simulation-based mock-up evaluation of a universal operating … · 2019-02-22 · lessons learned...
TRANSCRIPT
Simulation-Based Mock-up Evaluation of a UniversalOperating Room
Breakout Session B6
Shelly Fleck, VGH
David Borkenhagen, W21C
Project Team
Jonas Shultz, David Borkenhagen, Emily Rose, Brendan Gribbons,
Hannah Rugill, Shelly Fleck, Allison Muniak, John Filer
We have no involvement with industry and have nothing to disclose/cannot identify any potential conflict of interest.
Disclosure
Context
• Vancouver General Hospital.
• Renovating and expanding OR suites to include 28 universal ORs and 2 Hybrid ORs.
• Optimization current surgeries and accommodate future growth.
• The universal ORs are designed to accommodate a spectrum of cases.
• “Any case, any room.”
“Vancouver General Hospital” by chispita_666 is licensed under CC BY 2.0
Context
• Designing ORs (or any other environments for healthcare) is a complex process.
• Environments support and facilitate patient care.
• Mock-up evaluations can enhance patient safety, staff efficiency and user experience, and can yield financial returns.
Aim
• To conduct mock-up evaluations as part of the design process.
• To provide recommendations on:
– Space requirements for task completion
– Access to objects
– Placement of objects
– Visibility
PHOTO OF MOCK UPS
Method
• A mock-up Universal OR room was constructed.
• Simulation scenarios were enacted by nursing staff, surgeons, anesthesiologists, and residents.
• Behavioural data was analyzed to create recommendations for designers.
• Framework is available from: www.hqca.ca/humanfactors
Laparoscopic cholecystectomy
Total abdominal hysterectomy Thyroidectomy
• 90o bed rotations (both direction)
• Difficult intubation (DAVI cart)
• Specimen collection
Debrief data
Video analysis
Results
• 29 evidence-based recommendations presented to the design team.
• Recommendations include: relocating doors, booms, OR lights, wall mounted gases, workstation reconfigurations and equipment procurement criterion.
Iteration 1 Iteration 2
Second Aim
• Following design changes, one scenario was repeated to allow comparison between the initial and final mock-up designs.
Iteration 1 Iteration 2
Iteration 1 Iteration 2
• Greater utilization of space along core wall in iteration 2
Iteration 2
• 68% reduction in congestion (74 to 24 occurrences)
• 8% reduction in bumps (26 to 24 occurrences)
• 64% reduction in readjustments (80 to 16 occurrences)
Iteration 1
Iteration 2
Equipment boom
Aux boom
Anesthetic workstation
Anesmachine
Iteration 1
Lessons Learned
• Simulation-based mock-up evaluations offer an effective approach for engaging front line users and creating evidence-based data on the design.
• Enacting simulation scenarios in mock-ups can effectively identify opportunities to improve design, and likely result in cost savings by discovering these possibilities prior to constructing the space.
Next Steps
• VGH has toured other sites in mock space – Royal Columbian, Richmond Hospital, Lion’s Gate Hospital, St. Paul’s Hospital staff – and shared findings from our experiences.
• Recommendations generated through this series of mock-up evaluations can be considered for incorporation in future OR designs.
• Hospitals should consider mock-up evaluations as part of any construction/renovation project.
Contact Information
Jonas Shultz, HQCA
Shelly Fleck, VGH
David Borkenhagen, W21C