There is a lack of information to support the design of the rapidly growing number of ambulatory surgical centers (ASCs). These centers have become more popular as trends in reimbursement, technology, and services have evolved. Research is needed to inform how the built environment of ambulatory surgical environments impacts the critical interactions between people, supplies, and equipment.
This research was conducted to identify environmental design strategies supporting or hindering critical interactions between patients, care team members, and technology. The following questions were considered:
1. What are the types of interactions between staff as well as staff and patients/care partners in the preoperative (preop) and postoperative (postop) workspaces of ASCs, and where are these interactions occurring?
2. What are the characteristics of the spaces that either support or impede these interactions?
3. How does spatial layout and configuration impact the integration of technology, such as electronic medical records and associated work processes in ASCs?
Two ASCs were observed using a multi-method approach that included behavior mapping, shadowing, spatial analysis, and semi-structured interviews with nursing staff. The systematic observational strategy of behavior mapping was used to assess behavioral dynamics of nurses and staff but only the data points associated with nurses were selected for analysis into a proprietary application called Detailed Observation Task and Time (DOTT). Coding criteria and definitions were developed from a literature review to label activities, behaviors, and interactions observed by two researchers. Select nurses were shadowed by a single researcher to capture intricacies of specific interactions and activities. Semi-structured interviews were also conducted using photographs to elicit contextual insights from participants. The interview protocol included the following questions: 1) In your current role, what tasks do you most commonly perform? 2) Where are you most likely to perform those tasks? 3) In what ways does your workspace support your ability to perform those tasks? 4) In what ways does your workspace inhibit your ability to perform those tasks?
Key findings from this study are summarized as follows:
- There is a distinct ebb and flow of activities and space usage at the both surgery centers, with postop areas underutilized during the morning and preop areas underutilized in the afternoon.
- The most common activity observed among both preop and postop nurses were talking and listening, indicating the importance of face-to-face interactions and communication in ambulatory surgery centers
- Preop and postop nurses spend a majority of their time on their feet (standing and walking).
- Nurses’ work is everywhere—in the central work areas, in corridors as well as in patient bays—and they perceive all these spaces as their work areas.
- The majority of direct patient care activities, such as bedside care and charting, are done directly with the patient in the patient bays, thus making these spaces the primary work areas for nurses.
- The size and configuration (walls vs. curtains) of the patient bays impact the ability of a facility to effectively integrate wall-mounted computer workstations for charting and patient care.
- The integration of EHR does not eliminate paper from the system.
- The key environmental facilitators and barriers to nurses’ work in surgery centers include: size, access, flexibility, visibility, and privacy.
Both ASCs observed were from a single healthcare system with similar organizational structures and policies that may have influenced workflow. Because this was a purely observational study, behaviors of nurses may have been influenced by the presence of researchers.