Impact of Surgical Table Orientation on Flow Disruptions and Movement Patterns during Pediatric Outpatient Surgeries

Abstract

(1) Background: The surgical table within a typical ambulatory surgery operating room is frequently rotated and placed in different orientations to facilitate surgery or in response to surgeon preferences. However, different surgical table orientations can impact access to different work zones, areas and equipment in the OR, potentially impacting workflow of surgical team members and creating patient safety risks; (2) Methods: This quantitative observational study used a convenience sample of 38 video recordings of the intraoperative phase of pediatric outpatient surgeries to study the impacts of surgical table orientation on flow disruptions (FDs), number of contacts between team members and distance traveled; (3) Results: This study found that the orientation of the surgical table significantly influenced staff workflow and movement in the OR with an angled surgical table orientation being least disruptive to surgical work. The anesthesia provider, scrub nurse and circulating nurse experienced more FDs compared to the surgeon; (4) Conclusions: The orientation of the surgical table matters, and clinicians and architects must consider different design and operational strategies to support optimal table orientation in the OR.

Anesthesia Workspaces for Safe Medication Practices: Design Guidelines

“…The recordings began when the patient entered the OR and stopped when the patient was removed to recovery. These data have been previously used to address research questions related to OR design and the likelihood of surgical safety events (Joseph et al, 2019;Joseph et al, 2021;Jurewicz et al, 2020;Neyens et al, 2019). This study focused on the intra-operative and postoperative phases of the procedures.…”

“…Published studies (Held & Krueger, 2000; Joseph et al, 2018; Joseph et al, 2019; Joseph et al, 2021; Jurewicz et al, 2020; Palmer et al, 2013; Pape & Dingman, 2011) have highlighted the high rates of perioperative medication errors and adverse drug events in the operating room with one study finding that as many as one in 20 medication administrations included an error or adverse drug event (Nanji et al, 2016). There are many factors that contribute to this problem (Nanji, 2020) including time pressure, high-acuity nature of patient care in the Operating room (OR), medication label design, design of technology, and equipment and the design and layout of anesthesia workspaces.…”

Evolving with technology: Machine learning as an opportunity for operating room nurses to improve surgical care—A commentary

“…Machine learning could assist in managing the intrinsic factors that cause the most disruption to surgical workflows: managing equipment and OR theatre layouts (Neyens et al, 2019). To someone unfamiliar with the OR environment, layouts and locating equipment may seem trivial; however, something as seemingly innocuous as the OR table facing the wrong direction can lead to a nearly two times increased chance of having surgical flow disruptions (Joseph et al, 2021). These disruptions are important to minimize because they prolong surgical procedures, which means higher costs for hospitals, more exposure to anaesthetics for patients and a higher chance of developing a surgical site infection (Cheng et al, 2017; Koch et al, 2020).…”

Understanding “Work as Done”: Using a Structured Video-Based Observational Method to Understand and Model the Role of the Physical Environment in Complex Clinical Work Systems

“…First, a playback model was developed using simulation software to visualize movements of staff while adhering to dwell times and departure times from zone locations previously recorded. The model used the data to simulate the movement between zones, capturing data that could be used to assess the flow of individual OR staff (Bayramzadeh et al, 2018; Joseph et al, 2019; Joseph, Neyens, et al, 2021; Neyens et al, 2018). Through a social movement algorithm, interdependencies that accounted for collision avoidance were used to show how individuals are forced to walk around other staff members or objects in the OR.…”

“…Since understanding interactions with the physical environment is important in healthcare design studies, cameras must be positioned to maximize views of all spaces, people, and equipment such that key research questions can be effectively addressed. For example, in our OR study, four video cameras were mounted on poles in the four corners of the rooms so that the cameras were unobtrusive, out of the path of movement of clinicians and equipment, and enabled views of most objects, people, and surfaces in the room (Joseph, Neyens, et al, 2021; Mousavi et al, 2018; Neyens et al, 2018).…”