CREATURE COMFORTS Your staff should look forward to spending a day in the OR.

The OR is their home away from home, the place where your surgeons and staff spend countless hours mired in the grueling grind of surgery. The least you can do is make sure they're comfortable on the job. When Belleville General Hospital in Ontario, Canada, opened 6 state-of-the-art ORs earlier this year, the shiny new instruments and sparkling video towers were welcome additions, but the surgical team wanted more. They wanted to move around without knocking heads. They wanted better lighting and integrated controls. Ultimately, they wanted to be comfortable in the rooms where they spend hours on end putting others' needs ahead of their own.

"We got to see, hear, research and know what was extremely important to them," says Janet Baragar, RN, program director of surgical services at Quinte Health Care, the hospital's parent company. "In the end, we were able to address the issues that improve their work environment."

Room to breathe
Hospital leaders used 3D models to configure the new 500-square-foot rooms, which are nearly twice as big as the cramped ORs they replaced, to know where to place the booms, the surgical table and the nursing station in order to optimize use of the space. "It took a lot of time, but it was time well spent," says Ms. Baragar.

The difference is noticeable to Kristina Cruess, RN, RNFA, CPN(C), BA, BScN, MST, MPA, clinical educator at Quinte Health Care, who remembers standing pressed against the back walls of the old ORs to watch the surgical action while steering clear of it. Now surgeons, nurses, techs, anesthesia providers and medical students all have room to breathe. That's promoted better technique, which is important to the entire surgical team.

"Clutter was also a big issue," according to Ms. Cruess, referring to the tangle of cords that crisscrossed the floor and the piles of surgical supplies that made the small rooms feel even smaller. "When you decrease clutter, you decrease stress," she says.

In the new space, nearly all the equipment is hung on booms: flat screen monitors, insufflators, light sources, cameras, shavers, printers, cautery units and smoke evacuators. The only cord left on the floor is the one used to plug in the surgical table. "Cord congestion is greatly reduced from how we worked before," says Susan Stevens, RN, BScN, perioperative manager at Belleville General.

The redesign also included installation of a dedicated elevator that runs between the reprocessing department and center core. No, you don't have to rip down walls to realize the same supply decluttering benefits: When the hospital restructured how instruments move between the departments, they also took the much-needed opportunity to determine which supplies they used most often. The reevaluation identified which supplies should be kept in the ORs, and which could be moved to general storage until they were needed for specific cases. "Every supply cart has been reviewed and redesigned — made smaller — making them much easier for the reprocessing staff to push to central core," says Ms. Cruess. Streamlining the supplies also limited the amount of items that took up valuable space in the ORs.

HOME SWEET HOME The new ORs at Belleville General Hospital were designed with staff and surgeon comfort in mind.

Less pain, more gain
Easing the physical burden of surgery was an essential element of the redesign.

"Placing as much equipment as possible on booms eliminates moving it in and out of rooms for different cases," says Ms. Cruess. "Staff isn't pushing and pulling equipment, which decreases physical stress, avoids having to weave between obstacles as they move around the room and lets them focus more on patient care."

Belleville's leadership strongly considered adding anti-fatigue mats for staff to stand on during surgery, but the cases they work aren't very long. Still, says Ms. Baragar, the administration understands the mats might be an important comfort measure and is strongly considering adding them in the future.

The surgical tables are bariatric grade and easy for staff to manipulate, the stretchers are easy to maneuver when pushing patients around the surgical department, and each room is outfitted with table attachments and slider boards to ease the strain of transferring patients between surfaces.

Belleville's old ORs were equipped with high-definition imaging, but now screens are everywhere — on booms positioned in ergonomically friendly places around the table and along the back wall, which can display anesthesia monitoring data as well as images from laparoscopes and cameras positioned to shoot down on the surgical site. Surgeons and staff no longer strain to follow the action, which improves ergonomics and helps the circulating nurses anticipate the procedures' next steps.

LED surgical lights were also part of the redesign, a welcome addition for the surgical team, who sweated under the hot glare of the old halogen models. The new lights bathe the surgical field in cooler, brighter, high-quality light, which, according to Ms. Cruess, reduces eyestrain and improves ambient comfort. "I'm looking forward to this summer, when we'll really feel the difference," she says.

Fluid overflow is collected by a direct-to-drain management system. Staff move the system's rover unit into place, attach it to collection ports on the drapes or to floor wicking devices and go about their business.

When it's time to dispose of fluid, nurses wheel the mobile collection unit to a docking station, where fluid is automatically drained without exposing them to infectious waste. Nurses also don't have to remove and replace suction canisters, and carry them to the hopper for disposal, a laborious chore that increases risk of back injuries and falls.

MAJOR PERK
An Oasis Outside the OR

ROOM WITH A VIEW Staff need a comfortable place to relax.

Don't ignore the importance of the seemingly little things that make a big difference to your staff, like a comfortable area where they can go to get off their feet, exhale and escape the rigors of the OR, if only for a few minutes. Natural light sources at Belleville General Hospital in Ontario, Canada, were limited to 2 windows: One that faced outside and another that opened into the hospital's large atrium. "That's where we built the new staff lounge," says Janet Baragar, RN, program director of surgical services at Quinte Health Care, who points out the break room is outfitted with comfortable couches, a new dining table and a flat screen television. "It's tremendously important for staff to take their cherished breaks in a comfortable area filled with natural light."

— Daniel Cook

Attire counts, too
Belleville also signed new contracts with glove and linen suppliers that, because of construction delays, coincided with the opening of the new ORs. Staff wanted microfiber scrubs that wick away moisture from the skin for added comfort. They also wanted gloves that would protect during procedures notorious for causing perforations, such as orthopedics, form to the shape and size of their hands, have a more forgiving fit, provide adequate tactile sensation and have therapeutic agents in the inner linings to soothe dry hands.

You may not realize it, but gloves and scrubs are major issues to the frontline staff. "How they feel can make or break their day," says Ms. Baragar. "Those things were very important to our team, so with the changes we've been focusing on, it was important that we got them right."

Ms. Baragar laments the one design wish left unfulfilled: sound-absorbing surfaces for better acoustics. "The OR is a noisy place, but they don't work from an infection control standpoint," she says. Still, the move to the new space was successful well beyond her expectations. "We had our share of growing pains, but staff and surgeons love it," she says. "They feel like they're working in a new hospital." A new and comfortable hospital.