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

Article excerpt


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

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

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

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

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

Key Words: Operating room, three-dimensional video mockup, structured focus group


Because they are the most profitable services, surgical and interventional procedures are the engines of a hospital (Cima et al., 2011). Outpatient procedures increasingly constitute the bulk of profit (The Advisory Board Company, 2006). However, the profitability of surgical and interventional procedures can quickly be offset by exorbitant costs associated with construction, operational inefficiencies, and safety risks. Consequently, a properly planned and designed operating room (OR) setting should contribute to efficient operations, prevent unnecessary costs, and mitigate injury to patients and staff. What follows are efficiency- and safety-related concerns impacted by the planning and design of OR settings. These concerns informed an exploratory pilot project to facilitate design decision making during the construction documentation of a proposed OR set-up.

Cost and Efficiency

ORs come with several challenges, one being their cost. Park and Dickerson (2009) estimated the cost of running an OR at their institution to be upwards of $1,300 an hour. The cost of running an OR pales in comparison to the opportunity cost and lost revenue for an OR that is not utilized. Given the financial implications related to ORs, healthcare organizations considering their construction or renovation assign a high priority to identifying the ideal mix of OR types, efficiency in OR operations, and the number of ORs.

Material and supply costs account for approximately 47% of an OR budget (Souhrada, 1999). An OR with 20% of its budget in inventory has millions of dollars stored away that are not generating revenue, that are taking up space, and that may expire prior to use. There are three systems for supply distribution. First, supplies can be kept at the point-of-service. Second, an organization can use a case-cart system operated by a central sterile department. Carts of instruments and supplies are prepared prior to surgery. A case-cart system is more efficient than a point-of-service system (e.g., it decreases supply costs because inventories are not duplicated) and can be easily tracked. …


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