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

By Watkins, Nicholas; Kobelja, Mark et al. | HERD : Health Environments Research & Design Journal, Fall 2011 | Go to article overview

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


Watkins, Nicholas, Kobelja, Mark, Peavey, Erin, Thomas, Stephen, Lyon, John, HERD : Health Environments Research & Design Journal


Introduction

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. Third, a hybrid of point-of-service and case-cart systems can be used. With a hybrid system, some rarely accessed items are kept in the core of the OR for nurses to retrieve or in bins attached to case carts.

Safety

ORs can be unsafe. Researchers have argued that approximately one-half of hospitals' adverse events are associated with surgical procedures conducted in ORs (Gawande, Thomas, Zinner, & Brennan, 1999; Gawande, Zinner, Studdert, & Brennan, 2003; Leape et al., 1991). The majority of errors in healthcare settings result from latent conditions in the environment (Reiling, 2007). These latent variables set the physical, contextual, and organizational stage for every surgical procedure. They include environmental factors, management decisions, procedures, policies, teamwork, and communication (Wiegmann, El Bardissi, Dearani, Daly, & Sundt, 2007). Errors are also affected by distractions and interruptions, the complexity of a case, long surgery durations, personnel shortages, inefficient scheduling and supply management, fragmented communication among teammates, poor team situational awareness, the complexity of technology, and a surgical team's lack of experience (Barach et al., 2008; Catchpole, Mishra, Handa, & McCulloch, 2008; Cleary, Chung, & Mun, 2004; Girotto, Koltz, & Drugas, 2010; Sudan, 2009). In addition, a higher rate of minor errors during a procedure depletes team members' abilities to compensate for additional errors (Wiegmann et al., 2007).

Catchpole et al. (2007) found that, on average, 9.9 minor errors occur per surgery. Barach et al. (2008), in an observational study of 102 pediatric cardiac surgeries, discovered that on average 1.2 major adverse events and 15.3 minor adverse events occurred during a surgical procedure. An additional finding of the study was that case complexity and surgery duration were statistically significant predictors of major adverse events. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

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
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.