The Impact of Operating Room Layout on Circulating Nurse’s Work Patterns and Flow Disruptions: A Behavioral Mapping Study
Health Environments Research & Design Journal
The purpose of the study is to assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse’s (CN) workflow patterns and disruptions.
Background: The 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 environment might impact the CN’s 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.
Anjali Joseph, Ph.D, EDAC
Associate Professor and Endowed Chair
Architecture + Health Design and Research at Clemson University
As the Spartanburg Regional Health System Endowed Chair in Architecture + Health Design and Director of the Center for Health Facilities Design and Testing at Clemson University, Dr. Anjali Joseph is focused on using simulation and prototyping methods to research and test effectiveness of promising design solutions that may impact patient safety in high stress healthcare environments. She has focused her research on multidisciplinary approaches to improving patient safety in healthcare through the development of tools and built environment solutions. She is currently leading a multidisciplinary AHRQ funded project to develop a learning lab focused on improving patient safety in the operating room. She led the research activities at The Center for Health Design before joining Clemson. Here, she served as principal investigator on several grants from different organizations such as Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality, U.S. Green Building Council and the Kresge Foundation. Anjali’s work has been published in many academic journals and magazines. She frequently peer reviews articles for journals.
Anjali obtained her Ph.D. with a focus on Architecture, Culture and Behavior from the Georgia Institute of Technology, master's degree in Architecture from Kansas State University and bachelor’s degree in Architecture from the School of Planning and Architecture in New Delhi, India.