Using a systems approach to evaluate a circulating nurse's work patterns and workflow disruptions

David M Neyens; Sara Bayramzadeh; Kenneth Catchpole; Anjali Joseph; Kevin Taaffe; Katherina Jurewicz; Amin Khoshkenar; Dee San; RIPCHD.OR Study Group

doi:10.1016/j.apergo.2018.03.017

Using a systems approach to evaluate a circulating nurse's work patterns and workflow disruptions

Appl Ergon. 2019 Jul:78:293-300. doi: 10.1016/j.apergo.2018.03.017. Epub 2018 Mar 31.

Authors

David M Neyens¹, Sara Bayramzadeh², Kenneth Catchpole³, Anjali Joseph⁴, Kevin Taaffe⁵, Katherina Jurewicz⁶, Amin Khoshkenar⁷, Dee San⁸; RIPCHD.OR Study Group⁹

Affiliations

¹ Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA. Electronic address: dneyens@clemson.edu.
² Clemson University, School of Architecture, Lee 2, Clemson University, Clemson, SC 29634, USA. Electronic address: bayramz@clemson.edu.
³ Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, Charleston, SC 29425, USA. Electronic address: catchpol@musc.edu.
⁴ Clemson University, School of Architecture, Lee 2, Clemson University, Clemson, SC 29634, USA. Electronic address: anjalij@clemson.edu.
⁵ Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA. Electronic address: taaffe@clemson.edu.
⁶ Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA. Electronic address: kjurewi@g.clemson.edu.
⁷ Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA. Electronic address: akhoshk@g.clemson.edu.
⁸ Medical University of South Carolina, 169 Ashley Avenue, Suite 638, Charleston, SC 29625, USA. Electronic address: sandee@musc.edu.
⁹ The Center for Health Facilities Design and Testing, A SmartState South Carolina Center of Economic Excellence at Clemson University, Clemson, SC 29634, USA.

Abstract

The physical environment affects how work is done in operating rooms (OR). The circulating nurse (CN), in particular, requires access to and interacts with materials, equipment, and technology more than other OR team members. Naturalistic study of CN behavior is therefore valuable in assessing how OR space and physical configuration influences work patterns and disruptions. This study evaluated the CNs' work patterns and flow disruptions (FD) by analyzing 25 surgeries across three different ORs. The OR layouts were divided into transitional and functional zones, and the work of CNs was categorized into patient, equipment, material, and information tasks. The results reveal that information tasks involve less movement than other types of work, while across all ORs, CNs were more likely to be involved in layout and environmental hazard FDs when involved in patient, material, or equipment-related tasks compared to information tasks. Different CN work patterns and flow disruptions between ORs suggest a link between OR layout and a CN's work. Future studies should examine how specific layout elements influence outcomes.

Keywords: Flow disruptions; Nurse tasks; Operating room; Operating room layout; Spatial zones.

MeSH terms

Hospital Design and Construction
Humans
Nurse's Role*
Operating Room Nursing*
Operating Rooms*
Systems Analysis
Task Performance and Analysis
Workflow*

Grants and funding

P30 HS024380/HS/AHRQ HHS/United States