Keep Floors Clear and Dry

A better option — and one Ms. Fredette's staff also employs — is placing fluid-wicking devices around the surgical table to keep the floor dry and safe for surgical team members.

Slipping is just one risk surgical teams face during busy days is bustling facilities when their attention is often on paperwork, patient care and pulling supplies — everything but where they're walking, which they often do quickly. A stray cord or misplaced piece of equipment could be enough to trip up a hustling staff member.

Tripping risks have increased as cases continue to shift to outpatient ORs, which are often packed with the latest devices and equipment needed to perform procedures that are growing in complexity. Rolling in extra equipment can clutter walking lanes and limit maneuverability around the table, creating congestion that puts staff at risk if they don't watch where they're going.

Consolidating equipment is the simplest way to keep floors clear of tripping hazards, says Anjali Joseph, PhD, EDAC, director of the Center for Health Facilities Design and Training at Clemson (S.C.) University. Dr. Joseph is involved in a project funded by the Agency for Healthcare Research and Quality to reimagine current OR designs with the goal of creating safer spaces. She spends a lot of time watching surgical teams in action and asking them about their ergonomic needs. "OR clutter is a big concern based on our observations and conversations," says Dr. Joseph.

She points to several space-saving solutions that can help keep walkways clear in ORs where every square foot is valuable real estate:

• Equipment booms. Floor- or ceiling-mounted booms limit the number of video towers and equipment carts needed around the surgical table. Booms also let you adapt to evolving equipment needs by easily changing the configuration of ORs over time. "But booms present their own challenges," says Dr. Joseph. "They're expensive, staff often bump their heads on mounted screens and equipment never quite aligns as well as you'd like."

If booms aren't in your budget or are an impractical add, Dr. Joseph suggests making sure equipment carts and instrument tables are out of high-traffic areas and away from the pathway where patients are wheeled into and out of ORs. Also be sure to position carts in large enough spaces where open doors won't obstruct pathways of movement.

• Divided rooms. Dr. Joseph also says organizing ORs into four work areas — anesthesia at the head of the table, sterile zones on both sides of the table and a circulation zone outside the sterile field — ensures staff work in dedicated areas, keeps their steps to a minimum and limits movement during cases, which reduces the risk of trips and collisions.

Moving the surgical table closer to a side wall, away from the center of the room, and angling it toward one corner frees up space around its surface, giving staff more room to move and maneuver equipment during cases. It also lets you set up the anesthesia workstation in the corner closest to the head of the table, an area that's dead space in conventional room configurations. Setting up the anesthesia workstation in the corner keeps tubes and cords away from moving equipment and staff members, a secondary benefit that prevents vital connections between the patient and anesthesia machine from becoming accidentally dislodged during procedures.

• Smart storage. Storage solutions in new ORs are no longer a separate design component; they're instead integrated into walls to open up valuable square footage and limit how far doors extend into workspaces and walkways, according to Dr. Joseph. She says adding storage locations in the anesthesia work area and where the circulating nurse patrols limits the amount of distance they must travel during surgeries, a factor that improves efficiencies and decreases foot traffic throughout the room.
• Wireless imaging. Evolving video routing technology eliminates the cords that run from video towers to large flat screen monitors positioned around the room, where images from the surgeon's scope, the overhead view of the surgical field and different data sources can be shown simultaneously. Staff working away from the sterile field can monitor the surgery's progress, anticipate the next step in the case and ready needed equipment at a safe pace. "Teams that are aware of what's happening throughout the procedure are better able to coordinate their movements," says Dr. Joseph.
• Mobility. Mobile workstations designed for circulating nurses are gaining in popularity. The workstations on wheels let circulators position themselves near the surgical table for a better view of surgery and limit the amount of walking they have to do around the sterile field. The mobile nurses also have the ability to safely move out of the way if members of the surgical team need to reposition themselves or equipment.
• Cord covers. Until wireless technology and booms become commonplace, cord management is a reality of working in surgery. Dr. Joseph believes consolidating equipment whenever possible and making a concerted effort to keep equipment organized are the best ways to keep walking paths clear of tripping hazards, but also understands stretching cords across floors is inevitable in some ORs. She says it's difficult and time-consuming to safely tape down the cords of equipment that's moved in and out of ORs between cases, but points to commercially available covers and easy-to-peel on, easy-to-peel-off organizers as viable — and visible — alternatives for keeping cords corralled and ensuring your staff avoids them.