FUTURE DESIGN OF OPERATING ROOMS
Despite heightened awareness of safety
factors and increased educational efforts among operating room personnel, harm
to patients still occurs at a rate that most industries and the public deem
unacceptably high. Similarly, despite threats of payment withhold-ing, public
scoring of medical personnel and hospital systems, provider rating web sites,
and punitive legal consequences, the human factors resulting in medi-cal errors
have not been completely eliminated. In future, safety-engineered designs may
assist in the reduction of medical errors. One developing area is the use of
interlock devices in the operating room. An interlock device is simply a device
that cannot be operated until a defined sequence of events occurs. Anesthesia
personnel use interlock technology with anesthesia vaporizers that prevent the
use of more than one vaporizer at a time. Expansion of this tech-nology might
prevent release of a drug from an auto-mated dispensing device until a barcode
is scanned from a patient’s hospital armband or, at a minimum, the patient’s
drug allergies have been entered into the machine’s database. Other
applications might include an electrosurgical device or laser that could not be
used when the FiO2 content was higher than 30%, thus
eliminating the risk of fire. Likewise, computers, monitors, and other devices
could be designed to be inoperable until patient identification was confirmed.
Coordinating the activities of surgical
personnel, anesthesia providers, and operating room nurses is essential to the
day-to-day running of a surgical suite. Clinical directors in facilities
ranging from one- or two-room suites to multiroom centers must accommodate
surgical procedures of varying dura-tions, requiring varying degrees of
surgical skill and efficiency, while allowing for sudden, unplanned, or
emergency operations. The need to monitor work-flow and analyze data for
optimizing scheduling and staffing prompted the development of software
sys-tems that anticipate and record the timing of surgical events; these
systems are constantly being refined.Surgical suites are also being designed to
aug-ment workflow by incorporating separate induction areas to decrease
nonsurgical time spent in operat-ing rooms. Several models exist for induction
room design and staffing. Although uncommon in the United States, induction
rooms have long been employed in the United Kingdom.
One induction room model uses rotating
anes-thesia teams. One team is assigned to the first patient of the day; a
second team induces anesthesia for the next patient in an adjacent area while
the operating room is being turned over. The second team contin-ues caring for
that patient after transfer to the oper-ating room, leaving the first team
available to induce anesthesia in the third patient as the operating room is being
turned over. The advantage of this model is continuity of care; the
disadvantage is the need for two anesthesia teams for every operating room.
Another model uses separate induction
and anesthesia teams. The induction team induces anes-thesia for all patients
on a given day and then trans-fers care to the anesthesia team, which is
assigned to an individual operating room. The advantage of this model is the
reduction in anesthesia personnel to staff induction rooms; disadvantages
include fail-ure to maintain continuity of care and staffing prob-lems that
occur when several patients must undergo induction concurrently. This model can
utilize either a separate induction room adjacent to each operat-ing room or
one common induction room that ser-vices several operating rooms.
The final model uses several staffed
operating rooms, one of which is kept open. After the first patient of the day
is transferred to the initial room, subsequent patients always proceed to the
open room, thus eliminating the wait for room turnover and readiness of
personnel. All of these models assume that the increased overhead cost of
main-taining additional anesthesia personnel can be justi-fied by the increased
surgical productivity.
Radio frequency identification (RFID)
technol-ogy utilizes a chip with a small transmitter whosesignal is read by a
reader; each chip yields a unique signal. The technology has many potential
applica-tions in the modern operating room. Using RFID in employee identification
(ID) badges could enable surgical control rooms to keep track of nursing,
sur-gical faculty, and anesthesia personnel, obviating the need for paging
systems and telephony to estab-lish the location of key personnel.
Incorporating the technology in patient ID bands and hospital gurneys could
allow a patient’s flow to be tracked through an entire facility. The ability to
project an identifying signal to hospital systems would offer an additional
degree of safety for patients unable to communicate with hospital personnel.
Finally, RFID could be incorporated into surgical instruments and sponges,
allowing surgical counts to be performed by identification of the objects as
they are passed on and off the surgical field. In the event that counts are
mismatched, a wand could then be placed over the patient to screen for retained
objects.
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