The Impact of Operating Room Layout on Circulating Nurse’s Work Patterns and Flow Disruptions: A Behavioral Mapping Study

TLDR

Circulating nurses must constantly move throughout the operating room to support the surgical team, and the crowded, cluttered layout can disrupt their workflow. This study evaluates how the spatial adjacencies of functional areas in operating rooms influence circulating nurses’ workflow patterns and disruptions. The authors categorized the OR into transitional and functional zones, coded circulating nurses’ patient‑, equipment‑, material‑, and information‑related activities, and identified flow disruptions linked to environmental hazards and layout, noting that nurses traversed multiple zones in 91 % of activities. The study found that the circulating nurse’s workstation served as a central hub, with frequent trips to both sides of the table, the foot of the OR table, supply and support zones, and that transitional zones accounted for 58.3 % of disruptions, underscoring the need for optimal adjacencies in OR design to improve efficiency and safety.

Abstract

To assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse's (CN) workflow patterns and disruptions.The CN plays a significant role in promoting patient safety during surgical procedures by observing, monitoring, and managing potential threats at and around the surgical field. Their work requires constant movement to different parts of the OR to support team members. The layout of the OR and crowded and cluttered environment might impact the CN's workflow and cause disruptions during the surgery.A convenience sample of 25 surgeries were video recorded and thematically coded for CN's activities, locations, and flow disruptions. The OR layout was categorized into transitional zones and functional zones (workstations, supply zones, support zones, and sterile areas around the surgical table). CN's activities were classified into patient-, equipment-, material-, and information-related activities. Flow disruptions included those related to environmental hazards and layout.The CN traveled through multiple zones during 91% of the activities. The CN's workstation acted as a main hub from which the CN made frequent trips to both sides of the surgical table, the foot of the OR table, supply zones, and support zones. Transitional zones accounted for 58.3% of all flow disruption that the CN was involved in whereas 28% occurred in areas surrounding the OR bed.The similarity of the movement and flow disruption patterns, despite variations in OR layout, highlighted the adjacencies required between major zones that CNs regularly visit. These optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.