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.