Checklist for Operating Rooms

Surgery

Introduction

This check-list is meant to help in planning Operating Rooms (ORs) or improving existing ones.

Without a check-list, it is easy to forget important items and details because of the large number involved. Such omissions will only be noticed once the area is being used, when they are much more expensive to put right. To make sure this check-list applies to a particular area, and at a particular time in the future, it should be reviewed by all those involved with the OR. These include all staff working there, patients and their associates, those providing services such as information, power and water, supplies, cleaning, and maintenance, and those responsible for the safety or overall management of the area.

It is important to include all workers, and not just the managers, who are likely to forget important everyday details.

On its own a check-list won't ensure that all mistakes are avoided. Apart from actual use of the area, or learning from the mistakes of other ORs of similar design, simple plans of 1:10 scale can show clearance for cut-outs of mobile equipment, and of staff and patients which are moved around the plan.

Even plans like these won't prevent problems with noise, lighting, temperature, humidity, smells, and bacteriological safety. Some of these matters are dealt with in other papers by this writer. Some of the items mentioned may not be needed in individual ORs, depending on their type of likely work-load One or two of the items may be out of date, like viewing domes.

There is no reference to Standards, legal requirements, or engineering aspects. However it should help avoid some of the bigger blunders from the point of view of users. Future developments from this checklist may include separate detailed equipment lists and criteria and applications to other hospital areas, work-flow, process charts, and task analysis.

General requirements for all areas:

• Consistency - try and keep the same style throughout, the same style new nurses in your OR will already be used to from mainstream hospital design, where this does not interfere with function and usability
• Avoid mirror symmetry, so people would have to do exactly the opposite in one OR to what they do in another
• Fire, safety
• Signage
• Access, corridors, doorways, doors, proximity to related work areas
• Lines of sight, lighting, accessible label-tested light switches
• Noise insulation
• Cleanability [checked with cleaners]
• Maintainability [checked with maintenance tradespeople]
• Space calculations and estimates for equipment - static and mobile, and also space and clearance for people, checked with scale plans and cut-outs
• Information - phones, phone directory, computer facilities, where-is-it directories
• Power, water, hand-wash taps and basins or lower body splash shields
• Testing of plans, mock-ups, and signage with typical users as well as with managers.

Follow-up with

• Post-Occupancy Evaluation
• at 4 & 15 months for •Remedial Architecture•
• Reference materials and other documentation for all contents, • separate listing of contacts for technical problems and information

Reception Area For Patients

• Space for trolley
• Clearance for orderly, nurse, anaesthetist, 2 persons accompanying patient, and portable ventilator and monitors with critical emergency cases
• Lighting
• Doorbell, voice communication to main OR areas
• Security
• Video monitoring according to security policy and procedures
• Trolley or shelves for gowns, caps, and overshoes for parents or others accompanying children or other patients into the anaesthetic room.
• Chairs for accompanying persons in case of prolonged wait.

Corridors

• Width, lighting levels, white-board, notice-boards

Anaesthetic rooms

• Access from reception area, to OR
• Light indicating when room is in use
• Call bell or voice intercom through to OR
• Space as for reception area, but including anaesthetist and extra nurse
• Lighting, spot lighting, labelled light switches
• Anaesthetic gas outlets
• Cupboards, storage areas for equipment, supplies, stationary (these need to be listed in detail anyway at some stage - might as well be sooner)
• Secure lockable cupboards for drugs
• Shelves and benches, including room for writing
• Décor soothing to patient, including murals or ceiling decorations & posters

Scrub room ( may be shared between 2 or more ORs)

• Access from corridor, access to OR, with some visibility
• Lighting
• Elbow taps or taps with electronic sensors, digital temperature indicators and controls
• Timer for each tap
• Sinks (single waist-high slanted perspex or stainless steel sheet down to floor runnel, rather than individual wash basins
• Soap pack dispensing fixtures
• Trolley for donning gowns, gloves
• Trolley or shelving for gloves
• Adequate clearance for outstretched arms when gowning & gloving
• Mirror for checking cap and mask
• Rubbish bins

Operating room - general (Separately - OR for Subspecialties)

• Anaesthetic machine
• Seats for anaesthetist, surgeons, assistants, nurses - comfortable adjustable and mobile
• Pendants for gases, power, suction
• Power outlets - sockets on cords from ceilings, pendants, wall-sockets
• Info links - phones, computers, voice free-hand, video detailed, general
• Shelving
• OR table
• Room for instrument trolleys, supplies trolleys, diathermy, surgical suction, smoke evacuation, sponge racks or counting mats, video cart, other trolleys, IV stands, image intensifier, operating microscopes, second surgical team
• Supplies - storage baskets or trolleys for commonly used materials to save fetching outside the OR
• Storage for operating table accessories including arm rests, leggings and stirrups, positioning equipment
• X-ray viewing boxes
• Anaesthetic gas supply indicators
• Lighting general, special
• Temperature displays and controls
• Humidity sensor & control
• Plenum (positive pressure atmospheric) indicator & control
• Fire sensors and sprinklers
• Emergency call bell and intercom, with protocol for their use.
• Hooks for x-ray gowns, OR table accessories
• Whiteboard, possible separate device for swab counts

Recovery area / ward

• Access from OR (type of door?), to external corridor (security)
• Nurses station allowing clear lines of sight
• Gurney stations (?how many)with wall-mounted gas, power, monitoring, curtains, clearance for medical and nursing procedures
• Shelving, supplies
• Emergency call bell
• Patient toilet
• Portable Oxygen, suction, monitoring equipment
• Emergency trolley with defibrillator

Set-up room

• ? separate for each OR or each group of ORs
• Access from stores, CSSD, sterilizers, access to OR
• Floor-space for trolleys for next batch of set-ups
• Clearance for gowned and gloved set-up nurses and for sterile trolleys

Clean-up

• Maybe sited elsewhere
• Large enough to prevent congestion
• Rubbish bins - linen trolleys, infectious waste, sharps
• Trolleys for rubbish and soiled linen for transportation to dirty room
• Trolleys for transport of instruments to CSSD
• Standing or seated work areas with knee room
• Sinks and benches at correct height, spot lighting and magnification for instrument cleaning
• Sluices, plaster trap
• Ultrasonic cleaners. automatic instrument washing machines
• Storage for cleaning implements including special brushes
• Wall brackets for gloves, safety glasses, sharps containers, linen bags
• Shelving for instrument bays

Sterilizing department / area / autoclave / liquid-soak sterilization

• Varies according to overall hospital plans
• Based on separate specialized advice
Storage areas • Consumables - for each specialty
• Refrigerators for drugs
• Mobile equipment -microscopes, video carts, special-procedure items
• OR table add-ons [mentioned above]
• Trolleys, baskets for each specialty
• Toilets, shower
• Phone
• Wall hooks for equipment, shadow boards

Change room male, female

• Secure entrances
• Lighting, clearly labelled light switches
• Lockers, individual keys [secure storage for duplicate keys elsewhere, or other lock technology]
• Benches
• Linen shelves, cupboards
• Used linen containers

Lounge / coffee areas - medical, nursing, other

• Seats, tables, shelves
• Wet area for coffee, snacks
• Phones
• Dictation facilities including small quiet bays,
• Desk space for paperwork
• Refrigerator, microwave, water heater, beverages (hot, cold)
• Space for food or refreshment trolleys
• Quiet area for private conversation (if large enough)

Office and administration area

• Separate areas for receptionist, supervisor
• Desk, phone, computer, stationary
• Answering machine
• General access to bookshelves for instrument directories, texts
• Filing cabinets for info
• Office area for anaesthetists

Conference and discussion areas
• for separate listing

Cleaners cupboard
• for separate listing

Xray processing room
• for separate listing

Proximity to related work areas

• Day surgery [possibly included in design within OR]
• Emergency reception
• ICU
• CSSD (vertical access may be enough)
• Pathology (for frozen section) - or pneumatic tube or similar access, or secure area for specimen storage
• Xray and other imaging department
• Surgical wards
• Holding bays with call bells for pre-operative patients

Other considerations

• Wall finishes, colouring (avoid masking cyanosis etc - see •lighting requirements• separately)
• Maintenance procedures and schedules - implications for architectural design
• Ditto procedural information, equipment lists
• Design not wasteful of staff through e.g. areas isolated by poor communication
• Scheduling info readily available for wards, surgeons, set-up staff using the hospital computer system monitors

Common problems

• Storage areas - inadequate and scattered
• Lack of storage for special items e.g. stationary
• Lack of knee room for seated work
• Trailing power cords
• Lack of acoustic privacy
• w) in OR which drift or are difficult to position
• Confusion for newcomers, temporary staff
• Unanswered telephones
• Inadequate office space
• Theft of instruments, supplies, linen
• Poor maintenance of surgical equipment (poor planning, supervision, training)

Useful ideas

• Space for white-boards

Possible extra features • Music
• Flexibility
• OR of the Future - the Ethicon project - Integration - Aesop (voice-controlled robot etc)
• Extra monitors, Closed Circuit TV
• Viewing facilities for students and visiting surgeons, including mezzanine floor
• Later additions - plan diagrams & 3D diagrams & flowcharts

References

Architecture & Medicine : I.M. Pei Designs the Kirklin Clinic
Aaron Betsky, Tom Bonner (Photographer) / Hardcover / Published 1993
Hospital Interior Architecture : Creating Healing Environments for Special Patient Populations ~ Jain Malkin / Paperback / Published 1992
British Hospital and Health-Care Buildings : Designs and Appraisals P T Stone / Hardcover / Published 1980
Directory of Architects for Health Facilities Paperback / Published 1983
Hospitals and Health Care Facilities : A Design and Development Guide
Sir Anthony Cox, Philip Groves / Hardcover / Published 1990
Plant, Technology and Safety Management Series : Health Facility Design and Construction (No. 1, 1991 Series) Paperback / Published 1991
Architectural design for hospitals : hospital planning, ward design and efficiency, out-patient, accident and emergency departments : an update of A 148
The architecture of healing British hospital and health-care buildings : designs and appraisals Directory of Architects for Health Facilities, 1981 Ed. Issn 0192-2297
American Hospital Association 1981
Health Care Architecture : Designs for the Future Eleanor Lynn Nesmith 1995 Casper DE Health care facility design : recent trends and projects 1983-1985
James P, Noakes T: Hospital Architecture. Longman Building Studies 1994
Porter DR: Hospital Architecture : Guidelines for Design and Renovation 1982
Miller RL Swensson ES. New Directions in Hospital and Healthcare Facility Design 1995
Hardy OB,. Lammers LP: Hospitals, the Planning and Design Process
1986
Rohde DJ, et al Planning and Managing Major Construction Projects : A Guide for Hospitals 1985
Hospitals, Clinics, and Health Centers: Architectural Record Book 1972
Patkin M (1991) Hospital Architecture - An Ergonomic Debacle. Proceedings, First International Conference on Hospital Ergonomics, Paris

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Contents

Introduction

General requirements for hospital areas

Reception area for patients
Corridors
Proximity to related work areas

Anaesthetic rooms
Scrub room
Operating room - general
Recovery area / ward

Equipment
Set-up room
Clean-up
Sterilizing department / area / autoclave / soak-liquid sterilization
Storage areas

Staff areas
Change room male, change room female
Lounge / coffee areas
Office and administration area
Conference and discussion areas
Xray processing room
Cleaners cupboard

Other considerations
Common problems
Useful ideas
Possible extra features

Reference list

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This draft 991111a

A User's Checklist for Architectural Components of Operating Room Suites
Michael Patkin
Department of Surgery
Royal Adelaide Hospital, South Australia
____________________

Later published as:
Patkin M. 2003 A checklist for components of operating room suites Minim Invasive Ther Allied Technol 12,6, 263 - 267

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