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OBJECTIVES There is a pressing need to improve safety and efficiency in the operating room (OR). Postsurgical adverse events, such as surgical site infections and surgical flow disruption, occur at a significant rate in industrial countries where a considerable portion of such complications result in death. The aim of the study was to identify an ideal room design that improves the flow of staff members using risk and safety performance measures. METHODS Operating room designs were compared by using computer simulation modeling to analyze traffic flow inside an OR. The study was conducted in two phases. A historical data set was first created based on surgical flow data obtained from 23 video observations of actual surgical procedures. A detailed simulation-based model was then developed. RESULTS As room size increases, staff members have more available space to maneuver in the room, resulting in more distance walked but far fewer undesirable contacts. An angled table orientation is preferred with the circulating nurse workstation at the foot of the OR table, as it provides more space for staff to move across the room without increasing the number of contacts. Furthermore, when the nurse workstation is near the wall, staff members experience fewer undesirable contacts. CONCLUSIONS Simulation modeling was used to assess the impact of OR layout alternatives on three performance metrics, and the medium-sized OR prototype performs well across the metrics. Future research will consider the relative influence of several factors on traffic-based safety and efficiency performance metrics, resulting in a more predictive simulation design model.

Purpose: Understand how the interior design of single-family rooms (SFRs) in neonatal intensive care units (NICUs) can support family engagement behaviors. Background: Family members are integral contributors to infant care in NICUs, impacting infant development. While at the NICU, parents are encouraged to participate in a process called family engagement, where they are expected to move from passive to active caregivers, in preparation for their role after discharge. While family engagement is affected by the built environment, no studies have investigated this relationship in any depth. NICU settings morphed to involve families through the SFR design model, but the interior environment of SFRs have not been sufficiently explored as a resource to support specific family engagement behaviors. Methods: We interviewed family and staff and observed family engagement behaviors in SFRs at two NICUs. Behaviors were observed and described in terms of their location, number of people, and design elements involved. Built environment characteristics were collected through physical assessments, and interviews elicited participants’ perceptions about design factors impacting family behaviors inside SFRs. Data analysis followed grounded theory segments and pattern matching. Results: Three behavioral patterns and five themes were identified showing how SFRs’ private bathrooms, family storage, family zone partitions, positive distractions, and information boards can support families’ home-like, educational, collaborative, and infant care behaviors. Conclusions: The interior design of SFRs can be a resource to family engagement in the NICU. Future research should operationalize SFR features found in our study to measure and validate their impact on family engagement outcomes.

The built environment of an older person’s home can reduce or promote the possibility of a fall or other injury. A user-friendly tool can help the residents to evaluate their home environment withi...

Objective: The purpose of this study was to compare perceptions and behaviors of end users participating in simulations in a high-fidelity physical mock-up of an operating room (OR) prototype with the perceptions and behaviors of end users in the built out ORs postoccupancy. Background: Simulation-based evaluations of high-fidelity physical mock-ups of proposed layouts are increasingly being conducted during the facility design process to understand impacts on workflow and potential adverse patient safety outcomes. Nevertheless, it is unclear to what extent user experiences in these simulated healthcare spaces are similar to those in built and occupied healthcare environments. Methods: Using interviews, surveys, and observations, this study compared user evaluations in a high-fidelity physical mock-up of an OR with user evaluations of the built and occupied OR postoccupancy. Workflow disruptions were also analyzed using video recordings for a simulated pediatric surgery and five pediatric surgeries in the actual OR. Results: This study found that user perceptions and behavior in the two types of environments were mostly similar with regard to perceived support for the location of surgeon workstation, perceived space and task performance, perceived access to storage locations, boom setup, and OR cleanability. Participant’s ratings differed for supportiveness of the mobile Circulating Nurse (CN) workstation, maneuvering booms, and environmental disruptions. Conclusion: Simulation-based evaluations are extremely beneficial during the design process and can provide valuable input to design teams as well as clinical teams about workflow and safety issues that allow design issues to be addressed before construction.

Purpose: This study proposes a flow mapping approach for surgical facilities that can be implemented by design teams as a component of case study tours. Background: The provision of healthcare services involves simultaneous and closely coupled flows of people, objects, and information, and the efficiency of these flows is influenced by the spatial configuration of the buildings where these services are housed. Many architecture firms conduct case study tours to inform their design process. However, these tours often lack a structured way of documenting different flows and interpreting observations. A structured approach is needed during the design process to understand the impact of spatial configuration on healthcare flows. Method: Site tours were conducted at four surgery centers to develop and test an evidence-based flow mapping approach. Idealized flows within surgical facilities were first identified from the literature, followed by the development of a data collection tool aimed at documenting these flows in each case study through a pre-assessment questionnaire, a physical assessment, and interviews with staff. Results: The flow mapping tool kit was effective in allowing the design team to systematically understand the physical configuration of surgical flows across case studies. The tool also allowed the team to identify spatial configuration characteristics acting as barriers and facilitators to idealized flows. Conclusions: The flow mapping approach was able to provide structure for conducting these short tours more effectively via observations and staff inquiry, enabling design teams to draw more meaningful conclusions from case study tours and conduct comparisons between healthcare facilities visited.

BackgroundStudies in operating rooms (OR) show that minor disruptions tend to group together to result in serious adverse events such as surgical errors. Understanding the characteristics of these minor flow disruptions (FD) that impact major events is important in order to proactively design safer systemsObjectiveThe purpose of this study is to use a systems approach to investigate the aetiology of minor and major FDs in ORs in terms of the people involved, tasks performed and OR traffic, as well as the location of FDs and other environmental characteristics of the OR that may contribute to these disruptions.MethodsUsing direct observation and classification of FDs via video recordings of 28 surgical procedures, this study modelled the impact of a range of system factors—location of minor FDs, roles of staff members involved in FDs, type of staff activities as well as OR traffic-related factors—on major FDs in the OR.ResultsThe rate of major FDs increases as the rate of minor FDs increases, especially in the context of equipment-related FDs, and specific physical locations in the OR. Circulating nurse-related minor FDs and minor FDs that took place in the transitional zone 2, near the foot of the surgical table, were also related to an increase in the rate of major FDs. This study also found that more major and minor FDs took place in the anaesthesia zone compared with all other OR zones. Layout-related disruptions comprised more than half of all observed FDs.ConclusionRoom design and layout issues may create barriers to task performance, potentially contributing to the escalation of FDs in the OR.

In this study of low-income Hispanic/Latino adults living in 291 individual apartments in the Bronx, New York, the apartment layout was significantly associated with the odds of depressive symptomology. Women living in apartments in which the most central rooms were the living, dining, or kitchen (i.e., rooms commonly used for communal activities) were less likely to have depressive symptomology (OR = 0.44, 95% CI = 0.22–0.86) than women in apartments where the central rooms were lobbies or corridors, adjusting for demographics, health conditions, and housing and neighborhood characteristics. No statistically significant association was observed in men. We present the logic underlying the use of layout variables in this study and discuss the implications it may have for understanding the role of the home environment on psychological distress among inhabitants. The results of this study show how space syntax analysis can be used to better understanding disparities in the risk of depression and offer an additional opportunity for public health stakeholders to identify those most at risk for depression.

Este trabalho disserta sobre o processo de adaptação arquitetônica dos edifícios hospitalares frente às mudanças físicas e funcionais trazidas pelas inovações tecnológicas na área médica. Principalmente após a segunda metade do século XX, se acelerou o desenvolvimento científico na medicina, com a descoberta de novas enfermidades, novos tratamentos e, especialmente, novas formas e ferramentas de diagnóstico. A existência e o aperfeiçoamento destas atividades têm se apoiado cada vez mais na tecnologia, cujas inovações foram sendo introduzidas nos edifícios na forma de equipamentos, exigindo espaços e instalações especiais. Os hospitais existentes, tendo que se adaptar às especificidades técnicas, foram submetidos a um ritmo intenso de transformações arquitetônicas, no intuito de evitar a sua obsolescência. Para investigar o impacto destas freqüentes inovações tecnológicas sobre os edifícios hospitalares, buscou-se analisar o desenvolvimento arquitetônico dos mesmos, nas suas áreas mais relacionadas ao uso de tecnologia. Os casos estudados foram o Instituto do Coração (InCor), o Hospital Israelita Albert Einstein (HIAE) e o Hospital de Doenças do Aparelho Locomotor Sarah Kubitschek de Brasília (HDAL), cujos edifícios são representativos do cenário ilustrado. Reconhecendo nas instituições de saúde o dinamismo técnico-científico, a complexidade espacial e os desafios quanto à preservação da sua integridade arquitetônica, esta pesquisa espera alertar os arquitetos sobre a inconstância das variáveis que desenham as edificações hospitalares, sobre a importância de depreendê-las e sobre a necessidade de projetar edifícios flexíveis para incorporar estas variáveis de modo menos impactante. This dissertation is about the architectural adaptation process that medical buildings undergo in face of physical and functional changes brought by technological innovations in medicine. Especially after the second half of the 20th century, the scientific progress in medicine accelerated with the discovery of new diseases, new treatments and new forms and tools of diagnosis. The existence and improvement of these healthcare activities have been supported more and more by technology and its machinery, which were absorbed by medical buildings in the form of equipment, demanding special space and infrastructure. Existing hospitals were forced to adapt to the technical needs, and were submitted to an intense pace of architectural transformation, fighting against their obsolescence. In order to investigate the impact of these frequent technological innovations upon medical buildings, their architectural development was analyzed in the areas most affected by technology. The case studies were the Instituto do Coração (InCor), the Hospital Israelita Albert Einstein (HIAE) and the Hospital de Doenças do Aparelho Locomotor Sarah Kubitschek (HDAL) of Brasília, whose buildings represent the illustrated scenario. Acknowledging in medical buildings the spatial complexity, the technical and scientific dynamism and the challenges involving the preservation of their physical integrity, this research expects to call attention to the lack of constancy of the elements that design medical buildings, to the importance of knowing them and to the necessity of planning flexible buildings that are able to absorb those elements with less impact.