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Realizing Improved Patient Care Through Human-Centered Design in the Operating Room (RIPCHD.OR)

Principal Investigator: Anjali Joseph, Ph.D., Clemson University, Clemson, SC
AHRQ Grant No.: HS24380
Project Period: 09/30/15–08/31/21
Description: The overarching goal of RIPCHD.OR was to use an integrated systems engineering approach to develop ergonomic and safe operating room (OR) design solutions that improve staff workflow and perioperative outcomes.

The specific aims were to:

  1. Improve the usability of anesthesia-related alarms in the OR.
  2. Understand and improve traffic flow in the OR.
  3. Develop a safer and more human-centered OR that supports technology integration and staff workflows.

RIPCHD.OR explored dynamic interactions of providers and other staff in the OR, numerous OR design elements (e.g., OR size and layout, lighting, design and positioning of the surgical table, location of doors), and processes and technologies (gestural displays) by engaging clinicians and other medical personnel in surgical simulations.1

The lab’s key accomplishments included a human-centered OR design concept and a high-fidelity mockup of an OR to explore design alternatives at the microlevel via iterative testing. In addition, the lab created a flow mapping toolkit to guide the design team in systematically assessing other institutions’ physical configurations of surgical flows to identify barriers and facilitators.2-6 The team also created an anesthesia workstation simulator to conduct studies related to the tactile modality of displays and alarms.

The design, process, and technology solutions that emerged from RIPCHD.OR were implemented at the new Medical University of South Carolina Ambulatory Surgery Center and at the Emory Executive Park Musculoskeletal Institute in Georgia.7

The lab’s findings were synthesized and shared via the Safe OR Design Toolkit, which gives multiple stakeholders an opportunity to understand the implications of design on OR safety and to interact with components in an OR environment through a 3D model.8 The toolkit also offers design strategies and their associated desired outcomes for a series of design elements commonly found in OR environments. For example, one key strategy calls for orienting the surgical table within the room to minimize reorientation and associated disruptions during surgery.

Toolkit users may filter design strategies by the type of strategy embedded within the work system and access citations associated with each design strategy.7 This toolkit supports an evidence-based approach to designing or renovating ORs for a safer, more ergonomic OR environment for patients and staff. It was developed based on an indepth literature review and the findings from RIPCHD.OR. The toolkit was then vetted through a three-stage modified Delphi process by an expert panel of eight clinicians and eight healthcare designers with extensive experience working in and designing OR environments.

Early on, the lab disseminated its work to reach a broader general audience. In 2017, it showcased a scale model of OR design at a 2017 innovation festival at the National Museum of American History in Washington, DC. During the event, researchers provided virtual reality experiences of the OR design to numerous visitors.6 Later the same year, RIPCHD.OR received two awards for conceptual design excellence at the Healthcare Design Expo + Conference in Orlando, FL.

In addition, Principal Investigator Anjali Joseph and Scott Reeves were featured in a 2018 article in the Wall Street Journal9 and, more recently, in the New York Times10 for their efforts with the lab to design safer and more efficient ORs. To date, the work products and research publications developed as part of this learning laboratory represent the most comprehensive body of work related to OR work systems design.7

RIPCHD.OR’s work has resulted in at least 24 peer-reviewed journal publications, as well as posters and presentations at conferences across the United States.

Publications

2021

2020

2019

2018

2017

2016

References

  1. Bayramzadeh S, et al. Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes. Appl Ergon 2018 Jul;70:288-99.
  2. Betza SM, et al. The effect of movement and cue complexity on tactile change detection. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2017;61(1):1541-45. https://journals.sagepub.com/doi/abs/10.1177/1541931213601749.
  3. Joseph A, et al. Integrating technology in patient care spaces: using scenario-based evaluations to compare design alternatives in virtual reality. Congress of International Ergonomics Association, 2018, Florence, Italy.
  4. Joseph A, et al. Safety, performance, and satisfaction outcomes in the operating room: a literature review. HERD 2018;11(2):137-50.
  5. Ibrahim AM, et al. Building a better operating room: views from surgery and architecture. Ann Surg 2017;265(1):34-36.
  6. Joseph A. Progress Report: Realizing Improved Patient Care Through Human-Centered Design in the OR. Clemson, SC: Clemson University; 2018.
  7. Joseph A. Final Report: Realizing Improved Patient Care Through Human-centered Design in the OR (RIPCHD.OR). Clemson, SC: Clemson University; 2021. p. 19.
  8. Safe OR Design. Clemson, SC: Clemson University School of Architecture; 2019.
  9. Landro L. The operating room of the future: a host of changes hold out the promise that surgery will be more efficient, more effective and less risky for patients. Wall Street Journal 2018 May 28.
  10. Rosen E. Operating rooms go under the knife. New York Times 2021 May 5.
Page last reviewed April 2022
Page originally created April 2022

Internet Citation: Realizing Improved Patient Care Through Human-Centered Design in the Operating Room (RIPCHD.OR). Content last reviewed April 2022. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/patient-safety/resources/learning-lab/ripchdor-long-desc.html

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