Operating room workflows JEfferson
Reimagining the operating room to be more efficient and increase patient safety.
Role Lead Design Researcher, UX Strategist
Project Goal Increase efficiency in the operating room to reduce surgery times, improve patient safety, and maintain OR schedules.
Project Considerations Various roles, unique environment, systems thinking, interconnected departments, patient safety
Skills Highlighted Interviewing, shadowing, contextual inquiry, focus group, concept design
ABOUT THE PROJECT
Our team was approached by a talented neurologist interested in improving efficiency in his operating rooms (ORs). He theorized that momentum was lost by people not being on the same schedule, losing track of the stage a surgery was in, and being unsure of how to prepare for the next stage.
Our goal was to validate his hypothesis and design the product requested.
However, once we started our research, we recognized that there were many other factors influencing operating room schedules and efficiencies. After observing multiple surgeries, we determined that these other factors were so highly influential over efficiency that we requested to dive into the identified opportunity areas as well.
Research
Observed 24+ hours of neurological surgery procedures.
Observed case cart workflows and interviewed case cart team members.
Audited OR and SPCC data, tools, and processes, to identify opportunities for data tracking and analytics.
Conducted a survey on debriefing and communication.
Comprehensive, cross-team OR discussion session and process review.
Attended weekly perioperative team huddles.
Interviewed O.R. team members at both JHN and Gibbon.
Multiple walkthroughs in Sterile Processing and interviews with team members about their process, tools, challenges, and successes.
Conducted secondary research and reviewed O.R. informatics data at Jefferson.
Analysis + Synthesis
We found that the physician’s solution was a bandaid solution for larger, more deeply embedded problems with the OR workflow and system.
Examples of this finding include:
The problem he noticed of people not paying close enough attention wasn’t because they weren’t paying attention, but because they were distracted by the need to run out for tools and supplies, or check on the status of supplies they were waiting for.
Despite required debriefings, teams were not debriefing following procedures. Our large group interview revealed that teams had not reflected on procedures or processes together in a very long time, leading to misunderstandings about basic procedures and expectations.
Teams were not communicating across roles and therefore did not understand the diverse perspectives within the operating room.
Administrators were unaware of the issues within the ORs.
Administrators struggle to combat hospital politics that prevented them from streamlining certain practices.
Our research also revealed that sterile processing (S.P.C.C.) was an easy scapegoat for problems in the operating room.
Speaking with our employees, it became clear that this was a pervasive thought pattern. However, when we met with sterile processing, we learned that many of the problems down the line started with what they received from the OR. This problem was intensified by administrators only tracking metrics about what came out of SPCC, not what went into it. No one was looking at how other departments’ behavior influenced sterile processing’s output.
Solutions
Our solutions aimed to optimize operating room workflows through improved communication and accountability across departments, as well as by creating and maintaining a shared understanding of how each role across departments contributes and their impact on the overall operating room workflow cycle.
Debriefing Tool
What
Debriefing via automated text and feedback.
Why
Despite being required and necessary, debriefs rarely took place, meaning team members were not communicating at all about how they worked together or important notes on the procedure. We found that this lead to unclear expectations and widespread frustration, which could easily be avoided if group reflection and communication were taking place.
How
Once a procedure is marked complete in EPIC, an automated text message will be sent to each team member assigned to that procedure. The message will prompt each recipient for feedback on the procedure and team coordination. Individuals can respond quickly or get a follow-up (either through text or a phone call).
Success Metrics
Debrief analytics
Surgery times
Patient outcomes
Phase Identification Tool
What
A tool that visually communicates the current phase of surgery along with key details and objectives of each phase to provide O.R. staff with the information they need at a glance. The solution can also help with room set-up and preparing for later phases of the procedure.
Why
To ensure all team members in the OR are aware of what stage the surgeon is in, so they know if they are needed or will be needed soon.
With better planning, O.R. staff could minimize their movements throughout the surgery and decrease room traffic and distraction during the Incision phase.
How
This tool would display the current phase of a surgery on one of the currently unused television monitors in the operating room. The surgeon, or another team member, would be able to change and direct the tool to display the correct stage using the Jefferson Smart Rooms device located in the room as an operating room assistant.
The tool would pilot with the spinal cord stimulator surgery and continue to be built our for other procedures over time.
Success Metrics
Debrief analytics
Surgery times
OR Assistant
What
Allow teams to take notes during procedures for later follow-up.
Why
Due to the pressured and focused nature of an operating room, important things that came up during procedures were forgotten once a procedure was completed and the teams needed to rush to get the patient out and get to their next procedures.
How
Utilize Jefferson’s Smart Room technology to install voice assistants in the OR that would email any notes from the procedure directly to the surgeon and operating room administrators. Those notes could then be reviewed at their convenience and kept in mind for future discussions, planning, and troubleshooting.
Success Metrics
Debrief analytics
Patient outcomes
Interdepartmental Accountability Kiosk
What
A dashboard displaying data on trays returned, including the rates of sprayed trays and accurate trays (trays without extra or missing tools), that would be shown compared to the rates of bioburden and surgery start times.
In future iterations, this tool may benefit from interactive features, like sending kudos to teams across departments, to boost recognition and morale.
Why
OR staff can understand how their behavior (how they break down and return sterile trays to SPCC) directly impacts what they receive from SPCC, and in turn, the overall efficiency of the OR.
This data serves as a powerful reminder that the S.P.C.C. and O.R. not only share day-to-day goals, but that the tools they hand off to each other impact their own work and efficiency later on.
The processes that take place between Sterile Processing and Case Carts Departments can impact the efficiency of the operating room. Despite that interdependence, there is little to no communication between most staff as well as no daily reminder of that connection.
How
Pulling data from SPCC regarding sprayed trays and complete trays returned and comparing it to the data already collected by the operating room administrators regarding bioburden, first case start times, and delayed schedules.
Success Metrics
Schedule delays
Bioburden rate
Tools lost
OR Schedule Share
What
Improving the distribution of, and allowing real-time updates to, the O.R. schedule sheet through the creation of a custom application.
Why
Many surgeons make last-minute changes to their surgery plans, including the tools they need and procedure adjustments. Usually, only one person in the room has that updated schedule, and that person is solely responsible for catching everyone else up and making sure they all prepare as needed. If that person was busy or not in the room, there were problems down the line. This practice leads to surgeries being delayed and staff being frazzled.
This solution allows for more efficient and collaborative case planning. It also provides real-time communication between surgeon, vendor, and O.R. teams.
How
Using a platform like ServiceNow to pull information from EPIC to allow physicians to create dynamic surgery schedules that:
Allow multiple people to modify procedure schedules
Provide timestamps for changes
Sending real time notifications as schedules are updated to staff members tied to each case through push notifications or emails
Success Metrics
Schedule delays
Debrief analytics
Surgery times
Patient outcomes