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While design of the operating room itself is crucial, the flow of patients, staff, and materials dictates the success of the Surgery Department overall. Traffic flow and the relationships between functions are keys to staffing and running a suite efficiently.

The following diagrams illustrate a variety of current approaches to OR planning, incorporating the principles described below.

Inner Racetrack

Inner Racetrack: Combined CSS/Service Core

Outer Racetrack

Central Spine

Patient-centered Pods

Issues outside the Surgery Department space have much to do with the experience of the patient: Ease of parking and access, good signage, an efficient preoperative testing process, and convenient registration all contribute to a positive patient experience. A comfortable family waiting space with refreshments and a play area for young children make the time spent there less stressful. Subdividing large waiting space into small seating groups allows for quiet areas for reading, while other areas may have a TV. Computer workstations provide additional convenience.

For the OR manager, critical physical planning considerations begin in the preoperative area with the flow of day-of-surgery admission patients and inpatients. Convenient access to the preoperative area for anesthesia personnel will enhance their effectiveness. Direct access from the preoperative/holding area to the restricted corridor serving the ORs will minimize patient transfer time.

When patients’ procedures are complete, their transport to the postanesthesia care unit (PACU) should be by direct access from the restricted corridor. This allows staff to circulate efficiently while maintaining proper protocol. Desirable characteristics of patient circulation in the OR include:

• Minimizing the number of turns for maneuvering.
• Keeping transfer distances as short as possible.
• Separating patient traffic from the flow of supplies.
• Allowing space for holding carts out of the flow of traffic during procedures.

Entry: Staff begin their day by changing to scrub attire in the locker room. Each locker area should have one entrance to a public corridor and another to the restricted corridor so that once in scrub attire, staff can enter the OR suite without crossing public corridors.

The other point of entry from public space occurs at the control desk. In larger units, staff needing to circulate to public areas of the hospital should be able exit or enter at this point without returning to or through the locker room. It is helpful to have consulting rooms so surgeons may confer with family and companions without traveling far from the suite. The less convenient the arrangement, the more likely it is that good practices will not be followed.

Staff Lounge: Separating the lounge from the locker room and placing it within the OR suite for greater convenience make it more likely that staff will be nearby when needed. Beyond being a break space, the lounge is taking on a variety of functions: education/training, project work, business center, and work center. These transformations keep staff within the surgery suite while allowing them productive use of time between cases.

Exit: At the end of a shift, staff flow reverses back through the locker room. Locating the locker room entrance/exit adjacent to the staff/physician entrances ensures that this stream of traffic does not interfere with public circulation.

Material flow can be described as a loop within a loop. The inner loop consists of reusable materials that are separated from materials returning from the operating rooms. Reusable items should flow from the OR to decontamination, assembly, packaging, sterilization, storage, and back to the OR suite.

The outer loop begins at the receiving dock and proceeds through stores and breakdown to the Central Sterile department, where materials are given final preparation, combined with sterilized instruments, and sent on to the OR. Decontamination separates waste from reusables, sending the waste to the dock.

The more closely Central Sterile space is tied to the OR suite, the more effectively these material loops will function. This can be accomplished in many plan configurations. If it is necessary to locate CS away from the surgical suite, preferable locations are either directly above or below the suite to facilitate flow by dedicated cart lifts or elevators.

With the development of minimally invasive surgery, ORs have a considerable investment in endoscopes and other instruments that require low-temperature sterilization or disinfection. That has led to the development of low-temperature sterilization equipment that does not use steam or ethylene oxide. The limited number of these instruments and the small footprint of point-of-use sterilization has made it common to locate small decontamination and sterilization areas within the OR suite, immediately adjacent to the ORs in which the instruments are used. Faster turn-around times and reduced instrument damage can offset the cost of having these instruments processed by more expensive OR personnel.

Source: OR Manager, Inc. www.ormanager.com . 800/442-9918.