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OR Design Best Practices for Improved Workflow

The surgical suite represents one of the most complex and expensive hospital departments to design. Continual advancements in medical procedures and technological innovation, including the use of state-of-the-art imaging during surgery, are placing new demands on operating room (OR) setups. Today’s OR designers need to provide for an efficient staff workflow that promotes infection control, safety, and durability while also offering maximum flexibility to meet the needs of differing procedures.

By integrating a careful planning process that includes the entire healthcare team, designers can deliver safe, efficient spaces for patients and staff that are also flexible enough to anticipate the needs of surgical suites well into the future. Parkin provides architectural services that covers everything listed below.

The Surgical Suite Footprint

In the past, a typical OR might measure about 400 square feet. Today, to allow for more in-suite technology, standard ORs range in size from 600 to 650 SF. Hybrid ORs are even larger, requiring as much as 1,000 SF to accommodate imaging systems, the surgical table, and control/equipment rooms. Ceiling heights accounting for above-ceiling services can measure from 12 to 16 feet to allow for housing electronics, cabling, and ductwork.
When it comes to surgical team workflow planning within the OR, however, size is not everything. A well-designed space achieves a balance between efficiency and accommodating the people who work in the suite. Simply increasing an OR’s size could engender other inefficiencies such as increased travel distances between supplies and the surgical field.

Who is in the OR?

In addition to a patient, the OR staffing complement can vary from six to twelve professionals; there may be surgeons, the anesthetist, nurses, students, interns, and technical assistants, as well as medical device representatives. With more personnel in the suite, there is potential for congestion and collision between staff and equipment.
While surgeons and scrub nurses are relatively static at the surgical table, the other nursing staff circulate frequently during a procedure, moving between the sterile core and instrument trays. The choreography within the suite needs to be supported by the design. It should facilitate the flow between the sterile field and other zones by considering equipment placement and any other potential obstacles that might hinder movement.

Sterile Zones and Workflow Constraints

Movement in an OR is constrained by concentric zones of sterility. The sterile field is a three-foot-wide zone centred on the surgical table side and foot that is reserved primarily for the surgical team and scrub nurse. The rest of the nursing staff circulate regularly during a procedure, moving between the sterile core and instrument trays.
Beyond the sterile field is another three-foot ring of circulation for activities such as positioning equipment or bringing instruments to the surgical team. The outermost ring is two feet, six inches wide, and is reserved for the storage of equipment and supplies.
A separate non-sterile work zone for the anesthetist is centred at the patient’s head and is typically a 6’ x 8’ area that can accommodate both the anesthetist and support staff along with the anesthesia apparatus and medication cart.
A common complaint from surgical staff is physical strain due to static positions with a bent or twisted back and head. For nurses, it is the long travel distances between supplies and the OR sterile field, as well as obstacles hindering their movement. A frequent complaint from anesthetists is equipment congestion around the head of the patient.

Planning Considerations

To address some of these concerns, the layout of the room needs to be carefully considered, including the OR table placement and orientation within the room. Based on orientation, the position of doors accessing the OR from both the non-sterile corridor and sterile core should be placed to reduce areas of congestion and potential for collision with equipment.
Positioning the entry door into the OR towards the foot-end of the operating table allows for a better path of circulation around the foot-end of the table without the need to enter directly into the sterile field. It also reduces congestion around the anesthetist’s location. Doors also need to facilitate easy movement of the patient and equipment into and out of the surgical suite along with the easy movement of supplies.
To alleviate bending and twisting, the placement of instrument trays also needs to be considered. Ideally, trays should be placed to the side of the surgeons, rather than behind them, to reduce the amount of rotation and reaching between the scrub nurse and surgeon. The OR design may need to provide more area around the foot-end of the surgical field to accommodate the instrument trays.

Ceiling Mounts

Crucial floor space is freed up by implementing ceiling-mounted booms that can house medical equipment, monitors, and OR lights; however, they require a minimum ceiling height of at least 10 feet. The booms provide flexibility so that lighting, equipment, and monitors can be easily adjusted closer to the surgical team when needed. Strategically placed single mounts that house several arms centred directly over key zones can also minimize obstructions around the table while providing the greatest coverage.
Twelve and 6 o’clock arm positions at the head and foot of the table are common arrangements that provide good coverage and allow unobstructed access to either side of the operating table. In any case, a separate equipment arm is required at the head of the patient for the anesthetist team.

Working With the Healthcare Team

A number of mock-up processes can help the design team work with healthcare professionals to develop optimal workflow planning. These tools help the team members visualize the proposed space and give them the ability to provide valuable feedback to the design team. 
3D visualization mock-ups provide an initial understanding of the design concept and furnish sightlines from a first-person perspective for users to assess in the early stages of the process. Later in the process, full-scale physical mock-ups with the equipment allow healthcare teams to test-drive the fit and feasibility of the proposed plan and quickly make adjustments. 
Workflow Planning in Practice: The New Clinical Services Building at Cape Breton Regional Hospital
Parkin designers are using this process to help in the surgical workflow planning process at Cape Breton Regional Hospital’s clinical services expansion.
Along with a new cancer centre, a neonatal intensive care unit (NICU), and an expanded emergency department, the new clinical services building in Sydney, Nova Scotia, will include eight new surgical suites plus an interventional OR.
Drawing on the OR planning best practices discussed earlier, the design team is currently addressing some of the challenges posed by the redevelopment of the facility, such as accommodating the nine-metre grid and minimizing the encroachment of grids into the ORs. Some design considerations include integrating strategic storage locations with the aim of reducing congestion and travel times between supplies and the sterile field. The OR tables will be repositioned and access doors into the OR will allow more clearance at the foot of the table and create clear paths for entry without the need to cross the sterile field.
For the two Orthopaedic ORs, supply storage will be centrally located to serve both suites. Meanwhile, another elevator has been added near the C-section OR to provide rapid transport of mothers directly from the Women and New-born unit above.
To aid the early planning of these ORs, the designers have developed renderings to help administrators and the surgical team evaluate the initial planning concept. In the next stage, physical mock-ups will be built so that surgical teams can do dress rehearsals through the proposed spaces, make any adjustments, and validate the final design.

Level 3 Surgical Services at CBRH

C-Section OR

Through this iterative process, the new Clinical Services Building at Cape Breton Regional Hospital will offer Nova Scotians nine additional state-of-the-art, custom designed ORs that serve the needs of both patients and surgical staff. Looking for a healthcare architecture solution? Get in touch with us today to see how we can help.

SOURCES:

https://europepmc.org/article/MED/29866321

https://www.nytimes.com/2021/05/05/health/operating-rooms-change-technology.html

http://building-tomorrow.ca/projects/cape-breton-regional-hospital/

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