A user's checklist for Operating Room suites

Introduction
This check-list is meant to help in planning Operating Rooms (ORs) or improving existing ones. Without a check-list, it is easy to forget important items and details because of the large number involved. Such omissions will only be noticed once the area is being used, when they are much more expensive to put right. To make sure this check-list applies to a particular area, and at a particular time in the future, it should be reviewed by all those involved with the OR. These include all staff working there, patients and their associates, those providing services such as information, power and water, supplies, cleaning, and maintenance, and those responsible for the safety or overall management of the area. It is important to include all workers, and not just the managers, who are likely to forget important everyday details. On its own a check-list won't ensure that all mistakes are avoided. Apart from actual use of the area, or learning from the mistakes of other ORs of similar design, simple plans of 1:10 scale can show clearance for cut-outs of mobile equipment, and of staff and patients which are moved around the plan. Even plans like these won't prevent problems with noise, lighting, temperature, humidity, smells, and bacteriological safety. Some of these matters are dealt with in other papers by this writer. Some of the items mentioned may not be needed in individual ORs, depending on their type of likely work-load One or two of the items may be out of date, like viewing domes. There is no reference to Standards, legal requirements, or engineering aspects. However it should help avoid some of the bigger blunders from the point of view of users. Future developments from this checklist may include separate detailed equipment lists and criteria and applications to other hospital areas, work-flow, process charts, and task analysis.

General requirements for all areas:

Consistency - try and keep the same style throughout, the same style new nurses in your OR will already be used to from mainstream hospital design, where this does not interfere with function and usability Avoid mirror symmetry, so people would have to do exactly the opposite in one OR to what they do in another Fire, safety Signage Access, corridors, doorways, doors, proximity to related work areas Lines of sight, lighting, accessible label-tested light switches Noise insulation Cleanability [checked with cleaners] Maintainability [checked with maintenance tradespeople] Space calculations and estimates for equipment - static and mobile, and also space and clearance for people, checked with scale plans and cut-outs Information - phones, phone directory, computer facilities, where-is-it directories Power, water, hand-wash taps and basins or lower body splash shields Testing of plans, mock-ups, and signage with typical users as well as with managers.

Follow-up with
Post-Occupancy Evaluation at 4 & 15 months for Remedial Architecture Reference materials and other documentation for all contents, separate listing of contacts for technical problems and information

Reception Area For Patients

Space for trolley Clearance for orderly, nurse, anaesthetist, 2 persons accompanying patient, and portable ventilator and monitors with critical emergency cases Lighting Doorbell, voice communication to main OR areas Security Video monitoring according to security policy and procedures Trolley or shelves for gowns, caps, and overshoes for parents or others accompanying children or other patients into the anaesthetic room. Chairs for accompanying persons in case of prolonged wait.

Corridors
Width, lighting levels, white-board, notice-boards

Anaesthetic rooms
Access from reception area, to OR Light indicating when room is in use Call bell or voice intercom through to OR Space as for reception area, but including anaesthetist and extra nurse Lighting, spot lighting, labelled light switches Anaesthetic gas outlets Cupboards, storage areas for equipment, supplies, stationary (these need to be listed in detail anyway at some stage - might as well be sooner) Secure lockable cupboards for drugs Shelves and benches, including room for writing Dcor soothing to patient, including murals or ceiling decorations & posters

Scrub room ( may be shared between 2 or more ORs)

Access from corridor, access to OR, with some visibility Lighting Elbow taps or taps with electronic sensors, digital temperature indicators and controls Timer for each tap Sinks (single waist-high slanted perspex or stainless steel sheet down to floor runnel, rather than individual wash basins Soap pack dispensing fixtures Trolley for donning gowns, gloves Trolley or shelving for gloves Adequate clearance for outstretched arms when gowning & gloving Mirror for checking cap and mask Rubbish bins

Operating room - general (Separately - OR for Subspecialties)

Anaesthetic machine Seats for anaesthetist, surgeons, assistants, nurses - comfortable adjustable and mobile Pendants for gases, power, suction Power outlets - sockets on cords from ceilings, pendants, wall-sockets Info links - phones, computers, voice free-hand, video detailed, general Shelving OR table Room for instrument trolleys, supplies trolleys, diathermy, surgical suction, smoke evacuation, sponge racks or counting mats, video cart, other trolleys, IV stands, image intensifier, operating microscopes, second surgical team Supplies - storage baskets or trolleys for commonly used materials to save fetching outside the OR Storage for operating table accessories including arm rests, leggings and stirrups, positioning equipment X-ray viewing boxes Anaesthetic gas supply indicators Lighting general, special Temperature displays and controls Humidity sensor & control Plenum (positive pressure atmospheric) indicator & control Fire sensors and sprinklers Emergency call bell and intercom, with protocol for their use. Hooks for x-ray gowns, OR table accessories Whiteboard, possible separate device for swab counts

Recovery area / ward

Access from OR (type of door?), to external corridor (security) Nurses station allowing clear lines of sight Gurney stations (?how many)with wall-mounted gas, power, monitoring, curtains, clearance for medical and nursing procedures Shelving, supplies Emergency call bell Patient toilet Portable Oxygen, suction, monitoring equipment Emergency trolley with defibrillator

Set-up room
? separate for each OR or each group of ORs Access from stores, CSSD, sterilizers, access to OR Floor-space for trolleys for next batch of set-ups Clearance for gowned and gloved set-up nurses and for sterile trolleys

Clean-up
Maybe sited elsewhere Large enough to prevent congestion Rubbish bins - linen trolleys, infectious waste, sharps Trolleys for rubbish and soiled linen for transportation to dirty room Trolleys for transport of instruments to CSSD Standing or seated work areas with knee room Sinks and benches at correct height, spot lighting and magnification for instrument cleaning Sluices, plaster trap

 Ultrasonic cleaners. automatic instrument washing machines Storage for cleaning implements including special brushes Wall brackets for gloves, safety glasses, sharps containers, linen bags Shelving for instrument bays

Sterilizing department / area / autoclave / liquid-soak sterilization

Varies according to overall hospital plans Based on separate specialized advice Storage areas Consumables - for each specialty Refrigerators for drugs Mobile equipment -microscopes, video carts, special-procedure items OR table add-ons [mentioned above] Trolleys, baskets for each specialty Toilets, shower Phone Wall hooks for equipment, shadow boards

Change room male, female

Secure entrances Lighting, clearly labelled light switches Lockers, individual keys [secure storage for duplicate keys elsewhere, or other lock technology] Benches Linen shelves, cupboards Used linen containers

Lounge / coffee areas - medical, nursing, other

Seats, tables, shelves Wet area for coffee, snacks Phones Dictation facilities including small quiet bays, Desk space for paperwork Refrigerator, microwave, water heater, beverages (hot, cold) Space for food or refreshment trolleys Quiet area for private conversation (if large enough)

Office and administration area

Separate areas for receptionist, supervisor Desk, phone, computer, stationary Answering machine General access to bookshelves for instrument directories, texts Filing cabinets for info Office area for anaesthetists

Conference and discussion areas

for separate listing

Cleaners cupboard
for separate listing

Xray processing room

for separate listing

Proximity to related work areas

Day surgery [possibly included in design within OR] Emergency reception ICU CSSD (vertical access may be enough) Pathology (for frozen section) - or pneumatic tube or similar access, or secure area for specimen storage Xray and other imaging department Surgical wards Holding bays with call bells for pre-operative patients

Other considerations
Wall finishes, colouring (avoid masking cyanosis etc - see lighting requirements separately) Maintenance procedures and schedules - implications for architectural design Ditto procedural information, equipment lists Design not wasteful of staff through e.g. areas isolated by poor communication Scheduling info readily available for wards, surgeons, set-up staff using the hospital computer system monitors

Common problems
Storage areas - inadequate and scattered Lack of storage for special items e.g. stationary Lack of knee room for seated work Trailing power cords Lack of acoustic privacy w) in OR which drift or are difficult to position Confusion for newcomers, temporary staff Unanswered telephones Inadequate office space Theft of instruments, supplies, linen Poor maintenance of surgical equipment (poor planning, supervision, training)

Useful ideas
Space for white-boards

Possible extra features Music Flexibility OR of the Future - the Ethicon project - Integration - Aesop (voice-controlled robot etc) Extra monitors, Closed Circuit TV Viewing facilities for students and visiting surgeons, including mezzanine floor Later additions - plan diagrams & 3D diagrams & flowcharts References
Architecture & Medicine : I.M. Pei Designs the Kirklin Clinic Aaron Betsky, Tom Bonner (Photographer) / Hardcover / Published 1993 Hospital Interior Architecture : Creating Healing Environments for Special Patient Populations ~ Jain Malkin / Paperback / Published 1992

British Hospital and Health-Care Buildings : Designs and Appraisals P T Stone / Hardcover / Published 1980 Directory of Architects for Health Facilities Paperback / Published 1983 Hospitals and Health Care Facilities : A Design and Development Guide Sir Anthony Cox, Philip Groves / Hardcover / Published 1990 Plant, Technology and Safety Management Series : Health Facility Design and Construction (No. 1, 1991 Series) Paperback / Published 1991 Architectural design for hospitals : hospital planning, ward design and efficiency, out-patient, accident and emergency departments : an update of A 148 The architecture of healing British hospital and health-care buildings : designs and appraisals Directory of Architects for Health Facilities, 1981 Ed. Issn 0192-2297 American Hospital Association 1981 Health Care Architecture : Designs for the Future Eleanor Lynn Nesmith 1995 Casper DE Health care facility design : recent trends and projects 1983-1985 James P, Noakes T: Hospital Architecture. Longman Building Studies 1994 Porter DR: Hospital Architecture : Guidelines for Design and Renovation 1982 Miller RL Swensson ES. New Directions in Hospital and Healthcare Facility Design 1995 Hardy OB,. Lammers LP: Hospitals, the Planning and Design Process 1986 Rohde DJ, et al Planning and Managing Major Construction Projects : A Guide for Hospitals 1985 Hospitals, Clinics, and Health Centers: Architectural Record Book 1972 Patkin M (1991) Hospital Architecture - An Ergonomic Debacle. Proceedings, First International Conference on Hospital Ergonomics, Paris

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