simulation-based mock-up evaluation of a universal operating … · 2019-02-22 · lessons learned...
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Simulation-Based Mock-up Evaluation of a UniversalOperating Room
Breakout Session B6
Shelly Fleck, VGH
David Borkenhagen, W21C
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Project Team
Jonas Shultz, David Borkenhagen, Emily Rose, Brendan Gribbons,
Hannah Rugill, Shelly Fleck, Allison Muniak, John Filer
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We have no involvement with industry and have nothing to disclose/cannot identify any potential conflict of interest.
Disclosure
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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
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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.
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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
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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
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Laparoscopic cholecystectomy
Total abdominal hysterectomy Thyroidectomy
• 90o bed rotations (both direction)
• Difficult intubation (DAVI cart)
• Specimen collection
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Debrief data
Video analysis
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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
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Second Aim
• Following design changes, one scenario was repeated to allow comparison between the initial and final mock-up designs.
Iteration 1 Iteration 2
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Iteration 1 Iteration 2
• Greater utilization of space along core wall in iteration 2
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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
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Iteration 2
Equipment boom
Aux boom
Anesthetic workstation
Anesmachine
Iteration 1
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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.
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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.
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Contact Information
Jonas Shultz, HQCA
Shelly Fleck, VGH
David Borkenhagen, W21C