Bayramzadeh Sara, Joseph Anjali, San Dee, Khoshkenar Amin, Taaffe Kevin, Jafarifiroozabadi Roxana, Neyens David M
1 Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC, USA.
2 Medical University of South Carolina, Charleston, SC, USA.
HERD. 2018 Jul;11(3):124-138. doi: 10.1177/1937586717751124. Epub 2018 Jan 22.
To assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse's (CN) workflow patterns and disruptions.
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.
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.
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.
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.
评估手术室（OR）内功能不同区域的相邻关系如何影响巡回护士（CN）的工作流程模式及干扰情况。
巡回护士在手术过程中通过观察、监测和管理手术区域及周边的潜在威胁，对促进患者安全起着重要作用。他们的工作需要不断在手术室的不同区域移动，以支持团队成员。手术室的布局以及拥挤杂乱的环境可能会影响巡回护士的工作流程，并在手术期间造成干扰。
对25台手术进行便利抽样录像，并对巡回护士的活动、位置和流程干扰进行主题编码。手术室布局分为过渡区域和功能区域（工作站、供应区、支持区以及手术台周围的无菌区域）。巡回护士的活动分为与患者、设备、材料和信息相关的活动。流程干扰包括与环境危害和布局相关的干扰。
在91%的活动中，巡回护士穿梭于多个区域。巡回护士的工作站作为主要枢纽，巡回护士频繁往返于手术台两侧、手术台脚部、供应区和支持区。过渡区域占巡回护士所涉及的所有流程干扰的58.3%，而28%发生在手术床周围区域。
尽管手术室布局存在差异，但移动和流程干扰模式的相似性突出了巡回护士经常访问的主要区域之间所需的相邻关系。在设计手术室时应考虑这些最佳相邻关系，以便使其更高效、更安全。
