MUSC, Clemson University collaborate in integrated OR suite designs

Olivia Franzese
August 29, 2017
Clemson University Architecture and Health students envision an operating room that is safe, efficient, flexible as well as patient- and staff-centered.
Clemson University Architecture and Health students envision an operating room that is safe, efficient, flexible as well as patient- and staff-centered.

While the practice of medicine continues to advance through information and technology, the design of the standard operating room in most hospitals has remained largely the same for decades. Two innovators aim to change that.

Scott T. Reeves, M.D., the John E. Mahaffey, M.D. endowed chair and chairman of the Department of Anesthesia and Perioperative Medicine at MUSC, and Anjali Joseph, Ph.D., the Spartanburg Regional Health System endowed chair in architecture and director of the Center for Health Facilities Design and Testing at Clemson University, are part of a joint MUSC-Clemson project titled “Realizing Improved Patient Care Through Human-Centered Design in the OR.” The goal of RIPCHD.OR is to analyze every aspect of the current OR standard and redesign it with efficiency and improved patient care in mind.

The team of researchers, engineers and clinical specialists involved in this project received a four-year $4 million research grant from the Agency for Healthcare Research and Quality in 2015 to continue research and the development of a safer, more efficient OR.

“There has been very little work examining the design of the operating room and how you incorporate standard architectural principles into it. We’re hoping we can establish a new standard on what should be considered when you build an OR,” said Reeves, co-principal investigator of the project.

Currently, the typical OR in most hospitals across the nation consists of a cramped, square white room with a patient bed in the middle of the space. Many doctors and nurses feel that ORs are outdated and restrictive, and in light of today’s state-of-the-art hospitals and cutting-edge technologies, they should be modernized.

Among other factors related to reimagining the space, Reeves and Joseph are examining how to maximize space in the OR to improve accessibility to equipment and the patient, implementing changes like rearranging the typical placement of the patient bed and analyzing traffic flow in the room.

“The need for a better OR design in operating rooms has existed for many, many years. The standard OR does not support the needs of the patients, doctors or surgeons. It is very crowded and cluttered, and there are issues like staff getting hurt and operating room doors posing the risk of infections. There is a lot of room for improvements,” explained Joseph. “The idea is that a more comprehensive approach will help us to alleviate some of the problems we are seeing in the operating room.”

Overall, the project covers three specific areas of research designed to improve patient care and efficiency in a future OR design: unmasking of anesthesia–related alarms and communications, traffic flow and door openings, and an integrated OR suite design.

The first area involves the reduction of noises and interruptions associated with alarms meant to signal anesthesiologists. A typical OR has numerous alarms that monitor the patient’s vital signs during a procedure, like heart rate and blood pressure, but the complication of multiple alarms ringing simultaneously and frequent false positives creates a very distracting OR environment, according to Reeves.

“We’re looking at different technologies for establishing changes from baseline that might help us interact quicker when things go awry. We are exploring if there is a way to use different senses for alarms, like vibrations connected to Wi-Fi technology that can vibrate our arms if a certain parameter changes with the patient,” Reeves elaborated.

Their second goal is designed to regulate movement in the OR and decrease the risk of surgical site infections to patients.

“This aspect of the project is studying the frequency of people moving in and out of the OR. There’s a big problem with doors opening too quickly, because it disrupts the air flow in the OR, and it’s a poor practice. But, it’s very common in many ORs,” Joseph explained.

The third piece focuses on the development of a comprehensive plan that combines best practices related to lighting, visibility of the patient, position of the bed, size of the room and materials used.

With the project now entering its third year, Joseph, Reeves and the rest of the RIPCHD.OR team are preparing to build a full-scale mock operating room in the Clemson Design Center in the Charleston Cigar Factory to expand upon the cardboard mock design created last year. The full-scale OR will be created based on research of past literature on OR functionality; observation of best practices in updated, modernized ORs like those in the Seattle Children’s Hospital; and input from nurses, doctors and anesthesiologists on how the new OR should function.

Joseph is optimistic that the results will serve as a guide for all future OR designs due to the vast scope of their research.

“We are hoping to take everything we’ve learned in terms of design and how it all comes together and put it in a framework that other people can use when thinking about OR design, because we’ve delved really deep into this topic. I think it creates a great model for other people,” she said.

Reeves and Joseph agree -- this groundbreaking project would not have become a reality without the collaborative forces of two prestigious institutions teaming up to improve patient safety and care.

“It has been a really wonderful relationship between Clemson and MUSC that has made this all possible,” she explained. “We have the researchers and the manpower to do all of this, and MUSC has the leadership and know-how it takes to implement it.”

Reeves added, “This innovative partnership underscores the fact that when institutions of excellence align their interests and work together to achieve a common goal, patients win.”

About the Author

Olivia Franzese