korea university medical design report 2015 (1/8)

Korea University Industrial and Information Design

2011220026 Kim yebin

2011220031 Park eunji

2011220035 Song chaelin

PRODCUT DEVELOPMENTOPERATING ROOM TEAM REPORT

1. Overall Operating room Description

2. Stakeholder Mapping

3. Overall Operating room Issues

4. Obsevation - Indepth Interview - OR Observation

Contents

- Surgical Process

- Equipment

- OR room area division

Overall Operating room Description

Naver

, , , , . , , . , , , , , , , .

OR

Macro research about OR

Definition of Operating Room

Korea University Industrial and Information Design 4

Indian Journal of Anaesthesia 2007;51 (3) : 193-199

Overall Procedure Operating roomAreas we can cover for teams topic



Preoperative Period Intraoperative Period Postop Period1. Decision for Surgery2 Presurgical Education3. Consent - Surgery4. Speciality Referral5. Schedule Case in OR6. Request Surgical Equipment7. Set up Preop Evaluation8. More diagnostic testing9.Adjuvant Therapy10. Preop Eval / Exam / Education -Nurse / Anesthesia11. Consent - AnesthesiaI12. nstruction to patients13. More diagnostic testing14. Gather information15. Confirm callsI16,dentify patients17. Match patient to procedure18. Nursing Preop Assessment / Exam19. Premedication20. Transport to OR

1. Transport to recovery area2. Transfer Care to PACU team3. Post op labs / Test4. Find / Act on test results5. Recover from Anesthesia6.Pain management7. Discharge from recovery area

Surgery Proceeds

systematic approach

5

Surgeon

Operating table

lights

anesthesia cart

Electrodes (sticky pads or stickers)

pulse oximeter

blood pressure cuff

intravenous (IV) line

Anesthesiologist

Nurse anesthetist

Nurses

Who Are the Oerating Room Staff ? The Operating Room and Staff What Is Inside the Operating Room?

http://www.uofmmedicalcenter.org/healthlibrary/Article/89601


Overall Environemnt of Operating room


Different Zone of OT Complex

OT(Operation Theatre) complexes are designed and built to carry out investigative, diagnostic, therapeutic and palliative procedures of varying degrees of invasiveness. Many such set ups are customized to the requirements based on size of hospital, patient turnover and may be speciality specific.

The Patient The Staff The Material

- Change rooms for all medical and paramedicalstaff with conveniences- Transfer bay for patient, material & equipments- Rooms for administrative staff- Stores & records- Pre & post-operative rooms- I.C.U. and P.A.C.U.- Sterile store

The Location and Flow should be considered Based on varying degrees of cleanliness

Connects protective zone to aseptic zone and has other areas also like

Includes operation rooms (sterile)

Disposal areas from each OR & corridor lead to disposal zone



Designing Operation room


Protective zone

CleanZone

Disposal zone

Asepticzone

7

Sub areas (excluding OT place)

Men and women change dress from street cloth to OT attire; lockers and lavatory areessential

Preferably adjacent to recovery room.

Staffroom

A definite area to be designated. It should be in a cool, clean room that is constructed of fire resistant materials.

Induction room (anaesthetic

room).

Post anaesthetic care units (PACU)

This area is planned for IV line insertion, preparation, catheter / gastric tube insertion, connection of monitors

The anaesthetic room will provide a more tranquil atmosphere to the patient than the OT. It should provide space for anaesthetic trolleys and equipment and should be located with direct access to circulation corridors and ready access to the operating room.

Holding area

This is important with respect to maintaining privacy, for changing from street clothes to gown and to provide lockers and lavatories for staff.

Pre-operative check in area (reception)-

The anaesthesia gas / cylinder

manifold room /storage area





This is designed to store large but lessfrequently used equipment in the OT.

This is planned to be built within the restricted area. Elbow operated or infrared sensor operated taps / water source is ideal.

Store room

Intra-departmental discussions, teaching and training sessions for staff (with audio-visual aids)

Laboratory ScrubroomSmall lab. with refrigerator for pathologist to be arranged.

Rest rooms

Offices for staff nurse and

anaesthesia staff

Seminar room

Sub areas (excluding OT place)





Stakeholer Mapping

Medical team

Operating surgeon, resident, nurse

Anesthesiologist, anesthesiology unit nurse

Regular operation patient

Emergency operation patient

Patient Guardian


Designing Operation Stakeholder


OPERATING ROOM

11

Operating surgeonAssistants to the surgeon

Scrub person

Anesthesiologist Circulator

Biomedical technicians Radiology technicians




Operating Team members

Operating Team members

Direct Indirect

Sterile Group Unsterile Group

12

1. Perform surgical hand washing (arms are included). 2. Don sterile gowns and gloves. 3. Enter the sterile field. 4. Handles sterile items only. 5. Functions only within a limited area (sterile field). 6. Wear mask.

http://www.surgerymanagement.com/presentations/operating-room-scheduling.php



Surgeon

Assistants

Scrub Person

1. Preoperative diagnosis and care of the patient 2. Performance of the surgical procedure 3. Postoperative management of care

1. Help maintain visibility of surgical site 2. Control bleeding 3. Close wounds 4. Apply dressings 5. Handles tissues 6. Uses instruments

1.Registered Nurse 2.Surgical technologist 3. Licensed practical/vocational nurseThe responsibility of a scrub person is to maintain the integrity, safety and efficiency of the sterile field throughout the surgical procedure.

Operating surgeonAssistants to the surgeon

Scrub person

Sterile Group

Sterile Group Task

13

1. Handle supplies and equipments that are considered unsterile. 2. Touches unsterile surfaces only. 3. Keep the sterile team supplied with supplies handled aseptically. 4. Give direct patient care. 5. Assist the sterile team members need with strict observation of avoiding contact to the sterile field. 6. Handles other requirements arising during the surgical procedure.The unsterile operating room members are not allowed to enter the sterile field to prevent

contamination.

Anestheslologist

Circulator

Technicians

1. Choice and application of appropriate agents. 2. Choice and application of suitable techniques of administration. 3. Monitoring of physiologic function. 4. Maintenance of fluid and electrolyte balance. 5. Blood replacement. 6. Helps in minimizing the hazards of shock, fire and electrocution. 7. Use and interpret correctly a wide variety of monitoring devices. 8. Overseeing the positioning and movement of patients. 9. Oversee the postanesthesia care unit (PACU) to provide resuscitative care until the patient has regained vital functions.

1. Monitor and coordinate all activities within the room. 2. Manage the care required for each patient. 3. Provides assistance to any member of the OR team with strict observation to avoid a break in sterility. 4. Creates and maintains a safe and comfortable environment for the patient through the implementation of aseptic technique.

Biomedical technicians, radiology technicians or other staff that might be needed to set up and operate specialized equipment or devices essential in monitoring the patient during a surgical operation




Anesthesiologist Circulator

Biomedical technicians Radiology technicians

Unsterile Group

Unsterile Group Task

14


Korea University Industrial and Information Design http://www.surgerymanagement.com/presentations/operating-room-scheduling.php

Registered Nurse and surgical technologists that have a written hospital policy permitting the action.Second Assistant could be a registered nurse or surgical technologist. These staff should be trained and they mar retract tissues and suction body fluids to help provide exposure of the surgical site

A qualified surgeon or resident in an accredited surgical education program. The first assistant should be capable of assuming the operating surgeons responsibility in cases of incapacitation or accidents.

Assistants

Classification of Assistants

15

- Top problem with todays operating room

- Scheduling Issue

- Nursing Issue

- Case Issue

Overall Operating room Issues

Safety Sterility Simplicity

Operating Room Safety Issues Operating Room Cleaning and Sterility Problems

Areas for improvement in operating room efficiency

Clutter/Lack of Space

Operating Table

The modern OR is quite small (typically 300 to 550 square feet), and was not designed for the proliferation of high-tech equipment that is used today.

The operating table is not fixed in place, and can become unstable or move accidentally during surgery.

Operating room cabinets are small, with limited capacity for stocking supplies. Current practice for re-stocking during surgery relies on availability of a circulating nurse who must leave the room to obtain required supplies.

Operating Room Efficiency Needs

Inefficient Re-stocking

Walls

Floors

Most operating room walls are painted plasterboard, which compromises sterility.Paint cannot withstand repeated high friction scrubbing so operating room walls are rarely scrubbed, and therefore even when the hospital reaches its highest level of cleanliness bacteria still reside on walls.

operating room floors are not sterile; infection is transmitted from room to room. Until now, no reliable and simplified mechanism for sterilizing an operating room floor has been available.

Superbugs in the operating room

Use of Walls

Operating Room Lighting

Operating room walls are not multifunctional, and are used only to mount X-ray viewing boxes and wall outlets.

They may poorly illuminate the surgical field, are difficult to maneuver, and compete for precious space needed for other intra-operative technology.

A lack of real-time information results in an environment that is inefficient, and sometimes risky, when the absence of accurate data leads to hospital errors.

Information Flow

Systems Integration

Operating Room Turnover time

http://www.optimusise.com/top-problems.php



TOP PROBLEMS WITH TODAYS OPERATING ROOM

17

SurgerySchedule

The "optimal" design of an OR scheduling process is in many instances significantly different, depending on whether you are a:- Surgeon- Anesthesiologist- Operating Room Nurse- Administrator Hospital Bed

and AncillaryUtilization

Prodcutivity

Marketablilityof Program

Utilization

- Rooms- Anesthesia- Equipment- Nursing

- Surgeons-Anesthesiologists-Pre / Postop Units



Scheduling Affects the Entire Organization

Direct Costs

18


The Runaway Patient

Someone close to the patient on the OR table turns around and suddenly the patients arm or leg flings out and knocks over a sterile tray. Or worse, the patient slips to the floor.The critical moments are when the patient is being positioned before the restraints are in place, and when they have been removed before the patient is transferred.

Bad Medicine

Nurses in the OR are often the last person to check on a medication before it is handed to a physician to administer. Or, the nurse may be directed to give the medicine without further inspection. There are a series of checks and balances in place to make sure this doesnt happen.

The Leftovers

It is a reality that things are sometimes left in a patient during a surgical procedure. The typical items are sponges and various tools. Because our bodies are so good at isolating foreign bodies, this may happen way more than is ever reported.

Hospitals put many processes and procedures in place to reduce the risk of infection. Again, good team work is the key. Whenever someone sees a potential issue, they should report it to be investigated. Its easier to correct the problem than treat a wounded infection in the patient later.

An Infectious Environment

Nursing and Risk Management

Nurses must know a number of techniques to be effective in the operating room. On top of that, they must constantly be on guard for those unexpected issues. Hopefully, they can be corrected early, so they dont become a more dangerous situation for the patient during and after surgery.

http://educationcareerarticles.com/career-information

/career-news/common-nursing-issues-in-the-operating-room/


Common Nursing Issue in the Operating Room

19



Google GlassGoogle Glass is a wearable computer with an optical head-mounted display. Google Glass displays information in a smartphone-like hands-free format. Wearers communicate with the Internet via natural language voice commands


Google Glass

Indication of Operating information

Educational Purpose

Recording Operation in video

20

- Technician Indepth interview

- OR Observation : Deep Brain Stimulation Surgery

- OR Observation : Microvascular Decompression

Observation



Technician Indepth interview

Name :Affiliation: Date : 2014.04.14Place : KIST

22




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INSIGHTS?/ ISSUES

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Tasks

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Print the OCS paper

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Rate of the Communication

Issues occuring

Print the OCS paper - Scheduleissue

Running movement - Schedule issue

Phone communication - Communication issue

Delay, Cancle, Overtime - Schedule issue

Communication in OR - Sanitize issue

2014.04.17

HFS (hemifacial spasm)


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OR Observation : Micro Vascular Decompression SurgerySession : C arm operation


OR Observation : MicroVascular Decompression Surgery Operate Process & Issues

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50

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51Korea University Industrial and Information Design

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2014.04.17

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OR Observation : Deep Brain Stimulation Surgery


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OR Observation : Deep Brain Stimulation SurgerySession : Brain Drilling

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Hospital OR Scheduling Contextual Awareness OR Specic Information Awareness

Aware-Media ?

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Theoretical Research Aware-Media

78


System for OR Nurse

OR Nurse

Topic Direction


INSIDEDashboard for Other stakehoder

OR Nurse, Anesthesiology Resident, ( )

OUTSIDE

Target Stakeholder

PreoperativeStep.1

IntraoperativeStep.2

PostoperativeStep.3

Record System Dashboard

80

Monitoring Computer

5

Eletrode Equipment

6Operation Theater Operation Room

Check Point Dash Board

Topic DirectionCheck Point Dash Board

Description Of Check Point Dash Board





The overall system is based on a distributed architecture shown in the picture The AwareMedia architecture is an example of an hy-brid collabora-tive architecture, which uses a peer-to-peer architec-ture for routing video between participating clients, and a client-server architecture for distributing information on operations, sta-tus information, location, etc

AwareMedia - A shared Interactive Display SupportingSocial, Temporal, and Spatial Awareness in Surgery

Jakob E. Bardram, Thomas R. Hansen, and Mads SoegaardCentre for Pervasice Healthcare, University of Aarhus

Aabogade 34, 8200 Aarhus N, Denmark

{bardram, thomasr, madss}@daimi.au.dk

Topic DirectionTheoretical Research Aware-Media

79


Topic DirectionWireframe


Record System Check Point Board

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81


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82



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83


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85

First Draft



Design WorkCheck Point Board + System

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Preoperative Intraoperative

Preoperative Preoperative

Outside Check Point Board

Inside system


Opening Screen Preoperative


Design WorkCheck Point Board


Preoperative Intraoperative


Design WorkSystem


Design WorkSystem

Preoperative

Inside system

90

Thank You

1._Intro-Interview2.Obervation_3.Analysis_Affinity Diagram4._Topic Direction