Brownlee Sarah A, Whitson Paul J, Ibrahim Andrew M
1 Department of Surgery, Loyola University Chicago, Maywood, Illinois.
2 HOK Architects, St. Louis, Missouri.
Surg Infect (Larchmt). 2019 Feb/Mar;20(2):102-106. doi: 10.1089/sur.2018.291.
Existing research regarding design improvements to the operating room (OR) is scarce and emphasizes the compelling need to measure and test new design strategies and interventions.
We propose a conceptual framework for measuring and improving OR physical space design by outlining how two existing measurement schemes can be adapted for ORs. The structure, process, outcomes model described by Donabedian in 1966 is used to show how each of these three measurement approaches can be used to evaluate OR design. In addition, we describe a common design framework that focuses on the end-user experience to highlight the impact different OR stakeholders can have on the prioritization of improvements.
The structure, process, outcomes model has both benefits and drawbacks for measuring OR design quality. For example, these components are easy to measure, highly actionable when deficient, and have high validity as the bottom line. However, they may not necessarily reflect better quality or correlate to better care, and some need risk adjustment to make comparisons fair. The end-user experience model should account for the needs of patients, OR nurses, anesthesiologists, surgeons, facilities managers, hospital administrators, infection control officers, and regulators, among others.
The design quality of ORs influences outcomes and determines the quality of experience for multiple stakeholders. Patients, providers, and hospital staff would benefit directly from efforts to improve OR physical space design. By adapting previously established frameworks, it is possible to measure, evaluate, and improve OR design.
关于手术室（OR）设计改进的现有研究稀缺，且强调迫切需要衡量和测试新的设计策略与干预措施。
我们通过概述如何将两种现有的测量方案应用于手术室，提出了一个用于衡量和改进手术室物理空间设计的概念框架。1966年由唐纳贝迪安描述的结构、过程、结果模型用于展示这三种测量方法中的每一种如何用于评估手术室设计。此外，我们描述了一个侧重于终端用户体验的通用设计框架，以突出不同的手术室利益相关者对改进优先级的影响。
结构、过程、结果模型在衡量手术室设计质量方面既有优点也有缺点。例如，这些组成部分易于测量，在存在缺陷时具有高度可操作性，并且作为底线具有很高的有效性。然而，它们不一定反映更好的质量或与更好的护理相关，并且有些需要进行风险调整以进行公平比较。终端用户体验模型应考虑患者、手术室护士、麻醉师、外科医生、设施经理、医院管理人员、感染控制人员和监管人员等的需求。
手术室的设计质量会影响结果，并决定多个利益相关者的体验质量。患者、提供者和医院工作人员将直接受益于改善手术室物理空间设计的努力。通过采用先前建立的框架，可以衡量、评估和改进手术室设计。
