- Email: [email protected]
OR staff finds planning, discomforts bring cohesiveness
Cynthia
C Hayes, RN, MN
OR staff finds planning, discomforts bring cohesiveness At Emory University Hospital in Atlanta, Ga, we have been involved in a n expansion of the number of hospital beds, diagnostic support services, and operating rooms. By sharing with you a descriptive chronological account of the addition and renovation, we may assist those of you who are in the throes of planning a new suite. Our experience may help you anticipate problems and provide some suggestions for solutions. There was no question that our need for improved and renovated facilities
Cynthia C Hayes, R N , MN, is assistant director of nursing, ORIRR, Emory University Hospital, Atlanta, Ga. A member of the AORN Board of Directors, she received her BS degree from the University of Michigan and a master’s degree in nursing from Emory University.
470
was great. A proposal was developed in 1970, and a gift of $30 million from a private benefactor made groundbreaking possible in February 1972. The project was divided into two phases. Phase I included a seven-story, 150-bed patient tower, new laboratory, pathology and pharmacy space, and physical therapy facility complete with pool. Operating room construction was planned for Phase I1 which meant that the 150 additional beds would be available before the new operating rooms were opened. When initial plans were developed, as assistant director of nursing, I began to request that administration include me when Phase I1 planning began. I would advise that requests for involvement start early and be persistent. The invitation to confer was finally extended. However, I found that the architect had already drawn plans with elaborate schemes for passthroughs, air locks, and patient transfer systems. Theoretically reasonable, the design was not functional because supplies were inaccessible from the OR to the central core. It was not practical because there were no sterilizers in the suite, thus, contaminated instruments could not be resterilized immediately.
AORN Journal, September 1976,Vol 24, No 3
It was obvious we needed to orient and educate the architect. This took a great deal of time and effort on the part of the staff, but it was worth it. The architect became an ally rather than an adversary. As a result of exchange of information, he designed the suite based on knowledge about the activities of patient care in our operating room. The rationales for design judgments were better understood. As an outgrowth of the indoctrination of our architect, the Georgia Institute of Technology School of Architecture invites nurses from various hospitals in the city to critique the health facilities and OR designs of its students. Incorporating the present 30-yearold suite into a new one posed many challenging problems. About 60 hours were spent in formal conferences with administration, surgeons representing all the specialties, anesthesiologists, architects, and others. Many informal conferences were held t o answer such questions of the architects as What, where, how, when, and why functions are to be performed? What functional spaces and dimensions are required? What fixed equipment is required? What environmental conditions are required? What workloads and work flow are entailed? What staffing complements and patterns are needed? What communication and transport networks are involved? What intramural and extramural relationships are to be accommodated? What provisions should be made for possible future changes? The answers were formulated with attention to the prevention of infec-
tion, the safeguarding of patients and personnel from hazards, the minimizing of shock and trauma of the patient, the provision for physical comfort and emotional support, and efficient operation permitting staff maximum time for patient care. The first major crisis came when central supply moved from next to the OR suite to the basement of the new addition. This location was temporary; central service would move to permanent quarters later. The move necessitated the use of large multicase carts to hold linen packs and wrapped sterilized instruments and supplies. It also forced the staff to plan and anticipate needs more efficiently since they could not immediately get a forgotten item. These carts had to be stored in the existing suite in the corridor, and they had to be covered to protect the contents from traffic and dust. Concurrent with the building program, the hospital nursing staff increased, new teaching programs began in the departments of anesthesiology and allied health fields, and new surgeons were added. This put pressure on the OR environment and personnel. Traffic congestion in the operating room increased. The movement of patients on beds and stretchers in the single corridor storing equipment and supplies was a constant source of concern and consternation. With additional bed space, pressure from all surgeons for more operating time became almost unbearable. Many cases were emergencies. To alleviate the scheduling problems, three of the eight rooms ran until 8:30 pm and one room until 11 pm. As we were able to accommodate more patients within the lengthened day, the “emergencies” seemed to drop. Obviously operating room utilization
AORN Journal, September 1976,Vol24, No 3
479
J
ackhammers had to be silenced to hear audible patient signs.
increased, but the need for more OR rooms was even more apparent. The noise and vibrations of adjacent construction posed unique problems. One day the 4,000-pound demolishing ball was battering away at the old central supply while neurosurgery was in progress. When the ball hit the building, it was exceedingly difficult for the surgeon to use the microscope to visualize structures deep in the brain. Halting construction for two hours costs $450. If construction stops, the workers are paid while they are waiting. At several other times, the jackhammers had to be silenced because anesthesiologists could not evaluate audible patient signs. OR personnel became edgy with the constant noise and the gradual closing-in effect caused by boarding up windows. The steam and air conditioning were turned off at various times necessitating advanced planning. Twice the power lines to the hospital were cut, but the emergency generator kicked on promptly. We minimized dust and tracking into the suite by frequent mopping in front of the main doors and by sealing off all adjacent external openings with plastic sheeting and masking tape. Interesting enough, apparently as a result of involvement in OR planning activities and sharing discomforts, cohesive behavior began to occur.
482
The men nursing assistants organized a Saturday morning basketball schedule. The nursing staff planned Friday afternoon festivities. Nurses from other parts of the hospital began requesting transfers to the OR and recovery room. AORN meeting attendance increased. The challenge of corporate problem solving produced desirable results. The total concept of instrument and materiel processing had to be changed. The instrument room would be moved from the OR to the ground floor and be incorporated into central supply, the decontamination area, and the hospital storeroom. The supplies are to be delivered to the operating room on the third floor through exclusive elevators in the central core of the OR suite and then sent to each room via individual case carts. Planning with instrument room personnel for the tripling of instrument inventory plus the design and work flow pattern of the new area was exciting for them, and their enthusiasm was contagious. All of us were more aware of the unique aspects of our daily tasks. It was decided to build cabinets in the new ORs to hold basic supplies, such as gowns, gloves, and dressings. A cabinet was added for table accessories and a component desk top with a small light and accompanying drawers included for requisitions and records. Modular columns at either end of
AORN Journal, September 1976, Vol24, No 3
the OR table provide connections for nitrous oxide, oxygen, nitrogen, and suction and electrical lines. Additional installed equipment includes a C-Arm image intensifier, overhead mounted microscopes, and television cameras and monitors. The manipulation, management, and maintenance of these devices will require some dry runs to determine the best way to drape and maneuver them while maintaining a sterile field. The suite also contains offices for the director, the nurse clinician, the unit manager, and the clinical instructor. For continuing education, a classroom includes a video tape deck and monitor, and slide carousel and overhead projectors. A board to be used with felt-tipped pens will be a valuable adjunct to teaching. Additional audiovisual equipment such as 16 mm and film strip projectors are available from the Department of Hospital Continuing Education. The OR library will also be in the classroom, and we are planning for additional shelves. As construction neared completion, the job supervisor invited the OR staff to visit the new area and offer suggestions. This was a most valuable experience for everyone concerned. We found there were no hot water lines in the four open heart surgery rooms. This could be corrected at less cost than if construction had been completed. Also, the entrance door to the recovery room was much too small for the traffic and size of the beds that would be used. This was enlarged. Cleanup sinks in the pump room were too small and shallow and had to be replaced. Clocks were missing above the scrub sinks. They have been installed. At this writing, coordinating efforts are underway with all departments. All movable equipment has been or-
484
dered and room specifications reviewed. Months and years of planning and anticipation are about to be realized. The staff is more than ready for the change in environment. The target date for moving is set. Environmental sampling is next. The operating room, upon completion, will have 16 operating rooms and 8 holding area beds. There will be 19 recovery room beds and 550 hospital beds. Coping with construction while delivering the best patient care possible has been a challenge. The success of the endeavor is directly proportionate t o the degree of involvement of the entire nursing, medical, and hospital
staff.
0
References Chvala, Carol. “Supervisors role in planning the surgical suite.‘’ AORN Journal 23 (June 1976) 1238-1254. DHEW Publication No (HSM) 73-4005. The Surgical Suite: Functional Programming Worksheets. Rockville, Md: US Department HEW, Health Services Mental Health Administration, Health Care Facilities Service, 1973. Laufman, Harold. “Planning the surgical environment.” Contemporary Surgery 5 (November 1974) 13-20; Archives of Surgery 107 (October 1973). Laufman, Harold, et al. “Symposium on operating room hazard control.” Archives of Surgery 107 (October 1973) 552-604.
AORN Journal, September 1976, Vol24, No 3
C Hayes, RN, MN
OR staff finds planning, discomforts bring cohesiveness At Emory University Hospital in Atlanta, Ga, we have been involved in a n expansion of the number of hospital beds, diagnostic support services, and operating rooms. By sharing with you a descriptive chronological account of the addition and renovation, we may assist those of you who are in the throes of planning a new suite. Our experience may help you anticipate problems and provide some suggestions for solutions. There was no question that our need for improved and renovated facilities
Cynthia C Hayes, R N , MN, is assistant director of nursing, ORIRR, Emory University Hospital, Atlanta, Ga. A member of the AORN Board of Directors, she received her BS degree from the University of Michigan and a master’s degree in nursing from Emory University.
470
was great. A proposal was developed in 1970, and a gift of $30 million from a private benefactor made groundbreaking possible in February 1972. The project was divided into two phases. Phase I included a seven-story, 150-bed patient tower, new laboratory, pathology and pharmacy space, and physical therapy facility complete with pool. Operating room construction was planned for Phase I1 which meant that the 150 additional beds would be available before the new operating rooms were opened. When initial plans were developed, as assistant director of nursing, I began to request that administration include me when Phase I1 planning began. I would advise that requests for involvement start early and be persistent. The invitation to confer was finally extended. However, I found that the architect had already drawn plans with elaborate schemes for passthroughs, air locks, and patient transfer systems. Theoretically reasonable, the design was not functional because supplies were inaccessible from the OR to the central core. It was not practical because there were no sterilizers in the suite, thus, contaminated instruments could not be resterilized immediately.
AORN Journal, September 1976,Vol 24, No 3
It was obvious we needed to orient and educate the architect. This took a great deal of time and effort on the part of the staff, but it was worth it. The architect became an ally rather than an adversary. As a result of exchange of information, he designed the suite based on knowledge about the activities of patient care in our operating room. The rationales for design judgments were better understood. As an outgrowth of the indoctrination of our architect, the Georgia Institute of Technology School of Architecture invites nurses from various hospitals in the city to critique the health facilities and OR designs of its students. Incorporating the present 30-yearold suite into a new one posed many challenging problems. About 60 hours were spent in formal conferences with administration, surgeons representing all the specialties, anesthesiologists, architects, and others. Many informal conferences were held t o answer such questions of the architects as What, where, how, when, and why functions are to be performed? What functional spaces and dimensions are required? What fixed equipment is required? What environmental conditions are required? What workloads and work flow are entailed? What staffing complements and patterns are needed? What communication and transport networks are involved? What intramural and extramural relationships are to be accommodated? What provisions should be made for possible future changes? The answers were formulated with attention to the prevention of infec-
tion, the safeguarding of patients and personnel from hazards, the minimizing of shock and trauma of the patient, the provision for physical comfort and emotional support, and efficient operation permitting staff maximum time for patient care. The first major crisis came when central supply moved from next to the OR suite to the basement of the new addition. This location was temporary; central service would move to permanent quarters later. The move necessitated the use of large multicase carts to hold linen packs and wrapped sterilized instruments and supplies. It also forced the staff to plan and anticipate needs more efficiently since they could not immediately get a forgotten item. These carts had to be stored in the existing suite in the corridor, and they had to be covered to protect the contents from traffic and dust. Concurrent with the building program, the hospital nursing staff increased, new teaching programs began in the departments of anesthesiology and allied health fields, and new surgeons were added. This put pressure on the OR environment and personnel. Traffic congestion in the operating room increased. The movement of patients on beds and stretchers in the single corridor storing equipment and supplies was a constant source of concern and consternation. With additional bed space, pressure from all surgeons for more operating time became almost unbearable. Many cases were emergencies. To alleviate the scheduling problems, three of the eight rooms ran until 8:30 pm and one room until 11 pm. As we were able to accommodate more patients within the lengthened day, the “emergencies” seemed to drop. Obviously operating room utilization
AORN Journal, September 1976,Vol24, No 3
479
J
ackhammers had to be silenced to hear audible patient signs.
increased, but the need for more OR rooms was even more apparent. The noise and vibrations of adjacent construction posed unique problems. One day the 4,000-pound demolishing ball was battering away at the old central supply while neurosurgery was in progress. When the ball hit the building, it was exceedingly difficult for the surgeon to use the microscope to visualize structures deep in the brain. Halting construction for two hours costs $450. If construction stops, the workers are paid while they are waiting. At several other times, the jackhammers had to be silenced because anesthesiologists could not evaluate audible patient signs. OR personnel became edgy with the constant noise and the gradual closing-in effect caused by boarding up windows. The steam and air conditioning were turned off at various times necessitating advanced planning. Twice the power lines to the hospital were cut, but the emergency generator kicked on promptly. We minimized dust and tracking into the suite by frequent mopping in front of the main doors and by sealing off all adjacent external openings with plastic sheeting and masking tape. Interesting enough, apparently as a result of involvement in OR planning activities and sharing discomforts, cohesive behavior began to occur.
482
The men nursing assistants organized a Saturday morning basketball schedule. The nursing staff planned Friday afternoon festivities. Nurses from other parts of the hospital began requesting transfers to the OR and recovery room. AORN meeting attendance increased. The challenge of corporate problem solving produced desirable results. The total concept of instrument and materiel processing had to be changed. The instrument room would be moved from the OR to the ground floor and be incorporated into central supply, the decontamination area, and the hospital storeroom. The supplies are to be delivered to the operating room on the third floor through exclusive elevators in the central core of the OR suite and then sent to each room via individual case carts. Planning with instrument room personnel for the tripling of instrument inventory plus the design and work flow pattern of the new area was exciting for them, and their enthusiasm was contagious. All of us were more aware of the unique aspects of our daily tasks. It was decided to build cabinets in the new ORs to hold basic supplies, such as gowns, gloves, and dressings. A cabinet was added for table accessories and a component desk top with a small light and accompanying drawers included for requisitions and records. Modular columns at either end of
AORN Journal, September 1976, Vol24, No 3
the OR table provide connections for nitrous oxide, oxygen, nitrogen, and suction and electrical lines. Additional installed equipment includes a C-Arm image intensifier, overhead mounted microscopes, and television cameras and monitors. The manipulation, management, and maintenance of these devices will require some dry runs to determine the best way to drape and maneuver them while maintaining a sterile field. The suite also contains offices for the director, the nurse clinician, the unit manager, and the clinical instructor. For continuing education, a classroom includes a video tape deck and monitor, and slide carousel and overhead projectors. A board to be used with felt-tipped pens will be a valuable adjunct to teaching. Additional audiovisual equipment such as 16 mm and film strip projectors are available from the Department of Hospital Continuing Education. The OR library will also be in the classroom, and we are planning for additional shelves. As construction neared completion, the job supervisor invited the OR staff to visit the new area and offer suggestions. This was a most valuable experience for everyone concerned. We found there were no hot water lines in the four open heart surgery rooms. This could be corrected at less cost than if construction had been completed. Also, the entrance door to the recovery room was much too small for the traffic and size of the beds that would be used. This was enlarged. Cleanup sinks in the pump room were too small and shallow and had to be replaced. Clocks were missing above the scrub sinks. They have been installed. At this writing, coordinating efforts are underway with all departments. All movable equipment has been or-
484
dered and room specifications reviewed. Months and years of planning and anticipation are about to be realized. The staff is more than ready for the change in environment. The target date for moving is set. Environmental sampling is next. The operating room, upon completion, will have 16 operating rooms and 8 holding area beds. There will be 19 recovery room beds and 550 hospital beds. Coping with construction while delivering the best patient care possible has been a challenge. The success of the endeavor is directly proportionate t o the degree of involvement of the entire nursing, medical, and hospital
staff.
0
References Chvala, Carol. “Supervisors role in planning the surgical suite.‘’ AORN Journal 23 (June 1976) 1238-1254. DHEW Publication No (HSM) 73-4005. The Surgical Suite: Functional Programming Worksheets. Rockville, Md: US Department HEW, Health Services Mental Health Administration, Health Care Facilities Service, 1973. Laufman, Harold. “Planning the surgical environment.” Contemporary Surgery 5 (November 1974) 13-20; Archives of Surgery 107 (October 1973). Laufman, Harold, et al. “Symposium on operating room hazard control.” Archives of Surgery 107 (October 1973) 552-604.
AORN Journal, September 1976, Vol24, No 3