Redesigning the operating room for safety

We have been designing hospital operating rooms (ORs) for nearly 300 years. One of the first such spaces was designed with seats so that observers at St Thomas Hospital in 1751 could watch and learn. Consequently, even today, ORs are often referred to as operating theaters. Prior to the establishment of ORs, surgical procedures took place on hospital wards, patient homes, or in doctors' consulting rooms. As medicine discovered important concepts such as antisepsis, and surgical techniques advanced, specifically designed rooms became a necessity. The size, layout, and design of these rooms have changed enormously over time to accommodate for the ongoing evolution in surgical practice and medicine. Today, ORs are expected to facilitate an increasingly diverse variety of procedures. However, there is relatively little understanding about the impact of design on human error, and evidence showing effects of OR design on surgical outcomes is scarce. Given the rising complexity of surgical procedures and the introduction of robotic and hybrid procedures, these complex interactions between humans and machines become even more important. Understanding how design impacts errors will allow healthcare architects to create safer spaces for an ever-complex procedural environment. One type of error is described as a flow disruption, which is defined as an obstruction of the ideal workflow. Importantly, these flow disruptions have been linked to adverse patient events. It stands to reason that if through optimizing the built environment we can reduce flow disruptions, then we can improve patient and provider outcomes.