Skip to main content

Table 1 Requirements considered during the intraoperative design of optimal OR design

From: Surgical workflow simulation for the design and assessment of operating room setups in orthopedic surgery

Functional requirements

1

Alignment of instrument tables

For the design of optimal OR setups, the positioning of instrument tables should allow the whole OR team, and especially the surgeon, 1st assistant and scrub nurse a direct view on the operating area whenever possible. Hence, the scrub nurse is able to anticipate the surgeons’ actual and next needs (e.g. instrument or material handover), which has a positive impact on the process flow of the surgery [17].

 2

Relative positioning of instrument tables in proximity to the surgeon

The instrument tables should be positioned in adequate proximity to the surgeon. This shortens the paths for instrument handover between the scrub nurse and the surgeon [17].

Spatial requirements

 3

Freedom of movement

The space for the OR staff, especially for the surgeon, should be planned generously to ensure unrestricted freedom of movement during surgery. There should also be sufficient space available in the setup if large-sized equipment is used during surgery [14].

 4

Planning of pathways

The pathways to supply stocks, workstations and the sterile area should be as short as possible to minimize the travel path of the circulator during surgery [61].

 5

Sufficient space for medical devices

If large-sized medical devices (e.g. c-arm or a surgical microscope) are needed during surgery, sufficient space should be planned in the setup. When the equipment is not in use, it should be located opposite to the surgeon and in proximity to the operating area to enable a fast preparation and set up.

Hygienic requirements

 6

Positioning of the instrument tables next to or in front of the surgeon

The instrument tables should not be located behind the surgeon. Although in most cases the surgeon is dressed completely in sterile clothing, the back is considered as less sterile due to the clothes closure.

 7

Minimizing staff circulation

The pathways of the OR staff, especially the circulator, should not impinge on the instrument tables. The airflow and unintentional contacts may cause physical and bacteriological effects and increases the risk of instrument and implant contamination.

 8

Positioning of the instrument tables in the proximity of the OR table

The instrument tables should be positioned in proximity of the OR table, which is specially protected against pathogens by a sterile area with a stable flow of filtered air.

Ergonomic requirements

 9

Minimizing the rotational movement of the OR staff

Where possible the instrument tables should be positioned next to or in front of the surgeon and in a U-shape in front of the scrub nurse. This minimizes rotational movement and improves an ergonomic body posture.

 10

Avoiding twisted or bent body postures

The height of the OR table and instrument tables should be adapted to the individual needs of the OR personnel [62]. In addition, the operating area and displays in the OR should be seen by the personnel without bending or twisting the head or back.