERY

CUBICLES CODE COMPARISON OF THE OR

BAYS

600 SF

BAYS

2001. SURGICAL SUITE(S)

60 SF BAYS

CODE COMPARISON OF THE OR 4ft of lounge 4ftTHE CODE COMPARISON ORchairs A. Operating/Procedure Room(s). OF or stretchers 4ft

SINGLE PATIENT ROOMS

alt

80 SF CUBICLES 80 SF 80 SF

100 SF SINGLE PATIENT ROOMS 100SFSF 100

CUBICLES SINGLE PATIENT ROOMS between the walls between the walls 3ft and100 the SF sides and 3ft and80 theSF sides and

the foot of lounge chairs the walls 80 SFbetween 3ft and sides and between thethewalls orbetween stretchersthe the foot of lounge the footand of lounge sides between the walls between the walls and the sides and and the sides chairs 3ft chairs of lounge chairs and the sides and 3ft the sides and the foot of lounge the foot ofand lounge or stretchers the foot of lounge the foot of lounge chairs 1. The number shall depend on the projected caseload and types of chairs chairs chairs between the sides space to between the walls between the walls procedures to be performed. Rooms shall have adequate ORthe sides and of lounge chairs and the sides and and accommodate necessary equipment and staff.

r o rf or stretchers

He 3ft

2. Each operating room shall have a minimum clear area of 180 square feet exclusive of fixed and movable cabinets and shelves. The minimum width shall be 12 feet.

e t n e C

and types of uate space to eload and types of adequate space to 180 square feet minimum width a of 180 square feet The minimum width

3ft

FGI 2014

3ft

the foot of lounge between chairs the walls 100 3ft and SF the the sideswalls and between the foot of lounge between the walls and the sides and chairs 3ft and the sides and the foot of lounge the foot of lounge chairs chairs

3ft

the foot of lounge chairs

OR BED OR BED

FLOOR

1. Anesthesia Storage Cabinet 2. Sharps Container 3. Trash Cans 4. Anesthesia Cart 5. Anesthesia Stool 6. Anesthesia Machine 7. IV Pole 8. Surgery Table 9. Kick Bucket 10. Linen Hamper 11. Ring Stand 12. Mayo Stand 13. Instrument Table 14. Prep Stand 15. Case Cart 16. Chair 17. Nurse Station with monitor 18. Storage Cabinet, Clinical Supply, Printer 19. Glove Dispenser

ies

& n g i s

2 4

10 11

18 15

16 17

CUBICLES PATIENT CUBICLES SINGLE SINGLE PATIENTROOMS ROOMS

BAYS 60 SF BAYS 60 SF

3ft

ROOM DATA SHEET

t i l i c a F h

4ft of patient beds the bed to the 3ft stretchers or beds curtain wall and adjacant walls from the foot of between the sides from the foot of closed between the sides between paient 4ft of patient beds between thepatient beds 3ftpaient the bed to the 5ft the bed toof stretchers stretchers or beds or beds closed curtain wall and adjacant walls 5ft

600 SF SECTION 2000 - PHYSICAL PLANT

4ft

chairs and adjacent walls

3.7-3.4.3.1 PHASE I POST-ANESTHESIA RECOVERY ROOMS

between the sides between the walls The size and design of the surgical suite(s) shall be in accordance with 60 3ft SF and the sides and lounge chairs 4ft of individual programs and this regulation. The following basic elements, or stretchers the foot of lounge designed to ensure no flow of through traffic, shall be incorporated in all between the sides between chairs the walls SF chairs facilities: of lounge the sides and between the sides60 between3ft the and walls

ccordance with basic elements, orporated in all with in accordance ing basic elements, e incorporated in all

3ftwalls and foot of lounge

g n ti s Te

ROOM DATA SHEET

BED the foot of lounge chairs

22 24

3ft 23

between the walls and the sides and the foot of lounge chairs

FGI 2014 OPERATING ROOM: 250 SF OPERATING ROOM THAT REQUIRE ADDITIONAL PERSONNEL AND/OR LARGE EQUIPMENT: 600 SF DHEC 180 SF EXCLUSIVE OF FIXED AND MOVABLE CABINETS AND SHELVES

CEILING MOUNTED

CEILING MOU

ANESTHESIA

20. Surgical Lights

20. Surgical Li

21. Anesthesia Booms Flowmeter, Oxygen Flowmeter, Air Insufflator, CO2 Pump, Infusion, Rapid Pump, Infusion, Syringe Pump, Irrigation, Arthroscopic

21. Anesthesi Flowme Flowme Insufflat Pump, In Pump, In Pump, Ir

21 23

SURGERY

22. Lighting Booms, Monitor, Physiological, Anesthesia 23. Lighting Booms, Monitor, Physiological, EEG 24. Surgical Boom Electrosurgical Unit, Bipolar Integration System, Surgical Smoke Evacuation, Surgical Waste Disposal System, Surgical Fluid

22 24

SURGERY

22. Lighting B Monito 23. Lighting B Monito 24. Surgical B Electros Integrat Smoke E Waste D

111

OPERATING ROOM: 250 SF Facility Guidelines Institute. (2014). 2014 FGI Guidelines for Design and Construction of Hospitals and Outpatient Facilities. Washington, D.C.: Facility Guidelines Institute. OPERATING FGI 2014ROOM THAT REQUIRE ADDITIONAL PERSONNEL AND/OR LARGE EQUIPMENT: 600 SF OPERATING ROOM: 250 SF OPERATING ROOM THAT REQUIRE ADDITIONAL PERSONNEL DHEC AND/OR LARGE EQUIPMENT: 600 SF 180 SF EXCLUSIVE OF FIXED AND MOVABLE CABINETS AND SHELVES DHEC 180 SF EXCLUSIVE OF FIXED AND MOVABLE CABINETS AND SHELVES

DESIGN STUDY SMART ENVIRONMENTS

MAXIMIZE VISUAL AWARENESS IN THE O.R.

Smart environments are systems of interacting objects and parts that work together to self-organize and to manipulate outcomes based on technologies. They are interwoven systems that communicate with themselves and others and can change the physically built environment as well as qualities of certain environments.

POTENTIAL PRODUCTS, SYSTEMS & MATERIALS Smart environment

Technology

homes-is-ai-the-

& n g i s

m/tag/smart-

t-window/

s/wall-systems/

Figure 10

Figure 11

MULTIMODAL INTERFACES

APPLICATION IN THE OR

Connecting the built environment with touch and thought Wiring everything to be connected via hubs and motherboards Allows room for plug and play Live updates

+ + +

Figure 23

+ +

BLUETOOTH TECHNOLOGY

Connection to thought Real time communication with the built environment Could be provoked by thought, touch, movement, or otherwise

+ + +

s e i ilit + + + +

Figure 12

Figure 13

SAMSUNG SMART WINDOW APPLICATION IN THE OR

SMART GLASS

+ +

Allows flexibility with glass panels Can be used as window, computer screen, wallpaper image, communication Allows integration of multiple sources Allows window to out of room Use of technological blinds ANESTHESIOLOGIST

Streamline process + + +

+ + + +

Use for window between scrub sink and operating room Adapt and make larger for exterior windows or large glass wall Use as control station on interior of scrub sink window Use to control lights, sound, blinds, images, etc.

Electric, switchable glass for adjustable opacity Electro-chromatic technology Quick changeability Can be used in many settings such as commercial partitions, bathroom partitions, hygenic interios Can be programmed for certain times or can do at any time

+ + + +

c a F h

APPLICATION IN THE OR + + +

Changes visual awareness in the operating room Can be used for scrub sink window or windows from the corridor Increases privacy for patient satisfaction Allows natural light when opaque or transparent

alt

e H r o rf

STREAMLINE PROCESS CONTINUED STREAMLINE PROCESS CONTINUED ANESTHESIOLOGIST

e t n e C

ANESTHESIOLOGIST

Coding clinical content for provider

STREAMLINING CARE exchange + Clinical information + + + + + +

Time Line Flexible Time Comparison

+ + +

+ + + + +

Hands free storage Doors do not require opening with touch Enclosed, airtight solutions Enhances cleanliness Enhances infection control Easy Touch promotes self closing cabinets Less time for staff dealing with storage

+ Medical reconciliation pharmacy-+ Coding clinical content for provider clinic-hospital Clinical information exchange + Patientreconciliation registries Medical pharmacy+ + Promoting patient engagement clinic-hospital + + Managing stakeholder expectations Patient registries Promoting patient engagement + Managing stakeholder expectations + + Step 1: Map the Process

+ Everything/everyone is trackable Streamline people, information, + Optimal design layout for efficient materials staff flow Everything/everyone is trackable + Option for parallel Optimal design layoutprocessing for efficient + Integration of work between surgical staff flow teams and phases Option for parallel processing Integration of work between surgical teams and phases

+ + +

+ + + + +

Could track patient throughout procedure alerting family/ other staff Could track staff in operating room, showing time left, patient stats, etc Seamless integration into patient centered design Continuously update staff on patients welfare Creates streamline process to track activities in real time

Figure 29

Less touching of cabinets and furniture in the OR during surgery Utilize technology to solve storage issues and complexities Access more supplies in the OR Free up space in the OR for more important items Recessed storage for decreased impact on the floor plate of the OR Allow enhanced infection control Allow personnel to stay clean

Plug- and -play + + + + +

+ + + + + +

Figure 30

INTERCHANGEABLE COMPONENTS

Systems can be updated or reconfigured by simply changing individual parts Configurable to personal preferences Flexible and efficient Reduces number of larger systems by utilizing smaller components

Product design + + +

Linear work flow Intersect work flow Interval time

Figure 31

APPLICATION IN THE OR +

+ + +

Components on an information display could be configured to show exactly what the surgeon needs for a procedure More specialized monitors, sensors, or equipment can plug into generic stands or ports Components on surgical booms could be interchanged quickly or even during surgery Operating room can be reconfigured to suit the needs of a specific procedure or surgeon Various imaging equipment could be connected to a standard set of displays and controls Whole wall panels could be swapped for storage or windows

Figure 8 Figure 18

APPLICATION IN THE OR

Use bluetooth technology to connect wearable technology with hardwired technology Products on the market include: watches, glasses, ear phones, clips, virtual reality, smart clothing, etc. Endless possibilities for applications Connect user to what is happening in body Use as tracking devices for multiple activities

Figure 28

+ +

Figure 18 APPLICATION IN THE OR + Streamline people, information, APPLICATION materialsIN THE OR

Plug - and - Play refers to the ability to plug in a device or other entity into a larger system or network without the user having to reconfigure the system and/or devices.

Figure 17 Figure 17 STREAMLINING CARE

+ + +

Wirelessly connect printer, monitors, smart glass, windows, etc. Long lasting batteries, for long procedures and multiple procedures Create cordless environments for cleanliness and safety Seamlessly connect technologies Economical with low power Easy learning curve Can have multiple ranges for different operating rooms, procedures, devices

PLUG - AND PLAY APPLICATION IN THE OR HANDS FREE/ EASY- TOUCH

ANESTHESIOLOGIST

With the deepening of industrialization and progress, streamline process design is applied in many aspects of design and technology. There are many areas of the application that engage in this ANESTHESIOLOGIST process like commercial, industrial, manufacturing and others.The most significant benefit of streamlined process design areANESTHESIOLOGIST to optimize efficiency and effectiveness while not compromising and specific needs of the users. Withquality the deepening of industrialization and progress, streamline process design is applied in many aspects of design and technology. There are many areas of the application that engage in this ANESTHESIOLOGIST process like commercial, industrial, manufacturing and others.The most significant benefit of streamlined process design are to optimize efficiency and effectiveness while not compromising quality and specific needs of the users.

STREAMLINE PROCESS IN SURGICAL PHASE

De +

Figure 24

WEARABLE TECHNOLOGY

APPLICATION IN THE OR

Wirelessly connect devices using radio waves instead of wires Short range communication Uses piconets which are networks of devices connected using bluetooth devices, one is the controller and one follows the commands Can enter and leave range of radio waves Low Power, saves electricity and battery life Easy to use Low cost

g n ti s Te

AUTOMATIC DISPENSING

+ + + +

Compact Can pre measure supplies Can dispense different materials and liquids Non-permanent

Figure 10

APPLICATION IN THE OR + + + + +

Easily accessible supplies Sanitary holding Less waste with individual containers Out of the way design Error reduction

SILICONE COOKING MAT

+ + + +

Liquids will not bond or stain material Keeps liquid off material Can cook with at high temperatures Durable

APPLICATION IN THE OR + + + + +

Provide non slip surface for tools Can be sterilized at high temperatures safely Reusable Create non-slip trays Impact safety and instrument errors

EQUIPMENT | MOVABLE EQUIPMENT | SEMI-FIXED

EQUIPMENT | FIXED

EQUIPMENT | MOVABLE

g n ti s Te

“Surgical booms have become increasingly popular with the advent of min

is required.” (OR today) “Surgical booms have become increasingly popularequipment with the advent of minimally invasive surgery and integrated operating room equipment is required.” (OR today) “Surgical booms have become increasingly popular with the advent of minimally in

PRODUCTS, SYSTEMS & MATERIALS PALLET

equipment is required.” (OR today)

Equipment

Ceiling systems

http://ortoday.com/surgicalbooms-for-high-functioningrooms/

STRUCTURAL MODULE

& n g i s

RACEWAY MODULE

Figure 7 | Hunt Air Structure LIGHTING MODULE INTERMEDIATE BOOM STRUCTURE

STORAGE PRODUCTS & DESIGN

AIR DIFFUSER MODULE

Figure 4 | Lami-Air System

Figure 5 | Hunt Air Clean Suite OR Ceiling System 2

OVERVIEW

•

FIXED EQUIPMENT

• • • • • • • • • •

• •

Access panels Optional factory acceptance tests

+ + + + + + + + + +

Storage + +

Designated structural system Modular Flexible Med gas connections Fully-integrated equipment HEPA filtration Laminar flow Durable Hunt Air Precision Air Products

GLASS WALL SYSTEM 3

MFPHD FORTRESS MODULAR ROOM SYSTEM 4

CHARACTERISTICS

Floor system + + + + + +

Frame-less glass element Thermally toughened single-pane safety glass (SSG) Fastened to the substructure with the aid of support profiles Joints are optically and hygienically caulked with sealing tape and exchangeable joint profiles Resistant against extreme temperature fluctuations Resistant against impacts and bumps Hygienic large surface of the glass is emphasized by the one-section wall panels Hygienic large surface of the glass is

+ +

VINYL

e t n e C MATERIALITY

Lighting

• •

Homogeneous UV cured polyurethane coating and filled jasped chips Sheet product

CHARACTERISTICS

+ + +

Wears well Affordable Many styles to choose from Lacks warmth Dented or scratched by heavy objects Non-recyclable material Heat-weld required during installation Often in need of replacing Does not handle common wear and cleaning cycles well

Figure 47

+ -

emphasized by the one-section wall panels Optical trinity of the system is maintained but adapted to the glass material Images can be mounted behind the glass Items can be recessed within Humidity control is not knownTechnical specialty needed May cause reflection issue

+ + +

•

+ + + + + -

CHARACTERISTICS Technology

lt a e

+ + + + + + + + + + + + + + + +

Figure 41 | DUR-A-FLEX

Figure 42 | Heartland Regional Hospital

TERRAZZO

MATERIALITY

•

Resilient polyester resin and combinations of marble,glass and stone 2’X2’ tile or 2’X4’ FUSION system panels

CHARACTERISTICS

+ + + + + -

Reduced sterilization time between cases Shorter install time than terrazzo Reduced need for wall and floor repair vs other floor coverings Resilient and durable Sanitary cove base and transition wall Floors need sealing approximately every 6 months Requires chemical melding of 2’x4’ panel systems

Figure 48

MATERIALITY

• •

moisture-tolerant, self-leveling cementitious urethane base coat with a decorative vinyl chip broadcast Poured/painted on product

CHARACTERISTICS

+ + + -

Shock resistant Fire resistant Water resistant Floor must be thoroughly cleansed before installation, if not, the whole process must be repeated again Small cracks or chips may occur if heavy objects are droppeds

Figure 49 | Cleaning Lights

Small cracks or chips may occur if heavy objects are dropped

CHARACTERISTICS + + + -

Durable Easy to maintain and clean High Density: impenetrable by Water Surface is very slippery when wet Difficult to stand on for long periods of time Expensive Only certain professionals can install this type of floor

Figure 50 | Headlamps

Have recently transferred from Halogen to LED lights Often incorporates LCD touchscreens

CHARACTERISTICS

TYPES

+ +

•

Different lighting for specific tasks Cleaning is very important, different lighting systems to check hygiene in room Headlamps and Handheld lights create the opportunity for closer examination

•

Tables with instruments of different

Figure 58

MANUFACTURERS & PRODUCTS • •

mfPHD Continental Metal Storage

Figure 59

THE OR OF THE FUTURE PLOYED Cleaning systems • • • • • •

Holograms Echopixel VR Neuro Touch iPad surgical assistance Robot

Figure 60

Figure 61

HOLOGRAMS WITH ECHOPIXEL 2, 3 CHARACTERISTICS

CHARACTERISTICS

Real-time workflow process improvement. Clinical decision support systems combining patient specific data with intelligent devices to create a perioperative zone of safety. Measuring outcomes to inform “evidence-based” OR facility design

Displays a fully three-dimensional image of the holographed subject True3D Viewer for use in diagnostics and surgical planning Converts existing 2D medical imaging data (MRI, CT scans etc.) into fully interactive images Doctors can view manipulate and dissect body parts that are re-created in mid-air above an ordinary desktop Accurately displays complex anatomies and procedures Easier and intuitive means to process complex medical information Additional operation needed

+ + + + +

LUT | Xenon Light Source | Cables won’t get tangled ENOVA | LED Headlights | First company to use LED Headlights, lightweight, double padded, aluminum lamp for durability, adjustable

Figure 11

Figure 12

ULTRA-V 5

Specialty technician needed No extra space for equipment

Figure 13

Figure 14

STERAMIST 6, 7

SWIPESENSE SYSTEM 8

OVERVIEW

CONSIDERATIONS

•

+ + + + + +

+ + + +

•

System emits ultraviolet (UV-C) light to eliminate pathogens in a diverse range of clinical areas, reducing the threat of hospital acquired infections (HAIs). Designed with Spectrome technology, which analyses, measures and adjusts

Significantly reduces HAI risk Shortens treatment time Validated assurance Increases UV-C accuracy Operated by a single person Quick and easy to set up

+ + + +

Room is safe to enter within minutes of application Non-corrosive Leaves no residue No mixing or diluting required Does not damage electrical equipment

TYPESTYPES

• MAYO TABLE | The tr • • Tables with instruments of different BOOM | These • Dioxide, MAYONitrogen, TABLE sizesOR and EQUIPMENT for different purposes be removed in some sizes and for purposes RECONFIGURABL booms candifferent be multi-functional be to removed in Trolleys carrying different supplies and and •is helpful have a m • equipment Trolleys different supplies and different compone ideally carrying reconfigurable to the surgeons is helpful instrument table to h what type of surge and patient’s equipment • Specific medical needs equipment trolleys instrument tabl • DRESSING TROLLEY prefer MONITOR ARMS |of Have extra • •that Specific equipment trolleys dependmedical on the type surgery • or surgeon’s DRESSING TR helpful for organizatio displays besides possible on These come in differe being performed at time that depend onthe the type displays of surgery helpful for or nearby walls. These can be synced sizes with different draw • Allbeing floor equipment should have performed at the time These come in possibly height adjustable and talk to theshould otherand screens • wheels, Alltogether floor equipment have table configurations. sizes with differ have a braking making forsystem a truly efficient OR setup. WORK wheels, possibly height adjustable and• ANESTHESIA table configurat These screenssystem help the surgeons and Station for horizont have a braking • ANESTHESIA assistants to better see what they are workspace. Station for operating on and make highly informed • KICK BUCKET | Cani workspace. decisions away surgery sponges a • KICK BUCKET • MEDICAL GASES | Medical air, them. away surgery s Instrument air, Oxygen, Carbon them. •

OTHER LIGHTING +

Stainless steel construction Heavy-duty hardware Durable Option door locks Can provide visibility of stored items Pass through options into clean core Custom sizes Adjustable shelving Safety glass Easy to clean Recessable Modular Durable Air-tight Recessed edges Flexible for future adaptation

TYPES OF TECHNOLOGY EM-

MATERIALITY •

•

Patient data is not integrated and displayed to caregivers in a timely fashion and turnover time between cases is lengthy. Technologies designed to impact procedural medicine are often introduced in isolation, usually failing to improve efficiency and safety, or reduce costs. Accurate data capture and analysis, multidisciplinary teamwork and thoughtful integration of technology are the building blocks in this environment that optimize patient safety, overall comfort, staff satisfaction and financial efficiency. Future trends include minimally invasive surgery, Figure 54 | Continental Metal Storage Figure 51 | TRUMPF OR Mock Up robotic surgery, increase of image-guided procedures, tele-surgery, technologies and other endoscopic access techniques. Figure 52 | mfPHDimage-guided casework vascular accessFigure 53 | mfPHD casework

FortressTM Stainless Steel Pre-fabricated per hospital design Recessed edges to reduce horizontal edges where dust and contaminants can accumulate With the mfPHD Fortress Modular Room System, every wall panel is an access panel. Quick construction Easy to maintain Easily to adapt Strength and durability Cost is much higher than ordinary OR wall systems

EPOXY

•

SU-03 | Electro-hydraulic, height + adjustable, reverse Trendelenburg STERIS | AMSCO 3085 SP | Flexible, + can accommodate up to 1,000 lbs FIXED PATIENT TRANSFER UNIT | Assists in hand-off of patient smooth and efficient, reduced risk of accidents creates efficient flow

Most booms are semi-fixed equipment • Trumpf Booms help keep equipment that is • Steris needed for Medical every surgery off of the • Famed Solutions ground to reduce clutter • Maquet Can create a highly flexible OR • Medifa environment • Uzumcuwithout added clutter Semi-fixed but maintains future • Techartmed flexibility • Panalex Easy to clean • Mindray Cannot be completely reconfigured on • Takara Belmont demand • DRE • Heal Force • Eschmann • Magna Tek • Technomed

STORAGE PRODUCTS

FLOORAZZO

CHARACTERISTICS Visual precision is paramount Delivers sufficient light levels and render colors accurately Ability for dim lighting Very low-maintenance Fixtures must be easy to clean, sealed

•

CHARACTERISTICS CHARACTERISTICS TYPES CHARACTERISTICS MANUFACTURERS & PRODUCTS

MAQUET TABLE | ALPHAMAXX | + Adaption to patient body size, stable + even at different angles with a heavy patient FAMED MEDICAL SOLUTIONS | +

1,that 2 are prevalent in use and shows how the new technology is applied in the surgical process. This section introduces technologies

Figure 40 | matsinc.

GENERAL LIGHTING + +

+ + +

H r o f r

Figure 39 | Armstrong 5

•

TECHNOLOGY

Figure 76

+ +

TYPES

•

Sturdy Lightweight if possible, to allow nurses to disassemble Areas for attaching other pieces depending on the type of surgery being performed Comfort for the patient since the patient could be on the surgical table for hours at hand Ability to lean and turn at different angles High cost

e i t i l i c a F h +

Figure 75

Figure 32 | Dressin Figure | Medical Ga Figure 32 |29 Dressing Trolley

MOVABLE MOVABLEEQUIPMENT EQUIPMENT

SEMI-FIXED EQUIPMENT

e D s

CONSIDERATIONS

Directs airborne contaminants away from OR personnel Flexibility in equipment placement Various lighting options Visible connection points Facility maintenance benefits Room-side replaceable HEPA-filtration Room-side adjustable equalizer dampers Single point supply air connection Single point lighting electrical and control connections Flush lighting allows for fast sterile wipe-down Walkable ceilings

Figure | MAYO 26 |Table Trumpf Figure 28 Monitor Arms Figure 3131 |Figure MAYO Table

Figure | Steris Figure 27 |25 Amico OR Equipment Boom

Storage in the operating room is vast and far between yet there seems to be plenty of storage at the same time. The lack of designed storage methods and furniture seems to be the huge issue in most operating rooms. Many health systems utilize the Pyxis system of storage which intends to enforce supply management within the system. Items being stored include surgical supplies i.e., gloves, sutures, gauze, sterile items, etc. The storage should be easily visible, organized and able to be restocked easily. Storage systems employed should consider flexibility, modularity, future growth, cleanability, durability and materiality.

INDAPT CEILING SYSTEM 3

Wall finishes

Figure 24 | Famed Medical Solutions

Figure 23 | Maquet

Figure 6 | Hunt Air Light Integration

The only point-of-care hygiene system Affordable Easy to install Real-time reporting Electronic chip sensor accuracy Wearable product may affect operation

Development of OR prototype, simulation & mock-up

e t n e C

H r o f r

The second year of this project involved translating the research findings into design ideas and testing design ideas iteratively through OR mock-ups of increasing levels of fidelity. This project explored the use of a range of different mock-ups starting with tape on the floor to cardboard mock-ups and virtual reality. Orthopedic and pediatric clinical teams from MUSC enacted scenarios in the mock-up, which incorporated typical events that occur during surgical procedures. Each mock-up was tested in terms of its effectiveness to achieve the goals set out through design objectives and design guidelines. To facilitate this process systematically, an evaluation toolkit was developed. Design refinements were made based on the feedback received from the surgical team during the simulations.

& n g i s

e D s

e i t i l i c a F h

lt a e

g n ti s Te

DESIGN CHARRETTE

c a F h

e i t i il

e D s

& n g i s

g n ti s Te

PHASE 1

lt a e

e t n e C

H r o f r PHASE 2

PHASE 3

RESEARCH

PRACTICE

Multidisciplinary Dialogue

Evaluation of Design Objectives

DESIGN

Design Objectives

RESEARCH, EDUCATION AND PRACTICE PHASE 1

OVERARCHING OBJECTIVES

TAPE ON THE FLOOR

g n ti s Te

Design Guidelines

Preliminary Design

-Case studies to document best practices and emerging concepts -Literature review -Document analogous design examples -Innovations in materials, products and interior

-Physical site/context -Functional requirements/context -Spatial program -Performance criteria/guidelines -Develop and test tape on the floor mock-ups

Design Guidelines

Preliminary Scenarios and Evaluation Criteria

Design Guidelines

e H r o rf

alt

-Program -Site analysis

& n g i s

e D s

e i t i l i c a F h

-Comprehensive OR literature review -In-depth case studies -OR flow and processes

-Review existing evaluation frameworks -Develop OR mock-up evaluation framework -Develop enactment scenarios and tasks that can be used to test key design issues under consideration -Develop process for running mock-up evaluations -Summarize findings and translate

Scenario Enactment and Feedback -Design Reviews -Mock-up evaluations

Design Charrette

Phase 1

-Optimizing the ability to change over time -Sustainable strategies -Clinical outcomes and health & safety -Positive experience for all users -Efficiency & effectiveness

-Diagonal placement of the OR table supoprted smooth transtion of patient gurney to the OR table side -Doors shoud be located on the longer side of the room -Alcoved can accommodate mobile equipment -Both circulating nurse and anesthesia team need equivalent of one tall Pyxis for storage

e t n e C SELECTED KEY FINDINGS

DESIGN CHARRETTE

PHASE 2

PHASE 3

CARDBOARD MOCK-UP

REFINED CARDBOARD MOCK-UP

g n ti s Te

Design Development

Design Refinement

-Understand and resolve issues around materials and systems -Incorporate findings from phase 1 mock-up evaluation to refine design solutions

-Understand and resolve issues around materials and systems -Incorporate findings from phase 2 mock-up evaluation to refine design solutions

Preliminary Scenarios and Evaluation Criteria

Scenario Adjustments and Evaluation Criteria

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-Refine evaluation process based on experience -Develop refined scenarios and tasks to respond to specific design issues that need to be tested at this phase -Obtain data from OR observations that may inform location of key zones -Develop template for documenting findings from evaluations to facilitate quick summarizing

-Document findings and provide design recommendations -Refine enactment scenarios -Refine evaluation protocols and process -Run mock-up evaluations

Scenario Enactment and Feedback

e H r o rf

alt

-Design Reviews -Mock-up evaluations

Phase 2

-View from the scrub sink to the OR is necessary -Wall-mounted screens should be placed above the workstation -Storage doors should require less space -Wall-mounted screens are preferred by anesthesia team & surgeons for the distance provided between them & the screens -Circulating nurses favored mobile workstations -Angled bed position works well in different situations -Door location should be away from the sterile field

e t n e C

-Design reviews -Mock-up evaluations

Phase 3 -The “plug and play” feature should be advanced -Surgeon’s workstation should remain far from traffic -Must have two workstation -Phone and glove dispenser required for anesthesia zone -Anesthesia booms should be parallel and behind the anesthesia machine -The displays should be lowered to minimize head/neck movement -Sliding doors are favored to swing doors

PHASE I TAPE ON THE FLOOR MOCK-UP The studio design team developed four design proposals in separate groups, two of which were selected to be tested in the mock-up phase. The design options included two OR sizes of varying proportions. Location of the walls and doors were marked on the floor using blue tape. Some real equipment like OR table were brought in to test circulation patterns and adequacy of space. In order to test effectiveness of both the conceptual designs, clinicians were asked to enact tasks that simulate part of a surgery to test a few design features. The goal was to understand how these features potentially impacted space usage, clutter and flow within the OR.

Design criteria evaluated

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e D s

e i t i l i c a F h

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H r o f r

Room size and proportions

Number of doors, location and sizes

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Positioning of OR table and its orientation Placement and sizes of work zones Location of storage and its usability Simulation of equipment placement

g n ti s Te

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g n ti s Te

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Tape markings on the floor

e i t i l i c a F h

Positioning and orientation of equipment

H r o f r

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Demarcating door openings and thier locations on the floor

Ideation session

DN DN

PHASE I 1

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Necessary components and equipment for the next mock-up were identified.

Mock-up area

Flex Studio

CACC Studio

Location and placement of the OR table was determined. The angled position of the OR table provides ample circulation area and might help to optimize movement. Offsetting the surgical table from the centerline provides ample room for pivoting the stretcher when moving into the room, feet or head first.

Seminar

lt a e

H r o f r

MUD Studio

Storage Fac Off

Fac Off

Fac Off Fac Off

Crit Rm

Adj. Fac.

Crit Rm

Fac Off

2 A-5

Seminar

Lounge

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& n g i s

It was concluded that tape mock-ups arenâ&#x20AC;&#x2122;t the most accurate even though they allowed maximum flexibility of entrance and exit locations.

g n ti s Te DN

Key findings

Dir O

Reception

Lib Wk

Adm.

Library

Copy

Second floor plan of Charleston Design Center, Charleston

26’-0” 24’-0” 22’-0”

22’-0”

DOOR

lt a e

DOOR

H r o f r

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CACC Studio

Tape on the floor: Initial design configuration

g n ti s Te Flex Studio

DOOR

c a F h

26’-0”

s e i ilit 30’-0”

26’-0”

30’-0”

Flex Studio

& n g i s DOOR

DOOR

26’-0” 24’-0”

DOOR

Seminar

CACC Studio

Tape on the floor: Adjusted surgical table position & orientation

PHASE II INITIAL CARDBOARD MOCK-UP The studio merged two groups of four into a group of eight for the second phase. They came up with consolidated designs that used the same footprint as determined in the previous simulation. Full-scale prefabricated cardboard modules were constructed and assembled on site by the graduate students. The modular wall components of the mock-up facilitated testing and evaluation of multiple design options quickly and easily. This second iteration of the mockup tested concepts associated with ancillary induction and preparation rooms, along with work zones and equipment placement in preoperative, intraoperative and postoperative phases of orthopedic and pediatric surgeries.

Design criteria evaluated

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g n ti s Te

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H r o f r

Number of doors and their locations

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Locations of scrub sink

Storage for circulating nurse Storage for anesthesia team Location and design of circulating nurse station

Simulation of C-arm flow during surgical procedure

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g n ti s Te

Openings for viewing mock-up simulations

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Notetaking during simulation of equipment movement

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H r o f r

e t n e C

Scale-model of the operating room

Simulation of location of surgical table during surgical procedure

Key findings

alt

Location of the scrub sink next to the door was favored.

Key items and elements of wall displays were identified.

e t n e C

e H r o rf

In addition, the evaluation helped to identify how the design of the OR impacted sightlines essential for team communication, and how door positioning and equipment flow could potentially impact disruptions and raised infection-control issues, specifically in the sterile zone.

OPTION A

22' - 0"

A.Z. 13' - 0"

Placement of door at the top the room was preferred.

e i t i l i c a F h

e D s

S.Z.

26' - 0"

The need for a movable nurseâ&#x20AC;&#x2122;s workstation was confirmed, however a moveable surgeon workstation was not tested.

C.Z.

13' - 0"

& n g i s C.Z.

C GB&A

A.Z.

An angled bed position was confirmed as a positive element of the room, as it creates a work triangle for anesthesia. Moreover, it provides ample turning space for the OR stretcher in transfer.

g n ti s Te C GB&A

PHASE II

S.Z.

C 11' - 0"

11' - 0" 24' - 6"

OPTION A | FLOOR PLAN

15' - 0"

C GB&A

A.Z.

GB&A C

c a F h

OPTION C

A.Z.

C GB&A

OPTION A | PATIENT MOVING IN

A.Z.

C.Z.

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OPTION D

GB&A

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alt

S.Z.

GB&A

OPTION B

s e i ilit

C.Z.

GB&A

S.Z.

14' - 0"

C.Z.

S.Z.

A.Z.

14' - 0"

GB&A C

C.Z.

S.Z.

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A.Z.

g n ti s Te

C.Z. S.Z.

S.Z.

OPTION A | INTRAOPERATIVE

OPTION A | PATIENT MOVING OUT

PHASE III REFINED CARDBOARD MOCK-UP The design team took lessons learned and the experiences from the first cardboard mock-up and revised the OR design which was then translated into a refined cardboard mock-up. Most of the placeholder equipment from the previous mock was replaced with real OR equipment to allow users to understand space availability. This mockup was dedicated to testing and confirming the entry exit sequencing, location of doors, and location of induction and preparation room in relation to foot of the bed and scrub sink. Additional elements like the location of supplies, wall mounted displays and customized mobile circulating nurseâ&#x20AC;&#x2122;s workstation were tested. The orthopedic and pediatric clinicians enacted simulation scenarios that helped to evaluate the six design variations.

Design criteria evaluated

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g n ti s Te

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Scenario team huddle

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Number of doors preferred and their location against the sterile and circulating nurseâ&#x20AC;&#x2122;s workstation

H r o f r

Position of surgical table based on side of the surgery

e t n e C

Location of the scrub sink Content and location of digital displays to support situational awareness and team communication Storage for circulating nurse and anesthesia team

Simulation of entry and exit sequence with induction room layout

MOCK-UP DETAILS

MODULAR STAINLESS STEEL WALL MOTOR

OVERALL ASSEMBLYDETAILS MOCK-UP

CHANNEL FOR WHEEL BELT WHEEL

8" METAL STUD WALL - 16" O.C. 0' - 8"

NEOPRENE GASKET SEALS PELMENT MAINTAINE

1A.1

BATT INSULATION

0' - 8"

0' - 3 1/2"

OVERALL ASSEMBLY MOCKUP DETAILS

BRICK ANCHOR 2 " AIRSPACE VAPOR BARRIER EXTERIOR SHEATHING WALL TIE BRICK LEDGER COPPER FLASHING

1' - 3"

1B.2

GYP CEILING AT 10'-0" F.E. WITH BACKER ROD & SEALANT

0' - 9"

0' - 1 1/2"

MOTOR CHANNEL FOR WHEEL BELT

0' - 6"

0' - 9"

DOUBLE PANE GLAZING L-ANGLE BOLTED CONNECTION TO SS CLIP L-ANGLE BOLTED CONNECTION TO FACADE SKIN

MODULAR STAINLESS STEEL WALL

0' - 1"

WHEEL

8" METAL STUD WALL - 16" O.C.

NEOPRENE GASKET SEALS

0' - 8"

STAINLESS STELL

PELMENT MAINTAINE

0' - 6"

SECTION 2 4' - 3"

0' - 7"

0' - 9"

STAINLESS STEEL PANEL

0' - 1"

0' - 2 1/2" 0' - 9"

STAINLESS STELL

STAINLESS STEEL CLIP 2.5" AIR SPACE DOUBLE PANE GLAZING L-ANGLE BOLTED CONNECTION TO SS CLIP L-ANGLE BOLTED CONNECTION TO FACADE SKIN

0' - 2 1/2"

e D s FACADE SKIN FRAME

1 1/2"=1'-0" 4' - 3"

0' - 0 1/2"

1A.3

FRITTED GLASS FACADE

1A.2

EXTERIOR WINDOW DETAIL

7' - 0"

1/2"=1'-0"

2' - 1" 2' - 1"

3' - 11 1/2"

DOOR GUIDE

0' - 6"

SECTION 2

NEOPRENE GASKET SEALS

0' - 7"

0' - 2 1/2"

LEAD PANEL

e i t i l i c a F h 1B

DOOR GUIDE

1A.3

0' - 0 1/2"

Simulation of C-arm flow during surgical procedure 4' - 0"

0' - 3 1/2"

4' - 0"

alt

0' - 1"

26' - 0"

2B.1

0' - 1"

1B.1

2E.1

2B.2

4" LIGHT GAUGE STEEL STUD

METAL PINS 2' - 0 1/2"

POWDER COATED STAINLESS STEEL WALL PANEL CONNECTION FLANGE FOR WALL PANEL

POLYMER MATERIAL FILL IN THE GAP

CONNECTION FLANGE FOR WALL PANEL

METAL CEILING/GLASS CONNECTOR

4" LIGHT STEEL STUD

2' - 0 1/2"

Mock-up construction details

ARCH 8720 | ASSIGNMENT 5 POLYMER MATERIAL AIR ISOLATION LAYER STAINLESS STEEL LAYER ARCHITECTURE + HEALTH, SECOND YEARSFILL IN THE GAP FINISH 1/8" LEAH BAUCH, QIAN (KENNETH) DONG,4"AUSTIN FERGUSON, LINDSEY HOFSTRA DOUBLE LAYER WINDOW LIGHT STEEL STUD SCRUB SINK CONNECTION SEE DETAIL 2D.2 YINGCE (INGCE) HUANG, SHIRUI (MAX) LIN, ZHIQUIN (JANE) LIU, RACHEL MATTHEWS

SINK & DOOR ASSEMBLY

SINK & DOOR ASSEMBLY SANITARY COVE BASE

1/3" GLASS PANEL

MOTION ACTIVATED GLASS DOOR HINGE

COLUMN & CABINET ASSEMBLY

FLOORAZZO TILE

RUBBER AIRTIGHT SEAL

ADJUSTABLE SHELF BRACKET

METAL GLASS CONNECTOR

COLUMN & CABINET ASSEMBLY

MAQUET GLASS WALL PANEL

SANITARY COVE BASE

CONNECTION SCREWS

COLUMN & CABINET ASSEMBLY

1/2" GLASS DOOR

MOTION ACTIVATED GLASS DOOR HINGE

2D INTERIOR WINDOW DETAIL

1 1/2" FURRING CHANNEL

ADJUSTABLE SHELF BRACKET

FLOORAZZO TILE

1 1/2"=1'-0"

4" LIGHT GAUGE STEEL STUD

FIBER BATT FOR NOISE CONTROL

MAQUET GLASS WALL PANEL

SURGICAL BED 1' - 5"

0' - 4"

2B.1

SILICONE SEALANT

Simulation of sugical table position

STEEL CHANNEL BASE

2D INTERIOR WINDOW DETAIL

SANITARY COVE BASE

1 1/2" FURRING CHANNEL

COLUMN & CABINET ASSEMBLY Scenario enactment in physical mock-up

6" LIGHT GAUGE STEEL STUD

RUBBER PAD

SANITARY COVE BASE

FLOORAZZO

4" LIGHT GAUGE STEEL STUD

1 1/2"=1'-0"

4" CONCRETE SLAB ON 3" METAL DECK

STEEL JOIST

SURGICAL BED

2B WALL PANEL DETAIL 1 1/2"=1'-0"

RECESSED CABINET DETAIL 1 1/2"=1'-0"

FLOORAZZO TILE

1/2 " HOLLOW STAINLESS STEEL SHELF

STEEL CHANNEL BASE

0' - 4"

6" LIGHT GAUGE STEEL STUD

0' - 3"

SILICONE SEALANT

2' - 0"

1/2" STEEL MOUNTING PLATE

FLOORAZZO TILE

4" LIGHT GAUGE STEEL STUD

ANCHOR SCREW

8MM DIA. ANCHOR BOLTS

COLUMN & CABINET ASSEMBLY

ANCHOR SCREW

0' - 3"

1/2" GLASS DOOR

BED FLOOR PLATE 5" DIA. CORED HOLE

FLOORAZZO TILE 1/2 " HOLLOW STAINLESS STEEL SHELF

CONNECTION FLANGE FOR WALL PANEL CONNECTION SCREWS

2B.1

2x 6x SINK & DOOR ASSEMBLY

SCRUB SINK FINISH LAYER

RUBBER AIRTIGHT SEAL

0' - 1"

4" LIGHT GAUGE STEEL STUD

FIBER BATT FOR NOISE CONTROL

205

SCRUB SINK CONNECTION SEE DETAIL 2D.2

C CHANNEL

CONNECTION FLANGE FOR WALL PANEL

METAL GLASS CONNECTOR

205

SCRUB SINK FINISH LAYER

STAINLESS STEEL LAYER FINISH 1/8" 0' - 1"

MOTION ACTIVATED DOOR MOTOR

FLATSCREEN TV MONITOR

4" LIGHT GAUGE STEEL STUD

C CHANNEL

1/3" GLASS PANEL

4" LIGHT GAUGE STEEL KICKER POWDER COATED STAINLESS STEEL WALL PANEL

2D.1

ARCH 8720 | ASSIGNMENT 5 AIR ISOLATION LAYER ARCHITECTURE + HEALTH, SECOND YEARS LEAH BAUCH, QIAN (KENNETH) DONG, AUSTIN FERGUSON, LINDSEY HOFSTRA DOUBLE LAYER WINDOW YINGCE (INGCE) HUANG, SHIRUI (MAX) LIN, ZHIQUIN (JANE) LIU, RACHEL MATTHEWS

2D.1

PLASTER CEILING SYSTEM

MOTION ACTIVATED DOOR MOTOR FLATSCREEN TV MONITOR

0' - 4"

KEY PLAN

SINK & DOOR ASSEMBLY THE OPERATING ROOM

SINK &ROOM DOOR ASSEMBLY THE OPERATING

22' - 0"

1/4" CARRIAGE BOLT

0' - 5 1/2"

2B.2

METAL PINS

2x 6x

EXPLODED AXONOMETRIC EXPLODED AXONOMETRIC EXPLODED AXONOMETRIC EXPLODED AXONOMETRIC

1B.1

4" LIGHT GAUGE STEEL STUD

2x 6x

SINK & DOOR ASSEMBLY

BOOM

CEILING & BOOM DETAIL

4" LIGHT GAUGE STEEL KICKER

SINK & DOOR ASSEMBLY

2x 6x

2' - 0 1/2"

1 1/2"=1'-0"

PLASTER CEILING SYSTEM

METAL CEILING/GLASS CONNECTOR

2A.1

2E.1

1/4" CARRIAGE BOLT

2x 6x 2x 6x COLUMN & CABINET ASSEMBLY WALL ASSEMBLY

SINK & DOOR ASSEMBLY

BOOM MOUNT COVER

2E.1

0' - 0 1/2"

BOOM

22' - 0"

4" LIGHT GAUGE STEEL STUD

1' - 4 1/2"

2x 6x

SYSTEM FLANGE, TANDEM

0' - 0 1/2"

KEY PLAN

0' - 4"

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2' - 0 1/2"

2x 6xOVERALL ASSEMBLY

2x 6x

BOOM MOUNTING PLATE

0' - 2"

2A.1

SINK & DOOR ASSEMBLY

COLUMN & CABINET ASSEMBLY

ELECTRICAL JUNCTION BOX

0' - 0 1/2"

2B.1

SYSTEM FLANGE, TANDEM BOOM MOUNT COVER

INDAPT SYSTEM 2E.1

2x 6x

WALL ASSEMBLY

1' - 11"

0' - 5 1/2"

1' - 4 1/2"

1' - 10"

26' - 0" 1' - 10"

0' - 2"

MOCKUP DETAILS

BOOM MOUNTING PLATE

ELECTRICAL JUNCTION BOX

2x 6x

METAL CEILING SEE DETAIL 2B.2

STEEL MOUNTING BRACKET

SOFFIT BRACKET

2B.2

WALL ASSEMBLY

2x 6x

PLASTER CEILING STSTEM

BOOM MOUNTING PLATE

KIT, ADAPTER NUT, THREADED ROD, & HEX NUT

1' - 11"

1 1/2"=1'-0"

BOLT TO ABOVE STRUCTURAL GRID

INDAPT SYSTEM

CEILING & BOOM DETAIL

WALL ASSEMBLY

UNISTRUT GRID

2x 6x

WALL ASSEMBLY

METAL CEILING SEE DETAIL 2B.2

STEEL MOUNTING BRACKET

2x 6x

PLASTER CEILING STSTEM

BOOM MOUNTING PLATE

SOFFIT BRACKET

1 1/2"=1'-0"

EXTERIOR WINDOW DETAIL WALL ASSEMBLY

WALL ASSEMBLY

SLIDING DOOR DETAIL

BOLT TO ABOVE STRUCTURAL GRID

UNISTRUT GRID

KIT, ADAPTER NUT, THREADED ROD, & HEX NUT

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0' - 2 1/2"

NEOPRENE GASKET SEALS

1 1/2"=1'-0"

0' - 2 1/2"

VERMICULITE BOARD

2B.2

0' - 2 1/2"

STAINLESS STEEL PANEL

SLIDING DOOR DETAIL

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WINDOW FRAME CAULK

OVERALL ASSEMBLY WALL ASSEMBLY

0' - 20'1/2" - 1"

0' - 6"

SECTION 2

LEAD PANEL VERMICULITE BOARD

GYP CEILING AT 10'-0" F.E. WITH BACKER ROD & SEALANT

0' - 2 1/2"

0' - 1 1/2"

ASSISTANT HANDLE

OVERALL ASSEMBLY WALL ASSEMBLY

OVERALL ASSEMBLY

2' - 1"

DOUBLE LEAD GLASS

BRICK ANCHOR 2 " AIRSPACE VAPOR BARRIER EXTERIOR SHEATHING WALL TIE BRICK LEDGER COPPER FLASHING

OVERALL ASSEMBLY WALL ASSEMBLY

2' - 1"

OBSERVATION WINDOW (SMART WINDOW)

3' - 11 1/2"

BATT INSULATION

1B.2

1' - 3"

7' - 0"

1/2"=1'-0"

FRITTED GLASS FACADE OVERALL ASSEMBLY

0' - 8"

g n ti s Te 6x

OVERALL ASSEMBLY

FACADE SKIN FRAME

1A.1

1A.2 0' - 3 1/2"

OVERALL ASSEMBLY

STAINLESS STEEL CLIP 2.5" AIR SPACE

ASSISTANT HANDLE

0' - 3 1/2"

MOCKUP DETAILS MOCKUP DETAILS

MOCKUP DETAILS

MOCKUP DETAILS MOCKUP DETAILS

DOUBLE LEAD GLASS

MOCKUP DETAILS

OVERALL ASSEMBLY

WINDOW FRAME CAULK

OBSERVATION WINDOW (SMART WINDOW)

SECTION 2

MOCK-UP DETAILS

1' - 5"

2C SURGICAL BED ATTACHMENT DETAIL

BED FLOOR PLATE

5" DIA. CORED HOLE1 1/2"=1'-0" 8MM DIA. ANCHOR BOLTS

PHASE III Key findings

lt a e

Storage cabinets with one single door is preferred in the anesthesia zone.

The location of the mobile workstation was satisfactory, if provided with adequate storage

e t n e C

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14' - 3"

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e i t i l i c a F h

The location of storage cabinets for anesthesia team and circulating nurse were identified.

H r o f r

FLOOR PLAN | 1

A.Z.

26' - 0"

The need for further investigation into the notion of one ancillary room attached to the OR to be used for preparation of instruments for orthopedic cases or induction for pediatric cases was confirmed.

13' - 0"

g n ti s Te

C.Z. S.Z.

C 12' - 3 1/2"

OPTION A

12' - 3 1/2"

26' - 0"

Anesthesia Zone B Scrub Nurse Zone Circulating Zone

595 NSF

g n ti s Te FGI MIN | 400 SF SC a MIN DIMENSION | 20 FT

14' - 3"

A.Z.

S.Z.

14' - 3"

26' - 0"

22' - 0"

S.Z.

13' - 0"

C.Z.

13' - 0"

S.Z.

A.Z.

26' - 0"

12' - 3 1/2"

13' - 11"

587 NSF

FGI MIN | 400 SF SC c MIN DIMENSION | 20 FT INDUCTION

INDUCTION

OR INDUCTION

INDUCTION

SINGLE CORRIDOR INDUCTION

INDUCTION

OR INDUCTION

C GB&A

26' - 0"

C GB&A

C.Z.

12' - 3 1/2"

13' - 0"

12' - 3 1/2"

SC b

584 NSF

SINGLE CORRIDOR

Anesthesia Zone Scrub Nurse Zone Circulating Zone

OPTION B

S.Z. C GB&A

14' - 3"

A.Z.

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

e t n e C

15' - 0"

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OPTION C

14' - 3"

C.Z.

S.Z.

13' - 0"

SINGLE CORRIDOR

Anesthesia Zone Scrub Nurse Zone Circulating Zone

12' - 3 1/2"

22' - 0"

e D s

e i t i l i FLOOR PLAN |5 c a F h C

alt

& n g i s GB&A

SC b

FLOOR PLAN | 3+4

22' - 0"

SINGLE CORRIDOR OR

FLOOR PLAN | 3+4

A.Z.

12' - 3 1/2"

S.Z.

22' - 0"

14' - 3"

A.Z.

FLOOR PLAN | 1+2

OPTION D

Anesthesia Zone Scrub Nurse Zone Circulating Zone

12' - 3 1/2"

15' - 0"

EVALUATION PROTOCOL MASTER PROTOCOL Three sessions of mock-up evaluations were conducted during the iterative design process. To evaluate the variations of the mocked-up prototypes, an evaluation toolkit was developed. The evaluation toolkit helped to gather feedback from the simulations in a structured manner to inform the next phase of the design process.

Overview of goals, scenarios and design feature tested

Scenario details for each surgical phase Evaluation objectives Scenario tasks Equipment and supplies list Design features tested Evaluation questions Photo protocol

The evaluation tool included an overall framework for conducting evaluations that contained:

Master protocol

Simulation director’s guide

Note takers template

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H r o f r

& n g i s

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g n ti s Te

Appendix Stakeholders Equipment used for each scenario

Task/scenario Patient entry into room and transfer to surgical table Pre-operative positioning of teams and equipment (based on procedure map) Preoperative tasks for different team members  Anes task related to accessing storage  Circulating nurse/scrub task related to accessing internal OR storage  Time out – look at large screen as a team to go through time out. Circulating nurse directs time out from her table? Transition from pre-operative positioning to intra-operative positioning of teams and equipment  Team members will orient themselves and the equipment to align with the different side of the surgical table  Teams simulate intra-operative position and tasks  Teams simulate specific tasks that may require them to view the large screen  Team simulate specific task that requires the anesthesiologist to access supplies, dispose trash Transition from intraoperative to postoperative positioning of teams and equipment  Scrub simulate disposal of trash  Circulator – epic documentation  Surgeon- epic documentation

Design features tested Door location Sidedness and impact on the CN and sterile zone location Sink location Distance to anesthesia storage for anesthesia team Ease of accessing storage (any obstructions?) Access to large screen for information

Surgical table sidedness Access to anes storage Access to circulating nurse storage Number and location of large screens and monitors Type of information that would be useful to display

Surgical work station location Circulating nurse workstation Display screen needs

Patient is transferred from room  Room clean up  Team discussion re next patient

Door size Door location Surgical table sidedness

Turnaround/room set up  Incomplete case cart – nurse has to obtain supplies, instruments from core  Instrument tray sterility problems – replace or run emergency sterilization load

Door location Storage location

SIMULATION DIRECTORâ&#x20AC;&#x2122;S GUIDE

NOTE TAKERS TEMPLATE

g n ti s Te

Pre-brief and recap of last evaluation

Floor plan of configuration being tested

Meeting goals

Participant contribution

Evaluation scenarios Task Design features tested

Checklist for each scenario phase Task Evaluation question Yes/No check box Notes

c. How often during a surgery would you need to get those? Debriefing questions d. Is there anyone else on the team who would need to get to the supplies located

c a F h

in this anesthesia cabinet? e. Is the location of storage near the CN convenient for everyone on the team? f. Are there any obstructions to using the CN storage? g. Where do you want the storage in the room? h. How much needs to be in the room?

alt

ENACTMENT: You will be playing a number of scenarios, which helps us evaluate the effectiveness of the adopted design strategies in the OR. You will not be evaluated on how you perform task, but we will be looking at the space accommodation for the tasks to which you are assigned. Before enacting each scenario, we will review the scenario and read it aloud to remind the details that may have been missed.

r o rf

DISCUSSION/FOCUS GROUP: During the enactment, we will be asking the players and observers to discuss some of the topics that need more input and explorations. These topics are the location and quantity of storage for anesthesia personnel and CN, location and content of the displays, and number of door to separate the travel paths for the CN and patient, and surgical table sidedness.

e t n e C

THINK ALOUD: While acting you may express your thoughts on the action needed and how you see the space supporting or hindering that. For example, if I were enacting the role of a nurse in the scenario and was hooking up an IV pump that needs to be plugged in, I might say that I need to plug in the pump and that there are no conveniently located electrical outlets. There are no right or wrong comments, so please speak freely. If you forget to state your thoughts out loud, I may occasionally prompt you to continue to do so. DEBRIEF: If you forget to mention something during a scenario, you will also be given an opportunity to have a reflective conversation through debriefing at the end of each scenario. For those involved in the scenario, I will be conducting the debriefing. For observers who were not directly involved in the scenario, [insert name of debriefing facilitator] will be conducting the debriefing session. For all design options: Jake to introduce the overall scenarios and tasks to all team members and then have them run through the surgery. Direct the team when they should transition from one stage (pre-op) to next. Try to remove yourself from what you have always done. Build upon your experience

e D s

e i t i il 4

& n g i s

Detailed debriefing questions for each plan Common debriefing section (open ended)

PREOPERATIVE PHASE PREOPERATIVE PHASE

Task

Evaluation question

Bed transfer

Does the transfer bed move through the room and rotate easily given the amount of space and surgical table placement and surgery sidedness? Is there enough space around the surgical table and gurney to facilitate transfer of patient? Is there anything that is blocking the anesthesia provider when they move from the anesthesia workstation to the supplies?

Stretcher brought in

Anesthesia task related to accessing storage (TBD)

Are there any bumps or challenges maneuvering the gurney? Is there a clear path of movement from the door to the surgical table?

check Notes

Where is the ideal storage location for the anesthesia personnel? How much storage is needed for the anesthesia personnel?

Surgeon enters and reviews patient information at surgical workstation. Discusses surgery with team members

Is there a clear path of travel for the surgeon to access the workstation? Is there enough space around the surgical workstation for the surgeon to confer with team members? Does there appear to be any conflict when the surgeon and nurse are at the shared workstation at the same time?

Time Out on large screen in the room

Is the circulating nurse able to lead the time out discussion from her station? Can all team members view the timeout screen?

Additional questions and notes:

FINAL DESIGN Anesthesia Storage

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

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

Angled OR table position

Scrub Sink Window

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

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

22' - 0"

15' - 0"

& n g i s

Parallel processing INDUCTION 206 SF

C.Z.

13' - 9"

S.Z.

ALCOVE 206 SF

C GB&A

26' - 0"

lt a e

H r o f r C

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

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

Provision of sufficient circulation area

Circulating Nurse Workstation

Integrated Digital Information Displays

Optimize movement and flow in the operating room

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

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

S.Z.

13' - 9"

14' - 3"

Integrated Digital Information Displays

A.Z.

C GB&A

e t n e C

c a F h

s e i ilit 6' - 0"

14' - 3"

O.R. 579 SF

S.Z.

14' - 3"

De C GB&A

A.Z.

g n ti s Te

Flexible room/suite chassis

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

13' - 9"

Anesthesia Workstation

PA C

INDUCTION | TOP ENTRY FROM ALCOVE RENDER 2

e D s

& n g i s

lt a e

e i t i l i c a F h

H r o f r

e t n e C

Rendering of final design

g n ti s Te

DEVELOPMENT OF DESIGN GUIDELINES

g n ti s Te

The development of design guidelines began during the design charrette with identifying the aim of the project to be quality and safetyin the OR. This aim was informed by five Evidence Based Design (EBD) goals. The design guidelines that were developed throughout the design process to address multiple evidence-based design goals. Each guideline was expanded upon with definitions, significance and implementation strategies.

& n g i s

The design guidelines served as a means of informing the design process as well as a future way to evaluate the design, and are reflected in many of the design decisions that were ultimately made.

e D s

EVIDENCE-BASED DESIGN GOALS

e i t i l i c a F h

OPTIMIZE THE ABILITY TO CHANGE OVER TIME OPTIMIZE SUSTAINABLE STRATEGIES

Maintain staff retention and satisfaction in the work place.

lt a e

H r o f r

OPTIMIZE CLINICAL OUTCOMES, HEALTH & SAFETY

e t n e C

Spatial continuity from operation to operation, day to day and future growth

Maintain patient comfort and satisfaction of services and, environmental interactions

Assessment of recovery time, surgery effectiveness, minimize patient readmission due to error Protecting staff and patient well-being, avoiding preventable complications, etc

OPTIMIZE POSITIVE EXPERIENCE FOR ALL USERS

Maintain staff retention and satisfaction of work place

OPTIMIZE OPERATIONAL EFFICIENCY & EFFECTIVENESS

Maximizing patient and staff outcomes while minimizing errors, time, and need for redundancy in the operating room

Maintain patient comfort and satisfaction of services

QUALITY & SAFETY IN THE OR

PROJECT VISION

e D s

EVIDENCE-BASED DESIGN GOALS

e i t i l i c a F h

OPTIMIZE EFFICIENCY & EFFECTIVENESS

lt a e

e t n e C

H r o f r

DESIGN GUIDELINES

& n g i s

g n ti s Te

PLAN THE O.R. TO OPTIMIZE MAXIMIZE VISUAL MOVEMENT AND AWARENESS IN THE O.R. FLOW

OPTIMIZE CLINICAL OUTCOMES AND HEALTH & SAFETY

PROVIDE INTEGRATED DIGITAL INFORMATION DISPLAYS IN MULTIPLE

LOCATIONS

MINIMIZE INSTITUTIONAL CLUTTER

OPTIMIZE POSITIVE EXPERIENCE FOR ALL USERS

PROVIDE APPROPRIATE & CONTROLLED ACCESS TO DAYLIGHT

OPTIMIZE SUSTAINABLE STRATEGIES

PROVIDE FLEXIBLE & CONTROLLABLE ARTIFICIAL LIGHTING

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

DESIGN GUIDELINES OPTIMIZE MOVEMENT AND FLOW

g n ti s Te

Minimize unnecessary effort, trips and steps by clinical staff engaged in surgical procedures, as well as reduce conflicts in movement patterns.

& n g i s

Why it is important: Planning the OR to optimize movement and flow: • Reduce unnecessary movement and steps • Reduce flow disruptions (Beldi et al., 2009; Broom et al., 2011; Bulitta, 2012; Chauveaux, 2015; Elbardissi, 2012) • Reduce door opening (Panahi et al., 2012)

e D s

How we addressed it:

lt a e

e i t i l i c a F h

Table Position: Surgical table is positioned diagonally and asymmetrically off-center in the room (Panahi et al., 2012) • •

Provides greater space for movement of staff between the room entry and their work areas Enables an efficient workspace for anesthesia staff and minimizes wasted space behind the anesthesia machine

H r o f r

Room Zoning: The room is organized into clear zones or quadrants:

e t n e C • • •

Anesthesia work zone [AZ] Sterile zone [SZ] Circulation zone [CZ]

REVISED CONFIGURATION 22' - 0"

C GB&A

A.Z.

O.R. 579 SF

e i t i l i c a F h E

S.Z.

13' - 9"

22' - 0"

14' - 3"

15' - 0"

14' - 3"

CONTROL ROOM 206 SF

ALCOVE 204 SF

C.Z.

S.Z.

C.Z.

C GB&A

ALCOVE 212 SF

13' - 9"

S.Z.

S.Z. 26' - 0"

14' - 3"

PREP 206 SF

26' - 0"

C.Z.

O.R. 579 SF

A.Z. O.R. 579 SF

S.Z.

13' - 9"

A.Z.

O.R. 579 SF

S.Z.

14' - 3"

26' - 0"

14' - 3"

15' - 0"

C.Z.

ALCOVE 212 SF

S.Z.

C.Z.

CONTROL ROOM 206 SF

ALCOVE 204 SF

S.Z.

C.Z. 13' - 9"

S.Z.

O.R. 580 SF

S.Z.

13' - 9"

PREP 206 SF

14' - 3"

S.Z.

14' - 3"

A.Z. O.R. 580 SF

14' - 3"

S.Z.

C GB&A

A.Z.

O.R. 580 SF

13' - 9"

A.Z.

13' - 9"

C.Z.

22' - 0"

C GB&A

INDUCTION

8' - 0"

14' - 3"

e t n e C A.Z.

S.Z.

14' - 3"

r o rf 2

C GB&A

INTRAOPERATIVE

A.Z.

35' - 9"

6' - 0"

He 14' - 3"

S.Z. C

22' - 0"

INDUCTION 206 SF

C.Z.

C GB&A

alt

S.Z.

INDUCTION SHARED ALCOVES

SINGLE CORRIDOR C.Z.

C.Z.

ALCOVE 204 SF

O.R. 580 SF

S.Z.

INDUCTION 206 SF

14' - 3"

A.Z.

13' - 9"

S.Z.

INDUCTION 206 SF

C.Z.

13' - 9"

C.Z.

14' - 3"

S.Z.

ALCOVE 204 SF

C GB&A

6' - 0"

S.Z.

C GB&A

S.Z.

14' - 3"

PATIENT PREPARATION 1

O.R. 580 SF

13' - 9"

C GB&A

A.Z.

28' - 0"

e D s

A.Z.

SHARED ALCOVE 416 SF

S.Z.

C GB&A

C.Z.

14' - 3"

S.Z.

14' - 3"

6' - 0"

14' - 3"

S.Z.

C.Z.

S.Z.

26' - 0"

C GB&A

& n g i s B

C GB&A

O.R. 579 SF

14' - 3"

13' - 9"

6' - 0"

14' - 3"

ALCOVE 206 SF

S.Z. 26' - 0"

14' - 3"

26' - 0"

C.Z.

S.Z.

C GB&A

A.Z.

C GB&A

A.Z.

g n ti s Te 15' - 0"

13' - 9"

15' - 0"

8' - 0"

C GB&A

22' - 0"

35' - 9"

C GB&A

22' - 0"

6' - 0"

MOCK-UP CONFIGURATION

POSTOPERATIVE

CLEAN CORE

PARALLEL PREP PROCESSING

CONTROL ROOM

DESIGN GUIDELINES FLEXIBLE ROOM/SUITE CHASSIS

g n ti s Te

The “chassis” includes the most stable elements of the space such as floor to floor height, column bay spacing, structural support systems for equipment, primary MEP distribution systems as well as the planning dimensions of the OR and overall surgical suite.

Why it is important:

e i t i l i c a F h

e t n e C • • • • •

13' - 9"

14' - 3"

S.Z.

C.Z. 6' - 0"

Single corridor, clean core, or work core surgical suite 579 NSF OR 22 x 26 clear floor area with thickened walls Multiple potential door locations Accommodates adjacent induction, control or equipment rooms Overhead MHED structural grid

14' - 3"

How we addressed it: •

lt a e

H r o f r

(Allison et al.,2015)

A.Z.

A.Z. 14' - 3"

Change occurs at multiple frequencies: over the duration of a patient procedure, across various types of surgical procedures, and over the life of the facility. Reduce down time and disruption to the surgical suite during reconfiguration.

13' - 9"

(Buffoli & Capolongo, 2012; Kendall, 2007;

35' - 9"

26' - 0"

•

e D s 22' - 0"

Carthey, 2010; Allison et al., 2015)

•

& n g i s

C GB&A

Rapid ever increasing rate of change in IT and surgical technologies, interventional procedures, and care processes.

C GB&A

•

BASIC ROOM CHASSIS WITHOUT ANCILLARY SPACES

S.Z.

SINGLE CORRIDOR

22' - 0"

2 35' - 9" 8' - 0"

A.Z.

O.R. 579 SF

S.Z.

28' - 7"

S.Z.

A.Z.

S.Z.

2 6' - 0"

O.R. 580 SF

S.Z.

C.Z.

28' - 7"

A.Z.

S.Z.

O.R. 579 SF

S.Z. S.Z.

C.Z.

O.R. 580 SF

A.Z.

S.Z.

C.Z.

S.Z.

C GB&A

A.Z. 6' - 0"

O.R. 580 SF

S.Z.

C.Z.

S.Z.

C.Z.

S.Z.

A.Z.

S.Z.

C.Z.

O.R. 579 SF

A.Z.

C GB&A

8' - 0" 35' - 9"

22' - 0"

WORK CORE

C.Z.

S.Z.

A.Z.

C.Z.

S.Z.

A.Z.

S.Z.

C.Z.

S.Z.

6' - 0"

C.Z.

S.Z.

A.Z.

S.Z.

A.Z.

C.Z.

S.Z.

A.Z.

22' - 0"

28' - 8"

A.Z.

S.Z.

C.Z.

S.Z.

C.Z. 22' - 0"

C GB&A

S.Z.

A.Z.

S.Z.

C.Z.

S.Z.

O.R. 579 SF

A.Z.

C GB&A

C.Z.

S.Z.

6' - 0"

C.Z.

C GB&A

S.Z.

SINGLE CORRIDOR

INDUCTION

Induction Shared Alcove

A.Z.

SINGLE CORRIDOR

INDUCTION

C.Z.

SINGLE CORRIDOR

S.Z.

C.Z.

S.Z.

A.Z.

28' - 8"

A.Z.

S.Z.

A.Z.

SINGLE CORRIDOR

23' - 8"

C.Z.

S.Z.

C.Z.

A.Z.

r o rf

e t n e C

e D s

il tie

18' - 0 1/2"

i c a F h

alt

& n g i s PREP

INDUCTION

C GB&A

19' - 4"

Prep Shared Alcove

17' - 10 1/2"

PREP

23' - 10 1/2"

Control Room

23' - 7"

20' - 8"

O.R. 580 SF

Induction

CONTROL ROOM

INDUCTION

S.Z.

CONTROL ROOM

S.Z.

INDUCTION

CONTROL ROOM

g n ti s Te

PREP

A.Z.

INDUCTION

23' - 7"

INDUCTION

Prep

No Ancillary Rooms

SUITE OPTIONS

PREP

C.Z.

PREP

CONTROL ROOM

S.Z.

INDUCTION

INDUCTION | SHARED ALCOVE PREP | SHARED ALCOVE

C GB&A

PREP

CONTROL ROOM

INDUCTION

NO ANCILLARY ROOMS PREP OPTIONS FOR ADJACENT SUPPORT SPACES

CLEAN CORE

DESIGN GUIDELINES INCORPORATE PLUG & PLAY SYSTEMS

g n ti s Te

Optimize the ability to easily and quickly replace, repair of reconfigure finish, furnishing and equipment [FFE] elements that may need to change frequently over the course of yearly or daily operations.

& n g i s

Why it is important: •

e D s

Rapid and ever increasing rate of change in surgical technologies, procedures, and care processes. (Allison et al., 2015; National Research Council, 1993)

• • •

Change occurs at multiple frequencies: over the duration of a patient procedure and across various surgical procedures Reduce down time and disruption to the operation of the surgical suite during routine maintenance, repair reconfiguration. Decrease hazards and improve safety during maintenance, repair and replacement

lt a e

(Matern & Koneczy, 2007; Patkin, 2003)

•

Enhance operational utilization of the room & suite

H r o f r

How we addressed it:

e t n e C • • • •

e i t i l i c a F h

Prefabricated wall systems Recessed modular storage cabinets Plug and play surgical booms Mobile staff workstations

& n g i s

g n ti s Te

Source: http://www.modularhospitech.com/prefabricatedmodularot.html

e D s

Maquet Glass Modular Wall System

e i t i l i c a F h

https://hospital-solutions.maquet.com/int/reference-projects/melbourne-australia/

Proposed High Fidelity Mock-Up

lt a e

H r o f r

e t n e C

TRUMPF booms with exchangable components https://www.trumpfmedical.com/globalassets/pdf/brochures/us-english/197886r1-truport_brochure_us-hr.pdf

Source: http://www.zovameurope.it/tavoli-operatori/modulo-tavolo-operator Modular furnishings and flexible equipment ani-trasferibili http://www.zovameurope.it/tavoli-operatori/modulo-tavolo-operatorio-modulare-a-piani-trasferibili

DESIGN GUIDELINES MAXIMIZE VISUAL AWARENESS IN THE OR

g n ti s Te

The OR is a complex milieu in which the optimal performance of the surgical team relies on the exchange of different kinds of information at different times and the monitoring, input and output of information.

& n g i s

Why it is important: •

Enhance teamwork and communication

e D s

(Watkins et al., 2011)

•

Reduce distractions (Watkins et al., 2011)

•

e i t i l i c a F h

Optimize/minimize staff movement and flow (Lu, 2010)

•

Enhance performance

(Matern & Koneczny, 2007; Pati et al., 2008; Rashid, 2009; Wahr et al., 2013)

•

Discourage adverse events

lt a e

(Watkins et al., 2008)

How we addressed it:

H r o f r

• Room Organization The OR table, view windows and glazed doors are positioned for visualization within and from outside the room. The scrub sink is positioned to visualize the sterile field

e t n e C

• Mobile Workstation A mobile circulating nurse workstation can be oriented and repositioned as needed if the OR table or surgical team is repositioned • Digital Displays Digital displays are located high on the walls around the room to be in the field of view from each staff work position

22' - 0"

1 A

& n g i s C

G B&A

O.R. 579 SF

e D s

4 1

e t n e C

H r o f r

1 SURGEON

2 SCRUB AREA

INDUCTION 206 SF

5 G B&A

lt a e

ALCOVE 212 SF

26' - 0"

e i t i l i c a F h

g n ti s Te 2

3 SURGEON

4 ANESTHESIA TEAM

5 CIRCULATING NURSE

OR: PEDIATRIC WITH INDUCTION ROOM

DESIGN GUIDELINES APPROPRIATE & CONTROLLED ACCESS TO DAYLIGHT & VIEWS Provide access to daylight and views to nature directly in the Operating room or indirectly through interior windows and borrowed daylight from adjacent spaces.

& n g i s

Why it is important: •

Improve health and reduce stress for staff (Azmoon et al., 2013; Duffy & Chan, 2002; Harris et al., 2002; Leather et al., 1998)

• • •

e D s

Improve staff and patient satisfaction (Alimoglu et al., 2005; Küller et al., 2006; Van Bonment & Van den Beld, 2004)

e i t i l i c a F h

Improve staff performance Improve patient outcomes (Alimoglu et al., 2005)

How we addressed it:

g n ti s Te

Inspiration: Community Hospital Brandenburg, Germany

• Window Wall Incorporation of either a full or partial floor-to-ceiling window wall opposite the entry side of the room.

lt a e

H r o f r

• Borrowed Light Provide borrowed light from the corridor when the suite design does not permit a window in each room

e t n e C

• Daylight/Privacy Control Provide window design that controls for glare and privacy, and enables darkening the room when necessary for certain surgical procedures. • Thermal Control Window systems to prevent condensation at the glazing surface. Rendering of the design

& n g i s

g n ti s Te

e D s

e i t i l i c a F h

lt a e

H r o f r

e t n e C

Revised Plan Configuration

DESIGN GUIDELINES INTEGRATED DIGITAL DISPLAYS IN MULTIPLE LOCATIONS

g n ti s Te

Enable each surgical team member to visualize real time patient status data, digital imaging and/or video feeds of the actual procedure from one or more locations. Also enable projection of virtual views to nature.

& n g i s

Why it is important: •

e D s

Enhance staff performance (Marcos et al., 2006)

•

Enhance teamwork and communication

e i t i l i c a F h

(Sanderson et al., 2005)

•

Provide opportunity positive distractions before induction (Quan et al., 2012)

How we addressed it: • • • •

H r o f r

lt a e

Wall-mounted displays Smart window Wearable monitors OLED Display surfaces

e t n e C

& n g i s

g n ti s Te

e D s

e i t i l i c a F h

lt a e

H r o f r

View from Scrub Sink through smart window

e t n e C

ELEVATION A

ELEVATION B

DESIGN GUIDELINES MIMINIZE INSTITUTIONAL CLUTTER

g n ti s Te

Minimize or organize the myriad of discrete equipment, cords, and cables that contribute to visual complexity of the work environment, makes it difficult and time consuming to clean, and contributes to hazards and task disruptions. (Hirsch, 2008; Fraind et al., 2002; Wahr et al., 2013, Brogmus et al., 2007; Drebit et al., 2010; Matern & Koneczny, 2007)

& n g i s

Why it is important: • •

(Hirsch, 2008; Fraind et al., 2002; Wahr et al., 2013)

•

e i t i l i c a F h

Decrease hazards

(Brogmus et al., 2007; Drebit et al., 2010; Matern & Koneczny, 2007)

• •

Improve clean-ability Improve room turnaround time (Matern & Koneczny, 2007)

•

H r o f r

Minimize horizontal surfaces and surface articulations Flush Wall Surfaces Modular stainless steel or glass panel walls with flush trim at openings Flush mounted wall elements Displays, control devices and objects are flush with the wall surface Recessed Storage Storage cabinets for anesthesia and the circulating nurse are recessed and flush Cable and Tube Management Wireless data interfaces , electrical cords and connecting gas lines to movable equipment and tools are minimized, organized and off the floor.

e t n e C • • •

lt a e

Reduce intimidating appearance for patients

How we addressed it: • •

e D s

Decrease visual distractions and complexity Decrease flow disruptions

& n g i s

g n ti s Te

e D s

e i t i l i c a F h

lt a e

H r o f r

Patient vitals via Samsung Transparent Smart Glass Technology

e t n e C ELEVATION A

Glass wall panels for circulating nurse “Whiteboard”

ELEVATION B

Laparoscopic View for Surgeons / Residents

ELEVATION C

Surgical Safety Checklist

View over Control Panel via Samsung surgical site for Transparent Smart Glass Anesthesia team Technology

ELEVATION D

DESIGN GUIDELINES FEATURES TO MINIMIZE CONTAMINATION

g n ti s Te

Provide both passive and active features to minimize surface and airborne contamination and make the room easy to clean and disinfect.

& n g i s

Why it is important: •

e D s

Reduce bacterial load and infection rates (Frabetti et al., 2009; Leest et al., 2012; Friberg et al., 1999; Scaltriti et al., 2007)

•

Make the OR easier and quicker to effecively clean

e i t i l i c a F h

(Frabetti et al., 2009)

•

Reduce turn over time between cases

How we addressed it:

lt a e

ACTIVE FEATURES • Spectrum lighting • Clean indicators • Hands free automatic sliding doors

H r o f r

PASSIVE FEATURES • Glass/stainless steel modular wall systems • Flush mounted touch screen control systems • Minimized institutional clutter • Minimized horizontal surfaces • Antimicrobial high touch surface materials • Recessed storage units • Overhead booms

e t n e C

& n g i s

g n ti s Te

e i t i l i c a F h

e D s

Control Panel System

Indigo Clean Light

SOURCE: http://www.htgroup.de/en/products-solutions/ it-solutions/ht-control.html

SOURCE: http://www.prweb.com/releases/2017/03/ SOURCE: https://thedoctorweighsin.com/best-of-the-best-vendor-displays-at-himss16/ prweb14194083.htm

lt a e

H r o f r

e t n e C

Samsung - Transparent Smart Window OLED Display

Maquet Glass Wall System SOURCE: https://hospital-solutions.maquet.com/int/room-equipment/glass-wall-system/

DESIGN GUIDELINES FLEXIBLE & CONTROLLED ARTIFICIAL LIGHTING

g n ti s Te

Flexibly accommodate a wide range of lighting “scenes” necessary to optimally support various critical activities in the execution of a surgical procedure and the turnover of the room for the next case.

& n g i s

Why it is important: • •

e D s

Improve clinical outcomes Enhance staff performance

(Dascalaki, 2009; Knulst et al., 2011; Küller et al., 2006; Mardaljevic et al., 2009; Okoro et al., 2007; Patkin, 2003)

•

e i t i l i c a F h

Decreasing hazards (Matern et al., 2007)

•

Provide positive distraction (Quan et al., 2012, Ulrich, 1997)

lt a e

How we addressed it:

Accommodate a variety of light scenes: • • • • • • •

H r o f r

Room prep and turnover: bright uniform light Patient arrival: subdued ambient lighting Patient prep/induction: task lighting in multiple locations Surgical phase: focused lighting on the surgical site Surgical phase: various types of background lighting Post-operative: task lighting with gradually brighter background lighting Terminal cleaning: bright uniform lighting, UV or spectrum lighting

e t n e C

& n g i s

g n ti s Te

e D s

e i t i l i c a F h

Patient Prep

Patient Arrival

lt a e

H r o f r

e t n e C Surgical Phase

Post Operative

lt a e

e t n e C

H r o f r

A virtual reality model was developed of the OR prototype in collaboration with researchers at the College of Computing at Clemson University. This platform provided an opportunity for all team members to visualize the space and ‘play’ with it prior to the development of a high-fidelity mock-up. An experimental study was conducted to evaluate the effectiveness of four different media in communicating design and workflow information with clinical end users. The purpose of the study was to evaluate the OR prototype in each medium (floor plan, perspective image, physical mock-up, and virtual environments) and to determine how the varying platforms support users’ perception of spatial characteristics, functionality, work performance and aesthetic quality, as well as establish which medium is most beneficial at different stages within the design process to gain feedback about function and workflow.

& n g i s

e D s

e i t i l i c a F h

Development and testing of OR VR simulation

g n ti s Te

S.Z.

ALCOVE 212 SF

S.Z.

G B&A

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ALCOVE 212 SF

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Floor Plan

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INDUCTION | BOTTOM ENTRY FLOOR PLAN

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INDUCTION | BOTTOM ENTRY FLOOR PLAN

Perspective

PHYSICAL MOCK UP

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VIRTUALMock-up REALITY Physical PHYSICAL MOCK UP

VirtualPERSPECTIVE Reality

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EXPERIMENT

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“[Floor plans are] Good for map, not good for spatial awareness.”

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“I like a drawing, but what I don’t get from a drawing is the vastness of space, right. 20 by 18…. My brain does not imagine what that equals.

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Floor plans may be useful for flow studies and basic orientation, not task evaluations

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Perspective

“[In one of the perspective images] I couldn’t see the circulator desk from the ‘entry view’. Would like to know how far to get supplies outside of room"

“Paper views are harder to sense feeling-walking / objects in way.”

Perspectives were reported difficult to use by themsleves as an instrument to understand design without relying on floor plans for orientation.

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Physical Mock-up "[mock-up was] Overall clearer than VR, but no booms. Helped understand space + workflow better than VR"

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I can stand in that room and picture someone back there and a bed in there, and someone prepping the table. I can’t do that in the virtual reality. (…) The field of vision is sort of… very… narrow. It’s a little harder for me to imagine.”

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Physical mock-up are the optimal design medium

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Virtual Reality

“Very hard time adjusting to VR”

“difficult to move” “I felt what was lacking in that [the VR] was getting the actual feel of how big the space was. I wasn’t getting to feel of actual walk around.”

Virtual reality lacks elements to mimic reality in task performance evaluation

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3D Gestural input study

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Since anesthesia providers only intermittently clean their hands while moving throughout the anesthesia work area, their potentially contaminated hands touch objects such as the patient bed, anesthesia cart and monitors, and computer keyboards. The touchless feature of 3D, vision-based gestural input is attractive to sterile environments such as operating rooms since 3D gestural inputs can help maintain sterility and limit the spread of bacteria that can occur through physical contact. The development of a touchless interface for perioperative anesthesia may reduce bacterial contamination and eventually offer a reduced risk of infection to patients.

The objective of this study was to map 3D gestural inputs to anesthesia functions in the operating room. The same experiment was repeated for two user groups: anesthesia providers (i.e., experts) (N=16) and students (i.e., novices) (N=30). Videos from both experiments were analyzed to determine intuitive gesture-function mappings, and response time to perform a gesture was collected as a complementary measure for cognitive load.

RESEARCH QUESTIONS RQ 1

RQ 2

Which gesture-function mappings that are most intuitive to the use? Are gesture-function mappings same or divergent for novices and experts of a 3D, vision-based gestural input system when exposed to the same context of anesthesia tasks in the OR?

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FINDINGS 1

The gesture-function mapping sets for the anesthesia providers and the students showed some of the same mappings and some divergent mappings

Anesthesia providersâ&#x20AC;&#x2122; divergent mappings exhibited gestures that showed a strong contextual relationship to the physical environment

The domain expertise of the anesthesia provider group may be influential in determining gesture-function mappings

Hand gestures do not require an anesthesia provider to turn their back away from a patient; therefore, there is the added benefit of not having to disengage from the patient to interact with a computer via hand gestures

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Experimental setting of the gestural research study

3D depth capture while performing â&#x20AC;&#x153;five upâ&#x20AC;&#x153; gesture

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Refining the gestural language for the gestural input interface and integrating the refined gestural language into the simulation for evaluation with the high-fidelity mock-ups

Duplicating the gestural study in the physical mock-up to test the position and configuration of gestural and OR equipment in the anesthesia space and to evaluate the gestural displays effectiveness

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Tactile display study

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Tactile displays being investigated in an anesthesia context as an alternative to traditional displays. This study investigated performance of tactile displays where participants are purposefully subjected to multiple movements and postural demands. An experimental study with 24 participants was conducted. The study investigated three movements including sitting while typing, standing, and walking along with tactile change detection task. The study looked at how movement type, body location, and tactile cue complexity influenced response accuracy. This study was followed up with a focus group with participants from the MUSC Department of Anesthesiology to evaluate tactile cues. These tactile cues manipulated intensity, spatial location, and temporal aspects and participants were asked to evaluate each cues based on its perceived urgency, ease of differentiating between other tactile cues, and what each cue could represent about mean arterial pressure, end-tidal carbon dioxide, and pulse oximetry.

RESEARCH QUESTIONS RQ 1 RQ 2

How does the complexity of the tactile display affect the arm and back during three movements? How does body movement affect tactile display perception?

RQ 3

How can tactile displays present patient parameters to clinicians?

RQ 4

How can tactile parameters be mapped to physiological parameters and events?

The findings of this study indicate that tactile displays have accuracy levels that are promising to be used in the OR. Using body location and intensity levels would allow designers to develop a tacton (i.e., tactile icon) set to communicate variable levels. A second tactile display study and focus groups were conducted with MUSC anesthesia providers. Here the findings showed that increasing tacitle intensity is effective in representing more urgent events. Also, tactile cues changing intensity may be better used to represent mean arterial pressure whereas changing temporal elements may be better used to represent pulse oximetry.

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FINDINGS

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Equipment set up for the study

Evaluating effect of body movement on tactile display

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Refining the tactile displays study from year 2 to evaluate how those displays are supportive of continuous monitoring in the physical environment and how effective in context of different movement and tasks

Integrating the tactile displays into the overall physical OR mock-ups to evaluate their effectiveness in supporting anesthesiologist and other OR personnel by conducting focus groups and anesthesiologist user evaluations

Influence of traffic, area location, and other factors on operating room microbial load

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To evaluate how microbial load is affected by PEMSI flows, a series of data collection in the OR was conducted. First baseline microbial loads of unoccupied ORs during nighttime was collected. Then the data collection relative to timing of key steps during the surgical procedure (e.g. patient in room, procedure start, procedure finish, patient out of room). A second round of data collection was then conducted and statistical analysis of the data was completed. Many healthcare professionals share the opinion that door openings suggest a lack of coordination. While there exists literature to suggest that door openings reduce the coordination performance, our analysis of literature did not find a relationship between door openings and changes in microbial load levels .

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RESEARCH QUESTIONS RQ 1

How does the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR?

FINDINGS Human agents in the OR play a critical role in microbe disturbance and transfer (significant difference between high and low traffic flow areas). Another key result is that we identified a statistically significant difference between high and low traffic flow areas and the resulting levels of microbial load. This indicates that the human agents in the OR play a critical role in microbe disturbance and transfer, and our future OR traffic flow management policies should reflect these findings.

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Microbial load in various OR locations

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Use the results from the microbial load analysis to create / propose traffic flow management policies that will help reduce microbial load counts during surgery

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The circulating nurse (CN) in an operating room (OR) plays a key role in supporting the progress of the operation and the surgical team, patient safety, and protecting and maintaining patient safety during both the preparation phase and intra-operative phase of surgery. The dynamics of travel within a room, which impacts usersâ&#x20AC;&#x2122; travel time, exhaustion, and confusion, is driven by the spatial relationships and adjacencies in a layout. While spatial relationships are studied in larger contexts of the overall healthcare settings or surgical suites, there is a lack of research on spatial relationships inside the ORs.

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

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RESEARCH QUESTIONS

RQ 1

How does 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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FINDINGS

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Most common travel paths were from the CN workstation to the OR table and storage area

Circulating nurse experiences most of the flow disruptions in transitional zones.

Logistic regressions comparing the three layouts in terms of the SFDs that the CN was involved in suggest: -SFDs were more likely to occur during equipment, patient, or material related tasks. -CN was more likely to travel longer distances in OR C -CN was more likely to be involved in layout-related FDs in OR C (compared to OR Surgery 14 A or B) -CN was involved in environmental hazards SFDs when working in OR B and OR C

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Evaluating the above proximities for the CN

Examination of zone adjacencies for other members of the surgical team such as surgeons or anesthesiologists

Examination of zone adjacencies for the CN while considering the interactions with Surgery 16 other surgical team members

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How does the layout configuration and adjacencies of functionally different areas within the OR impact movement patterns of the circulating nurse?

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RQ 1

operating room B

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Simulation-based design and traffic flow improvements in the operating room

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AnyLogic software package was used to simulate (playback) discrete events that were observed in the videos. To do this, extracted excel files from the observer were fed into the AnyLogic software to simulate a playback of the videos on the floor plan of the OR. This is a strong first step that allows for simulation and testing of behaviors in the OR prototypes under development. The simulation has been also helpful in studying flows and surgical flow disruptions. This has implications for studying layout design based on specific metrics.

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RESEARCH QUESTIONS RQ 1

What type of layout most efficiently supports staff and patient requirements on the day of surgery?

FINDINGS

Several discrete-event simulation models were developed to assist in analyzing the PEMSI flows that occurred in the videotaped surgeries. Key metrics recorded were the distances traveled of staff within the OR, the density of occupancy within each zone in the OR, and the frequency of common paths used within the OR. These metrics provide performance outcome measures that allow the team to compare OR design and layout changes, as well as changes in OR workflow practices, on coordination performance. Part of this finding has been studying the connections between different zones within the OR and the circulating nurseâ&#x20AC;&#x2122;s workflow pertaining to the zones configurations.

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Two YouTube videos are developed to demonstrate how an early version of the traffic flow simulation model provides data and outcomes visually. One video shows a heatmap that tracks staff and objects in the room. The second video displays not only the staff movements in the room (without a heat map) but also relevant statistics being considered for analysis.

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https://www.youtube.com/watch?v=g2IFmPWVVvE https://www.youtube.com/watch?v=W1mMHxnqZSU

NEXT STEPS 1

Design and traffic flow simulation model interface

Work closely with Team 3 in identifying OR designs that include zone location and sizing, travel distance, surgical flow disruption, storage location and sizing, and coordination points for staff in the OR. Test the designs using the computer simulation models being developed in AnyLogic.

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Journal publications, conference presentations and poster presentations have been utilized as an outlet for disseminating findings from the project. The results of the first year’s accomplishments (literature review, case studies, observations, and focus groups) were compiled and summarized in the form of a book “Realizing Improved Patient Care Through HumanCentered Design in the Operating Room | Volume 1 “. This book was printed and disseminated among the clinicians, researchers, and architects attending the workshop session in September 2016. In addition, an electronic version of the book was published at https://issuu.com/clemsonchfdt/docs/ripchd.or_volume_1, for public access.The OR mock-up construction and evaluation with clinicians was videotaped. Short videos of the process were developed by the research team using Adobe-premiere videos. The videos have been shared via social media and during conference presentations. The virtual reality OR has also been presented at multiple venues on and off campus.

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PUBLICATIONS | PRESENTATIONS INTERNAL PUBLICATIONS

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Design development & implemenattaion at MUSC

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AF108 - OPTION D1 AF109 - OPTION D2

AF107 - OPTION C4

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2016

AF104 - OPTION C1

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AF105 - OPTION C2

Joseph, A., Wingler, D. & Allison, D. (Editors) (2016). Realizing Improved Patient Care through Human-Centered Design in the Operating Room (RIPCHD.OR). http://issuu.com/clemsonchfdt/docs/ripchd.or_volume_1/1

Testing & evaluation

REALIZING IMPROVED PATIENT CARE THROUGH HUMAN-CENTERED DESIGN IN THE OPERATING ROOM RIPCHD.OR

VOLUME 1 | 2015-2016

PEER-REVIEWED PUBLICATIONS (Published)

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Catchpole, K., Neyens, D. M., Abernathy, J., Allison, D., Joseph, A., & Reeves, S. T. (2017, December). Framework for direct observation of performance and safety in healthcare. BMJ Quality and Safety, 26(12), 1015-1021.

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Bayramzadeh, S., Joseph, A., San, D., Khoshkenar, A., Taaffe, K., Jafarifiroozabadi, R., & Neyens, D. (accepted). The impact of operating room layout on circulating nurse’s work patterns and flow disruptions: A behavioral mapping study. Health Environments Design & Research.

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Aim: To assess how the adjacencies of functionally different areas within ORs can influence the circulating nurse’s workflow patterns and disruptions. Background: The circulating nurse (CN) plays a significant role in promoting patient safety during surgical procedures by observing, monitoring, and managing potential threats at and around the surgical field. Their work requires constant movement to different parts of the OR to support team members. The layout of the OR and crowded and cluttered ORs might impact their workflow and cause disruptions during the surgery. Method: A convenience sample of 25 surgeries were video recorded and thematically coded for CN’s activities, locations, and flow disruptions. The OR layout was categorized into transitional zones and functional zones (workstations, supply zones, support zones, and sterile areas around the surgical table). CN’s activities were classified into patient, equipment, material, and information related activities. Flow disruptions included those related to environmental hazards and layout. Results: The CN traveled through multiple zones during 91% of the activities. 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. Transitional zones accounted for 58.3% of all flow disruption that the CN was involved in whereas 28% occurred in areas surrounding the OR bed. Conclusion: The similarity of the movement and flow disruption patterns, despite variations in OR layout, highlighted the adjacencies required between major zones that CNs regularly visit. These optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.

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PUBLICATIONS | PRESENTATIONS PEER-REVIEWED PUBLICATIONS (Published)

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Betza, S., Abernathy, J., Reeves, S., & Riggs, S. (2017). The Effect of Movement and Cue Complexity on Tactile Change. Proceedings of the Human Factors and Ergonomics Society 60th Annual Meeting. Austin, TX.

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There is a growing interest in using touch to offload the often overburdened visual channel as its merit has been demonstrated in various work domains. However, more work is needed to understand the perceptual limitations of the tactile modality, including how it is affected by change blindness (i.e., failure to detect changes due to transients) as the majority of work on change blindness has been in vision. This study examines how movement and cue complexity affects the ability to detect tactile changes. The findings indicate the ability to detect changes are affected by: 1) movement (walking resulted in worse change detection rates compared to sitting) and 2) cue complexity (high complexity cues had worse change detection rates compared to low complexity). Overall, this work adds to the knowledge base of tactile perception and can inform the design of tactile displays for multiple work domains such as anesthesiology.

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Betza, S. M., Jurewicz, K. A., Neyens, D. M., Riggs, S., Abernathy, J. H., & Reeves, S. (2016). Anesthesia maintenance and vigilance examining task switching. In Proceedings of the 60th Annual Meeting of the Human Factors and Ergonomics Society Annual Meeting, 60(1), 608-612.

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Limited research has focused on vigilance during the maintenance phase of anesthesia work. The goal of this study was to identify anesthesia maintenance tasks and to identify the transitions between these tasks within the perspective of the vigilance paradigm. In this study, three bariatric surgeries were recorded and analyzed using a task categorization structure. Across the surgeries the primary anesthesia provider spent 71% of their time doing patient or display monitoring tasks. Task frequency and transition visualizations were generated to identify trends in the task switching. Transitions between the task categories occurred approximately once every nine seconds for the primary anesthesia provider. Additionally, it appears that regardless of the task, there was a high frequency of task transitions to looking at the visual displays and then from the visual displays towards the patient. The results of this study emphasize the importance of vigilance for anesthesia display design.

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PEER-REVIEWED PUBLICATIONS (Published)

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Joseph, A., Bayramzadeh, S., Zamani, Z., & Rostenberg, B. (2017). Safety, Performance, and Satisfaction Outcomes in the Operating Room: A Literature Review. HERD: Health Environments Research & Design Journal, 1937586717705107.

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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 universityâ&#x20AC;&#x2122;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.

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PUBLICATIONS | PRESENTATIONS PEER-REVIEWED PUBLICATIONS (Published)

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Jurewicz, K. A., & Neyens, D. M. (2017). Mapping 3D Gestural Inputs to Traditional Touchscreen Interface Designs within the Context of Anesthesiology. In Proceedings of the Human Factors and Ergonomics Society 61th Annual Meeting. Austin, TX. 2nd Place, Best Paper Award, Health Care Technical Group.

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Gestures are a natural means of every day human-human communication, and with the advances in gestural input technology, there is an opportunity to investigate gestures as a means of communicating with computers and other devices. The primary benefit of gestural input technology is that it facilitates a touchless interaction, so the ideal market demand for this technology is an environment where touch needs to be minimized. The perfect example of an environment that discourages touch are sterile or clean environments, such as operating rooms (ORs). Healthcare-associated infections are a great burden to the healthcare system, and gestural input technology can decrease the number of surfaces, computers, and other devices that a healthcare provider comes in contact with, thus reducing the likelihood of bacterial contamination. The objective of this research was to map 3D gestural inputs to traditional touchscreen interface designs within the context of anesthesiology. An experimental study was conducted to elicit intuitive gestures from users and assess the cognitive complexity of ten typical functions of anesthesia providers. Intuitive gestures were observed in six out of the ten functions without any cognitive complexity concerns. Two functions, of the remaining four, demonstrated a higher-level gesture mapping with no cognitive complexity concerns. Overall, gestural input technology demonstrated promise for the ten functions of anesthesia providers in the operating room, and future research will continue investigating the application of gestural input technology for anesthesiology in the OR.

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Khoshkenar, A., Taaffe, K., Muhs, M., Fredendall, L., Ferrand, Y., San, D., & Joseph, A. (2017). Simulation-based design and traffic flow improvements in the operating room, in Proceedings of the 2017 Winter Simulation Conference, Las Vegas, NV.

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A simulation model was created to model the traffic flow in the operating room. A key research challenge in operating room design is to create the most efficient layout that supports staff and patient requirements on the day of surgery. The simulation allows comparison of base model designs to future designs using several performance measures. To develop the model, we videotaped multiple surgeries in a set of operating rooms and then coded all activities by location, agent and purpose. Our current analysis compares layouts based on total distance walked by agents, as well as the number of contacts, measured as the number of times agents must change their path to accommodate some other agent or physical constraint in the room. We demonstrate the value and capability of the model by improving traffic flow in the operating room as a result of rotating the bed orientation.

PEER-REVIEWED PUBLICATIONS (Accepted for publication)

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Neyens, D., Bayramzadeh, S., Catchpole, K., Joseph, A., Taaffe, K., Jurewicz, K., Khoshkenar, A., & San, D. (under revision, accepted for publication). Using a systems approach to evaluate a circulating nurse work patterns and disruptions to workflow. Journal of Applied Ergonomics.

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Taaffe, K., Lee, B., Ferrand, Y., Fredendall, L., San, D., Salgado, C., Shvorin, D., Khoshkenar, A., & Reeves, S. (under revision, accepted for publication) The influence of traffic, area location, and other factors on operating room microbial load. Infection Control & Hospital Epidemiology.

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PEER-REVIEWED PUBLICATIONS (Submitted, under review)

Bayramzadeh, S., Joseph, A., Allison, D., Shultz, J., abernathy, J. (under review). Using a collaborative simulation approach for evidence-based evaluation of operating room design prototypes.

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Jurewicz, K., Neyens, D.M., Catchpole, K., & Reeves, S.T. (under review) Developing a 3D gestural interface for anesthesia-related Human-computer interaction tasks using both experts and novices.

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PUBLICATIONS | PRESENTATIONS CONFERENCE PRESENTATIONS

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Joseph, A., Bayramzadeh, S., Machry, H., Wingler, D & Jafarifiroozabadi, R. (2017). Realizing Improved Patient Care through Human-Centered Design in the OR: Phase 2 Findings. Healthcare Design Conference, Orlando, FL.

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Joseph, A., Wingler, D., Bayramzadeh, S., & Machry, H. (2017). Using a systems framework for observing behavior in operating room environments. Paper presented at the ACE-ODAM 2017: Organizing for high performance, Banff, Canada.

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Bayramzadeh, S., Joseph, A., & Machry, H. (2017, July 17-21). Operating room layout configuration: a tool to improve staff experience, performance, and efficiency. 8th International Conference on Applied Human Factors and Ergonomics (AHFE). Los Angeles, CA. Bayramzadeh, S., Joseph, A., Wingler, D., & Machry, H. (2017, May 31-June 3). Developing Methods to Observe and Analyze Behaviors in Operating Room Environments. Environmental Design Research Association (EDRA) 48 Conference. Madison, WI.

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Machry, H., Joseph, A., Wingler, D., & Mathews, R. (2017, May 31-June 3). Spatial Implications of Essential Surgical Flows in Ambulatory Surgery Centers. Environmental Design Research Association (EDRA) 48 Conference.

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Lee, B., Shvorin, D., Fredendall, L., Taaffe, K., Ferrand, Y., San, D., Muhs, M., & Reeves, S. Operating Room Management When Considering Microbial Loads. Submitted to the Journal of Hospital Infection, May 2017. Madison, WI.

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Taaffe, K., Khoshkenar, A., Muhs, M., Fredendall, L., Ferrand, Y., San, D., Joseph, A., & Reeves, S. (2017, May). Simulationbased Design Improvements in the Operating Room. Presented at the Clemson University Research Symposium, Clemson, SC.

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Taaffe, K., Khoshkenar, A., Muhs, M., Fredendall, L., Ferrand, Y., San, D., Joseph, A., & Reeves, S. (2017, March). Simulationbased Design Improvements in the Operating Room. Presented at the Greenville Health System Research Showcase, Greenville, SC.

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Lee, B., Shvorin, D., Fredendall, L., Taaffe, K., Ferrand, Y., Muhs, M., San, D., Joseph, A., & Reeves, S. (2017, May). Correlation of Microbial Load and Movement within the Operating Room. Presented at the Clemson University Research Symposium, Clemson, SC.

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Lee, B., Shvorin, D., Fredendall, L., Taaffe, K., Ferrand, Y., Muhs, M., San, D., Joseph, A., & Reeves, S. (2017, March). Correlation of Microbial Load and Movement within the Operating Room. Presented at the Greenville Health System Research Showcase, Greenville, SC.

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Catchpole, K., Joseph, A., Machry, H., & Zamani, Z. (2016, Nov. 12-15). Realizing Improved Patient Care through Human Centered Design in the OR: Phase 1 Findings. Healthcare Design Conference. Houston, TX.

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Allison, D., Catchpole, K., & Joseph, A. (2016, Nov. 12-15). Bench to Bedside: Integrating Research Education and Practice in Architecture and Health. Healthcare Design Conference. Houston, TX.

PUBLICATIONS | PRESENTATIONS CONFERENCE PRESENTATIONS

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Joseph, A. (2016, September 23). Designing Safer Operating Rooms Using: A Systems Approach. The Carolinas anesthesiology 2016 annual meeting, Charleston, SC.

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Shvorin, D., Taaffe, K. Fredendall, L. Ferrand, Y. & Joseph, A. (2016, October). Operating Room Management When Considering Microbial Loads. Presented at the American Society for Engineering Management Conference, Charlotte, NC.

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Lee, B., Fredendall, L., Ferrand, Y., Taaffe, K., & Joseph, A. (2016, November). Operating Room Management When Considering Microbial Loads. Presented at the Decision Sciences Institute Annual Conference, Austin, TX.

WEBINARS/POSTERS

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Joseph, A., & Reeves, S. (2017). Improving Patient Care through Human-Centered Design in the OR. Webinar presented at the AHRQ PSLL Webinar series.

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Jurewicz, K., & Neyens, D.M. (2017). A Gesture is Worth a Thousand Touches: Mapping Gestural Inputs to Traditional Touchscreen Interface Designs. Poster presented at the 2017 HFES Healthcare Symposium, New Orleans, LA.

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Joseph, A., Catchpole, K., & Allison, D. (2017, June 12-14). Using a systems approach to designing a safer and more ergonomic operating room. Poster presented at the European Healthcare Design Conference. London, UK.

USING A SYSTEMS APPROACH TO DESIGNING A SAFER AND MORE ERGONOMIC OPERATING ROOM

Literature Review

European Healthcare Design Conference | June 12th-13th, 2017 Authors: Anjali Joseph, PhD, EDAC | Clemson University Kenneth Catchpole, MD | Medical University of South Carolina

VIDEO CAPTURE

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

cameras mounted on poles microphones

David Allison, FAIA, FACHA | Clemson University

base machine & computer screen connections - camera to computer ﬁeld of view

Type of surgery

PEDIATRIC

ORTHOPEDIC

GENERAL

Number of surgeries

Range of length of surgery

30-77 min

154 min

54-181 min

Range for total number of

7-11

7-10

Room size

Main OR 11: 390 SQ FT

Main OR 14: 542 SQ FT

Art OR 5: 690 SQ FT

cameras mounted on poles

base machine & computer screen connections - camera to computer ﬁeld of view

GESTURE FUNCTIONS MAPPING

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

BACKGROUND

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

PARTNERS AND PROCESS

The incidence of adverse events such as surgical site infections and surgical errors are a huge problem in the operating room (OR) due to the highly vulnerable state of the patient and the complex interactions required between providers of different disciplines and a range of equipment, technology and the physical space where care is provided. Clemson University and the Medical University of South Carolina have been awarded a 4-year grant from the Agency for Healthcare Research and Quality to develop a learning lab focused on patient safety in the OR. This learning lab, titled ‘Realizing Improved Patient Care through Human Centered Design in the OR (RIPCHD.OR)’ is a multidisciplinary initiative involving architects, human factors experts, industrial engineers, nurses and anesthesiologists. The goal of this paper was to develop a systems approach for observing and analyzing the OR work system and to describe how this systems approach was used to analyze operating rooms environments, finally leading to the development of design guidelines for designing operating rooms.

PROJECTS

Art 5 General

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Literature Review

Problem Analysis and Coding Protocol IRB Approval

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Environmental Hazard

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JAN - APR ‘16

DEC ‘15

SEPT - DEC ‘15

Data Collection

Interruptions

Development of Anesthesia Workstation Simulator

40.32

70.10

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Main 11

Orthopedic

Equipment Failure

33.53

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Layout

Literature & Review

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Pediatric

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Behavior Observations of the OR System

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INDUCTION 206 SF

High number of SFDs observed in the shorter pediatric

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6 surgeries. Also duration of door openings higher in those

O.R. 579 SF

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observed SFDs in all observed surgeries

0 2

Corresponding Author: Anjali Joseph, PhD, Clemson University, Lee 2-141, Clemson, SC 29634, USA. Email: anjalij@clemson.edu

5 Layout related disturbances were the most frequently

15' - 0"

1 Clemson University, Clemson, SC, USA 2 EwingCole, Raleigh-Durham, NC, USA 3 Architecture for Advanced Medicine, San Francisco, CA, USA

surgeries. Link with room size and design Proportion of disturbances as a proportion of surgery time very high in the smaller OR in main

APR ‘16 ONWARDS

Data Analysis

Advisory Committee

JUNE ‘16 ONWARDS

Operating Room Mock-Up

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Case Studies

Tape on the Floor Mock up

Discrete Event Simulation Model

DISCOVERY

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DESIGN

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Cardboard Mock up

Design Reﬁnement

JAN ‘17

107.87

OR Location Surgery Type

A.Z.

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S.Z.

NOV ‘16

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2829 16

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SEP ‘16

AUG ‘16

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APR ‘16

MAR ‘16

Number of disturbances

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circulating nurse desk and interacting with the scrub nurse Anesthesia storage is primarily used by anesthesia 2 personnel while general storage is accessed by all team members, though primarily the circulating nurse The number of door openings and duration are 3 proportionate to the length of the surgery. However, this does not seem to hold true for some of the pediatric surgeries observed. Some surgeries had a large number of clean core door 4 openings

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He Study framework for RIPCHD.OR learning lab is based on the SEIPS 2.0 framework by Holden and colleagues (Holden et. al, 2013 )

ADAPTATION

1 the OR, though she/he spends the maximum time at the

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Patient

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Patient Work

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Environment

What are the different types of flow disturbances and frequency that occur during observed surgeries?

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Care Team

The operating room (OR) is a high-risk, problemprone patient care environment. According to the World Health Organization’s (WHO) Guidelines for Safe Surgery, in developed countries, patients undergoing inpatient surgeries experience major complications at a rate of 3–22% and a death rate of 0.4–0.8%. Roughly, half of these incidents

Paper published in Health Environments Research & Design Journal

13' - 9"

140

DESIGN CONCEPTS

OUTCOMES

Organizational

Professional Work Collaborative Care Team Patient Work

il tie

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PROCESSES

Technology and Tools

OCT ‘16

Externa l En vir on

WORK SYSTEM

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PROJECT FRAMEWORK

Circulating nurse makes trips to all different parts of

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

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Abstract 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 designfocused 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. Keywords operating room design, patient safety, staff satisfaction, staff performance

INTEGRATED OR SUITE DESIGN

PROJ

Findings: Using a systems approach yielded rich insights about the tasks and activities of key stakeholders, the locations of people, objects and equipment, space needs during different phases of surgery and also the inter-dependencies and relationships between key players in the OR. The operating room needs to be flexible and adaptable to meet current and future needs. Key areas of consideration include the amount and location of storage to minimize door openings in the OR, relative location of zones in the OR to optimize flows and the need to promote situational awareness among team members for optimal communication.

TRAFFIC FLOW AND DOOR OPENINGS IN THE OR This project will focus on understanding factors impacting traffic flow in the OR suite.

Mock-up

FINDINGS

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RIPCHD.OR

Organization

S.Z.

26' - 0" 14' - 3"

ECT 2

Person

C.Z.

A.Z.

CLEMSON

ARCHITECTURE FIRMS

2 Design projects

A systems framework provides a rigorous multidimensional approach for researching and designing a complex environment such as an operating room. This is a more holistic approach to designing healthcare facilities that allows for a deep understanding of the complex interplay between people, tasks, processes, technology and the built environment.

S.Z.

MEDICAL UNIVERSTITY OF SOUTH CAROLINA

IMPLICATIONS

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UNMASKING OF ANESTHESIA-RELATED ALARMS AND COMMUNICATIONS

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

An in-depth literature review was conducted to develop and refine a systems approach for studying the OR work system. The OR work system (people, tasks, technology, built environment, processes) was then studied through analysis of videotapes of 35 surgeries in three different departments (general, orthopedic and pediatric). Additionally, three case studies were conducted to understand alternate approaches and best practice in OR system design. Finally, design guidelines were created to help translate research findings into the design of a prototype OR.

DESIGN MOCK UPS T1

OJEC

Research

METHODOLOGY

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

Distractions and errors contribute to medical errors leading to patient harm

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OR is a highly complex risk prone area

OR concept rendering

High fidelity mock-up

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microphones

1/8” scale OR Model

Health Environments Research & Design Journal 1-14 ª The Author(s) 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1937586717705107 journals.sagepub.com/home/her

High Fidelity Mockup

1 | PATIENT PREPARATION | PATIENT ENTRY

Poster Presentation at European Healthcare Design Conference 2017

Presentation at Healthcare Design Conference

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It has been an incredible second year for the RIPCHD.OR learning lab. The team accomplishments range from developing mockups of varying levels of fidelity to dissemination of project work to communities of interest. The body of information collected during phase 1 and findings from phase 2 of the project based on an evidence based iterative process of design and evaluation provide a strong foundation as we step into the next phase of the learning lab. During the next year, RIPCHD.OR aims to:

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1.Continue iterative design development, and testing of design components 2.Integrate sub-projects into one system through a high-fidelity physical mock-up of the OR 3.Implement design concepts in live and simulated environments. Currently, the focus is on the development of the high fidelity OR mock-up based on the refined design developed by the group of graduate students in the Architecture + Health program towards the end of year 2. This mock-up will be evaluated by conducting simulations of surgical tasks. Several tasks that are been undertaken to achieve the aims for year 3 are presented in this section of the book.

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Currently, the process of building a high fidelity OR mock-up at the Clemson Design Center at Charleston (Cigar Factory) is underway. The high-fidelity mockup will include an OR boom, surgical equipment, modular wall systems, sliding doors, flooring and other features developed through the design project. This mock-up will allow the team to realistically simulate a complete surgery and identify any potential safety risks associated with the proposed design. Evaluation protocol and scenarios for testing the mock-up are being developed. Prototypes being developed by teams 1 and 2 will also be integrated into this high fidelity mock and will be tested.

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The goal for the third year of RIPCHD.OR learning lab is to use the feedback from the iterative testing of design and mockups to develop a high fidelity mock-up. In addition to this, the following activities will be undertaken in phase three of the overall learning lab:

SAFE OR DESIGN TOOL A key activity of year 3 will be to develop the safe OR design tool in order to support design and clinical teams in proactively assessing the potential impacts of OR environment design. The tool can be used as several stages in a project: -To provide guidance to design teams on OR design that includes components of design and related operational/behavioral strategies simultaneously -To design new ORâ&#x20AC;&#x2122;s as well as renovations and modifications to existing ORs -As a communication tool between architects and surgical team members -As an ongoing quality improvement tool by OR team members

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DISCRETE EVENT SIMULATION MODEL FOR ASC DESIGN Testing the OR design prototypes using the computer simulation models being developed and refined in AnyLogic for travel distance, zone locations, storage location and sizing, coordination points for staff, frequency of trips in/ out of the OR, and surgical flow.

SYMPOSIUM AND UNVEILING OF MOCK-UP A symposium will be conducted in January 2018 at the Clemson Design Center at Charleston. The purpose of this symposium will be to present findings from year 2 and unveil the high fidelity mock-up. Participants will include the RIPCHD.OR learning lab team, technical advisory committee members, and industry experts.

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The team will be analyzing key outcomes of interest related to safety and efficiency for ambulatory surgeries being currently conducted at MUSC. This data will also be tracked in the new ambulatory surgery centers for similar cases. MUSCâ&#x20AC;&#x2122;s OR data is being consolidated into a single database called Wise OR that allows for advanced analytics and data visualization.

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OR OUTCOMES REPOSITORY

DOOR OPENINGS This study will explore door openings in order to develop interventions to reduce unnecessary door openings. The aim will be to understand frequency and duration of door openings during different types of surgeries, people involved and pupose of door openings as well.

TASK SWITCHING -Research will be conducted to assess whether the proposed design and technology support anesthesia workflow and tasks, through a focus group with clinicians. -Evaluations on workload and task switching of anesthesia providers will be conducted, targeting clinical rather than human factors audiences.

The research will focus on examining the use of a smart watch as visual, auditory, and tactile feedback device and communication tool, and the associated impact on workflow of attending anesthesiologists while moving within the physical environment.

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The RIPCHD.OR team will interact and share information with the team at MUSC and the architecture firm LS3P to ensure that the findings and design concepts developed over the past 2 years are implemented into the new ambulatory surgery center project that is being planned in North Charleston.

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DATA ANALYSIS AND DISSEMINATION The teams will analyze the data collected during simulation of the high fidelity mock-up to obtain feedback on the final mock-up and share the findings in SC and nationally. This information will be disseminated through journal publications and conference presentations.

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SIMULATION MODELING Computer simulation models will be developed to understand the effect of moving instrument setup to a parallel processing room on throughput, surgeon non-operative time, turnaround time, and examine how patient volume will affect the system.

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The advisory committee consists of pioneers from the clinical, operational and design fields. These patient safety and industry experts from diverse organizations like Greenville Health System, the Veterans Administration and Health Quality Council of Alberta review progress and provide their valuable feedback to the team time and again through in-person meetings and via conference calls.

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BILL BERRY | M.D., MPA, MPH

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David Cull, MD received his medical doctorate from Baylor College of Medicine in Houston, Texas, and completed his residency in general surgery at Wilford Hall Medical Center in San Antonio, TX. He was a vascular surgery fellow at Eastern Virginia Graduate School of Medicine in Norfolk, VA. Dr. Cull is a Fellow of the American College of Surgeons, the Southern Surgical Association, the Southern Association for Vascular Surgery, the Society for Vascular Surgery, the Peripheral Vascular Surgery Society, and the Southeastern Surgical Congress. He is the Professor Vice Chair of Academics Department of Surgery at University of South Carolina School of Medicine, Greenville Health System. Dr. Cull has been employed with Greenville Health System in the Department of Surgery for almsot 20 years. During that time, he has been involved in the conception, planning, and implementation of a number of programs and systems that have improved patient care. Dr. Cull developed a network of hospitals and surgeons throughout Greenville County that focused on improving the quality of vascular access surgical care delivered to patients on hemodialysis. That network involved 23 surgeons,2 hospitals, and included a database for research and quality improvement.

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Bill Berry, MD, MPA, MPH is chief medical officer at Ariadne Labs. In this role, Bill oversees the growth and development of all the research activities including the program teams: Safe Surgery, BetterBirth, and Serious Illness Care as well as the Platform teams: Informatics and Measurement, Implementation and Improvement Science, and Program Management. In addition, Dr. Berry serves as the Director of the Safe Surgery Program and oversees the specific research and execution of the program. He is also a Surgical Consultant to the Risk Management Foundation of the Harvard Medical Institutions and serves as the Boston Program Director of the “Safe Surgery Saves Lives” initiative with the World Health Organization’s Patient Safety Program. For the last eight years, Bill has served as a faculty member with the Institute for Healthcare Improvement in collaborative projects focused on improving the safety of surgical patients. Prior to assuming these roles, Dr. Berry spent seventeen years in practice as a cardiac surgeon. Bill earned his MD from Johns Hopkins University School of Medicine and achieved his board certification in general surgery, thoracic surgery, and surgical critical care. He earned his MPA from Harvard Kennedy School of Government and his MPH from Harvard School of Public Health.

ELLEN TAYLOR Ph.D., AIA, MBA, EDAC (New AC member)

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With 30 years of experience in the fields of architecture and research, Ellen serves as the Vice President for Research at The Center for Health Design. She has been coordinating with varying disciplines within the Center to bring research-based clarity to the latest “hot topics” surrounding healthcare. Through the Pebble Project (an international initiative for organizations pursuing an evidence-based design process), she has helped facilitate design ideas into research questions and hypotheses and ultimately research projects whose goal is to study the impact of the environment on patient, staff, and organizational outcomes. She has developed content for the California Healthcare Foundation Safety Net Clinics white papers and Clinic Design website. She has also provided research services on numerous projects, such as the Annual Survey of Design Research Awareness, the AHRQ funded projects “Designing for Patient Safety: Developing methods to integrate patient safety concerns into the facility design process” and “Developing and Disseminating a Safety Risk Assessment (SRA) Toolkit”. She is the PI for a dissemination project to advance the Safety Risk Assessment Toolkit into an online format. She was an active participant in the 2014 Facility Guidelines Institute Health Guidelines Revisions Committee (HGRC) and led the Guidelines subcommittee surrounding patient safety and the development of the accepted language requiring a Safety Risk Assessment for healthcare facility design projects. She serves as the Editorial Advisory Board of the Health Environments Research & Design (HERD) Journal. Additionally, she coordinates projects with other organizations, serves on the Environmental Standards Council (ECS), and facilitates direction for the Center’s Research Coalition Annual New Investigator Award. Ellen has a bachelor’s degree in architecture from Cornell University’s College of Architecture, Art and Planning, Global Executive MBA degrees from Columbia University and London Business School, and a PhD in design, patient safety and human factors from Loughborough University in England.

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Eileen Malone, RN, MSN, MS, EDAC is the Senior Partner for Mercury Healthcare Consulting, LLC located in Alexandria, Virginia, who supports clients embracing evidence-based design in health facility projects, as a means to help improve healthcare outcomes. With over forty years in healthcare, Ms. Malone retired from the United States Army in 2004 having held a variety of key leadership positions including hospital commander (CEO), Army Medical Department CIO, Congressional Affairs Officer, quality assurance nurse, and in several internal medicine nurse practitioner assignments. She holds graduate degrees from Duke University and the National Defense University and is Evidencebased Design Accredited and Certified. In addition to many military awards, Eileen received The Center for Health Design’s (CHD) Changemaker Award in 2009 and the Leadership Award from the Health Information and Management Systems Society in 2004 for her leadership in the creation and implementation of a patient centered information technology strategy for the Army Medical Department. Now semi-retired, Ms. Malone devotes time to volunteer consultant activities related to the use of evidence-based design to help improve healthcare outcomes. From 2008 to 2013, EILEEN MALONE | RN, MSN, MS, EDAC Eileen served as a member of CHD’s Research Coalition and as its co-chair for the last two years of her tenure. She was a member of the Facility Guideline Institute’s Board of Directors and 2014 Healthcare Guidelines Revision Committee. Most recently, Eileen was a member of the Secretary of Defense’s Independent Review Panel on Military Medical Construction Standards, which provided detailed recommendations for the Department and Congress in two reports. Ms. Malone continues to explore the relationship between healthcare reform quality improvement targets and evidencebased design opportunities, through the delivery of national-level presentations, the creation of CHD white papers, and as an active member of numerous grant advisory boards for research around these topics.

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James (Jake) H. Abernathy, III, MD, MPH is an Associate Professor and Division Chief of Cardiac Anesthesiology at Johns Hopkins. Prior to joining Johns Hopkins, Jake was Division Chief of Cardiothoracic Anesthesiology at the Medical University of South Carolina. After completing medical school at the University of Alabama at Birmingham he did a residency in Anesthesiology and a fellowship in Cardiac Anesthesiology at the Brigham and Womenâ&#x20AC;&#x2122;s Hospital in Boston, MA. Collaborating with human factors engineers and health care architects, Dr. Abernathy is investigating the impact OR space, equipment, and design have on patient safety. During his time at the Medical University of South Carolina, he served as a co-investigator on the RIPCHD.OR project. Jake leads several national efforts to improve quality in the delivery of cardiac anesthesiology and surgery. Currently, he serves as Chair of the Quality and Safety Steering Committee of the Society of Cardiovascular Anesthesiologists. He is a proud husband and father.

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JAMES (JAKE) ABERNATHY | M.D., MPH (New AC member)

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John Schaefer, MD is an international expert in healthcare simulation who is transforming the way healthcare clinicians are taught, and in the process, helping to reduce patient injury and improve medical outcomes. Dr. Schaefer came to South Carolina from the University of Pittsburgh where he helped establish the WISER Institute. He served as director of the center from 1997 to 2006 and directed the multi-partnered expansion of the center. In South Carolina as a SmartState Endowed Chair, he has led the effort to establish a statewide network of 14 simulation programs including universities, technical colleges and health systems that now perform over 80,000 patient simulations annually. This network of collaborative simulation centers now provide training for medical, nursing and allied health students, as well as advanced continuing education to hospital employees and physicians in South Carolina, North Carolina and Alabama. They allow healthcare providers to practice their skills in a controlled, risk-free environment, rather than in an actual patient setting. This innovative training method results in better healthcare outcomes and increased patient safety. Additionally, Dr. Schaefer has established a number of industry relationships resulting in new innovations in simulation that are making South Carolina a leader in the medical simulation field. He co-founded a start-up company called SimTunes in 2008 to create and commercialize simulation educational technology and in 2015 was awarded a presidential citation from the international Society for Simulation in Healthcare for his contributions to the field of simulation globally.

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Jonas Shultz, MSc, EDAC works as a Human Factors Lead with the Health Quality Council of Alberta, and has 10 years’ experience working in medical human factors. He has provided human factors expertise to a variety of healthcare organizations, including Alberta Health Services, Health Canada, ISMP Canada, and the Center for Health Design in the United States. Jonas is also an adjunct lecturer with the Department of Anesthesia, Cumming School of Medicine with the University of Calgary. The majority of his work has focused on evaluating the design of built environments for healthcare, such as hybrid operating theatres or ambulances, minimizing human error during medication administration, and testing the usability of medical devices. Jonas has published his work in peer reviewed papers and has been an invited speaker at numerous national and international organizations and conferences.

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JONAS SHULTZ | MSc, EDAC

Keith Essen, PhD, MSN, BSN is a recently retired Active Duty Army Colonel. He has held multiple roles both as a Nurse Executive and as a Director of multiple medical center operating rooms. Keith attained CNOR certification and has spoken nationally at the annual AORN Convention multiple times. He has extensive experience serving as a staff nurse, OR course Director for 4 years, and as the Perioperative Nursing Director of 4 Army Medical Centers culminating as the Director of Perioperative Nursing at Walter Reed Army Medical Center. Keith was appointed by the Army Surgeon General in 1999 as the Perioperative Nurse Consultant. While serving in that role he was the Co-Leader in setting up the Patient Safety Program at Landstuhl Regional Medical Center in Germany. As a consultant Keith served during a pivotal time as the emphasis on patient safety culture evolved subsequent to the IOM report “To Err is Human”. He oversaw the Army’s initiative to develop the Universal Protocol for Surgical timeouts. Keith earned his PhD from Uniformed Services University for the Health Sciences. His dissertation was a structural equation model on safety culture. Keith has extensive management experience and is a recognized speaker nationally. He has conducted numerous presentations both locally and nationally on strategies to overcome Toxic Work Environments, Organizational Structural failures that impede safety and efficiency and an array of other issues. Currently Keith is employed with the Veterans Administration National Center for Patient Safety and assigned to the Central Office in Washington, DC.

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TIM BROOKSHIRE | MBA

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Tim Brookshire, MBA is the Senior Administrator for Perioperative and GI Services for the Greenville Health System. In this capacity, he has operational, financial and strategic responsibility for this Service Line throughout the Upstate including 8 facilities representing over 60 operating and procedure rooms providing care to over 40,000 patients annually. Tim joined GHS in 2014 and prior to that was a Vice President with Carolinas Healthcare System in Charlotte, North Carolina where he served as an administrator with Carolinas Medical Center since 2006. Prior to that, Tim worked as a consultant for the North Carolina Department of Health and Human Services and as an investment banking analyst with Lehman Brothers in New York. A native of Asheville, NC, Tim holds an MBA from the Kenan-Flagler Business School at the University of North Carolina as well as a BA in Economics and Political Science from UNC. He has previously served as the preceptor for the Administrative Fellowship program and has held adjunct faculty positions at the University of Alabama Birmingham and Xavier University. He and his wife Blake have 2 children, They enjoy traveling, running and nonfiction. He is active with St. Matthew United Methodist Church and serves as the Treasurer for the Mackenzie Foundation, an Asheville-based non-profit.

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Windsor Westbrook Sherrill serves as associate vice president for health research at Clemson and chief science officer at Greenville Health System. She is a professor in the Department of Public Health Sciences at Clemson and an adjunct professor at the University of South Carolina School of Medicine Greenville. She is an award-winning teacher and former health care administrator who teaches at both the undergraduate and graduate level in topics such as health care management, health care systems, and health care finance. Dr. Sherrill has expertise in health services administration, with specific training in operations research, program evaluation, health finance, health management education, and survey research. Prior to joining the faculty at Clemson, Dr. Sherrill served as adjunct faculty with the Medical College of Georgia, Medical University of South Carolina, and the University of North Carolina Charlotte. She has worked in health administration at the Medical College of Georgia, and has provided consultancy in the assessment and evaluation of health delivery systems for numerous public and private sector organizations. During her tenure at Brandeis University, she was a researcher with the Health Policy Institute through a fellowship from the Pew Foundation for Health Related Studies. She has served as PI or Co-PI on research grants funded by HRSA, NIH, BCBS Foundation and the Veterans Administration. Dr. Sherrill received her B.S. from Wake Forest University, her M.H.A. and M.B.A. from the University of Alabama at Birmingham, and her Ph.D. in Health Policy from Brandeis University. She is a South Carolina Liberty Fellow and an honorary member of the Clemson University Class of 1939.

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The RIPCHD.OR learning lab has been a golden opportunity for understanding the design and operation of operating rooms for which the team acknowledges the generous funding support from the Agency for Healthcare Research and Quality. We consider ourselves lucky and honored to be supported by members of the advisory board who guided us through another year of this research project. We also appreciate the dedication of our enthusiastic team that includes students, faculty, clinicians, and industry experts.

ANJALI JOSEPH | PH.D., EDAC

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Spartanburg Regional Healthcare System Endowed Chair in Architecture+Health Design Director | Center for Health Facilities Design and Testing Assoc. Professor | School of Architecture Assoc. Professor | Department of Public Health Sciences Clemson University

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SCOTT REEVES | M.D., MBA, FACC, FASE

Immediate past president | Society of Cardiovasular Anesthesiologists The John E. Mahaffey | MD Professor and Chairman Anesthesia & Perioperative Medicine Medical University of South Carolina

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