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LiveData OR-Schedule Board™ — A Dynamic Operating Room Schedule Board

How OR-Schedule Board Helps You on the Day of Surgery

Why choose livedata's or-schedule board.

OR-Schedule Board enables perioperative teams to manage each day’s events in real-time so that the impact of delays, cancellations, and resource constraints can be mitigated. It provides visibility into surgical scheduling so that OR managers can maximize surgical capacity while maintaining patient safety and promoting staff satisfaction. OR-Schedule Board enables perioperative teams to experience benefits such as:

• Optimized OR utilization: OR-Schedule Board provides transparency into OR utilization , allowing managers to organize and maximize rooms for optimal efficiency.
• Improved on-time starts: Managers can reassign cases to other ORs in real time as conditions dictate to ensure rooms, patients, and staff are ready simultaneously.
• Reduced unplanned overtime: With predictive insight into which rooms will run throughout the day, managers can arrange cases to decrease overtime and maximize team member availability.
• Enhanced communication: Unlike legacy whiteboards, OR-Schedule Board stays up-to-date automatically and in real-time, making the most accurate view of the day’s progress accessible to all team members throughout the perioperative suite.

How LiveData Can Improve Perioperative Workflows

LiveData's cloud-based real-time workflow solution empowers hospitals, surgery centers, and clinicians nationwide to run more surgical cases daily, on time, and with existing scheduled staff for maximum efficiency and resource utilization. Our solution enhances situational awareness and improves perioperative workflows that result in millions of dollars of incremental revenue, improved patient safety, and greater patient and staff satisfaction.

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We have worked with several leading surgical institutions to create effective scheduling workflow solutions that benefit perioperative processes, staff members, and patients. You can trust us to understand your organization's unique complexities and meet your surgical operational demands.

Family Waiting Board works within  LiveData PeriOp Manager™  to help streamline your processes and improve communication. Our scheduling workflow solutions enhance patient and staff satisfaction, increase your bottom line, improve efficiency, and offer greater scheduling success within the perioperative suite.

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When you need comprehensive OR scheduling workflow solutions that enhance block time utilization, staff satisfaction, and patient experiences, choose LiveData.  Request a demo  today to see how OR-Schedule Board can integrate and improve your team’s situational awareness.

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• v.9(6 Suppl 1); Nov-Dec 2002

The Operating Room Charge Nurse: Coordinator and Communicator

Jacqueline moss.

Affiliations of the authors: University of Maryland, Baltimore, School of Nursing (JM), University of Maryland, Baltimore, School of Medicine (YX), National University Hospital, Singapore (SZ).

Siti Zubaidah

To achieve the potential inherent in the use of computer applications in distributed environments, we need to understand the information needs of users. The purpose of this descriptive study was to document the communication of an operating room charge nurse to inform the design of technological communication applications for operating room coordination. A data collection tool was developed to record: 1) the purpose of the communication, 2) mode of communication, 3) the target individual, and 4) the length of time taken for each occurrence. The chosen data collection categories provided a functional structure for data collection and analysis involving communication. Study findings are discussed within the context of application design.

Introduction

The primary goal of operating room coordination is to insure the prompt, safe, and effective care of surgical patients. Central to this goal is the operating room (OR) charge nurse. The charge nurse is integrally involved in insuring that staff, patients, and equipment come together seamlessly to move patients through the surgical process. While in recent years, operating room patient and staff scheduling systems have been implemented, little attention has been directed at the totality of coordination needs. 1 Therefore, essential to understanding operating room coordination is an examination of the communication of the OR charge nurse.

The Association of Operating Room Nurses (AORN) lists coordination of care for surgical patients as the first item in their outline of the responsibilities of perioperative nursing practice. AORN specifically mentions communication skills as a key component of coordination. 2 Sonneberg advises OR charge nurses to “communicate, communicate, communicate” 3 for successful coordination. Communication is the method by which information is transferred and is essential for all organizational interaction. 4

In a review of 16,000 hospital deaths due to error, Wilson et al., found that communication errors were the leading cause and resulted in twice as many deaths as clinical inadequacy. 5 Donchin et al. found that 37% of errors in a critical care unit were the result of verbal exchanges between nurses and physicians. 6 On the other hand, facial and vocal cues provide a significant proportion of a message’s meaning and the removal of these cues, as with electronic messaging devices, decreases a message’s clarity. 7 In addition, messaging devices such as paging systems, 8– 10 and telephones 11 can disrupt current activities. Such disruptions can cause an individual to forget to carry out an intended act, even when only ten seconds separates the intention from the intrusion. 12

Communication provides a basis for judgements that are supported by a social network of nurses, surgeons, anesthesiologists, technicians, and auxiliary staff. 13 The OR charge nurse then becomes a conduit for information flow, receiving, processing, and communicating this information to others for the coordination of patient care.

Investigations of catastrophic accidents, such as the Challenger disaster, indicate that these incidents are often the result of faulty system design. Computer applications have the capability to change system processes to decrease communication that can lead to error. To achieve the potential inherent in the use of computer applications in distributed environments, we need to understand the information needs of users. 14 The purpose of this descriptive study was to document the communication of an operating room charge nurse to inform the design of a technological communication application.

Setting and Subjects

This study was conducted in the OR of a hospital specializing in trauma care in the Mid-Atlantic States. Only patients experiencing traumatic injury are admitted to this hospital, and gain access through emergency medical service helicopters or ambulances. The hospital includes six operating suites, one of which is reserved for patients’ requiring immediate surgery. The patients that are admitted to the OR may be from the trauma admitting area, hospital floor, or as previous patients admitted through the outpatient department for follow-up care. The operating room unit is located within the vicinity of the trauma resuscitation unit, post anesthesia care unit and the radiology department.

Operating room staff includes 54 nurses, 4 nurse assistants, and 1 clerk supervised by the operating room charge nurse. In addition, the charge nurse communicates with surgeons, surgical fellows, anesthesia, nursing and order to facilitate patient movement in a very robust environment. The charge nurse in the OR was chosen for this study due to her role as coordinator.

The Charge Nurse

The charge nurse is responsible for the day-to-day smooth running of OR activities. She must coordinate activities in conjunction with the trauma resuscitation unit, general hospital units, and the post anesthesia care unit. Besides managing the personnel under her supervision, some of her other activities included staff education, competency testing, scheduling, and other administrative duties such as budgeting.

The charge nurse starts her shift at 6:00am and ends her shift at 7:30pm. Her day begins with receiving report from the night nurse. The report focuses on the number of cases, the scheduling of patients into the specific operating rooms, patient’s readiness, staff availability, and any other pertinent information relating to the scheduling of the patients for surgery.

After receiving the report, she re-evaluates the cases and begins refining the schedule by either re-sequencing or re-scheduling them. On some occasions, she plans the listing with the attending anesthesiologist immediately upon receiving her report to determine availability of staffing and rooms. By about 7:00am, an ‘informal’ gathering takes place at the ‘desk’ and staff receive or sometimes discuss room assignments democratically. At this point the OR is ready for patients.

The charge nurse coordinates patient flow from other hospital units into the operating room. This includes ensuring that the patient is ready for surgery, surgeon is available to perform the surgery and the operating room is cleaned, and prepared with the appropriate equipment for the planned surgery, and a competent operating room staff is assigned.

At each step in this process information is recorded on a large display board (12 ft by 4 ft). The board is a visual representation of patient, staff, and equipment movement throughout the operating room suites and has evolved into a sophisticated coordination tool for clinicians and supporting personnel. Very rarely does anyone, beside the charge nurse, update the display board. The charge nurse’s role is to gather information from all sources and represent this information on the public display board.

Tool Design

Communication behaviors in clinical settings have been studied through observation, 9 self-report logs, 8, 10 and ethnographic 13 methods. The development of the data collection tool for this study was an attempt to consistently capture objective data specific to the organizational context.

Through experience and observation in the operating room, the initial categories for the data collection tool were developed. Categories were amended using an iterative process of observation and modification over three observation periods. Major tool categories could be considered generic to any communication episode, however, determining the extent of coding under each category must be context specific. Final categories recorded for each communication episode were the: purpose, and mode of communication; the target individual; and the length of time taken for each occurrence.

Data Collection

Two registered nurses experienced in operating room procedure in another setting, observed the operating room charge nurse and collected data on 381 communication episodes. Observations occurred during the operating room’s busiest time, in the morning, over 7 non-consecutive days. Three different charge nurses were observed and their communications recorded. The charge nurse usually remained at the ‘desk’, which can be likened to a command center. This is where the majority of coordination activities occur. This area consists of a long table situated in front of a 12ft by 4 ft wall-mounted public display board. The board is used to show the patient and staff operating room assignments. In addition, the area has a telephone with intercom and paging capability. The Charge Nurse occasionally moved away from her ‘desk’ to assess the progress of a surgery or to discuss room assignment face-to-face with the staff.

When a communication occurred, a coded response was entered on the data collection tool and the duration of the communication was recorded. When the observer was unclear about the purpose of the communication or the target person, the information was clarified with the charge nurse. Occasionally, the charge nurse voluntarily disclosed the information on the communication. This voluntary disclosure of information to the observer oftentimes occurred when the mode of communication was the telephone as it was difficult for the observer to discern the target person and the nature of the communication.

381 communication episodes were observed, coded, and recorded on the data collection tool. Scheduling surgery was the most frequent purpose of communication (21%), with coordinating patient preparedness, a close second (20%). Figure 1 ▶ shows the percentages associated with each purpose of communication.

Frequencies of communication episodes by purpose of communication.

The target persons of communication were most frequently OR nurses (37%), surgeons (17%), and floor nurses (13%). The vast majority (67%) of communications were face-to-face, then by phone (27%), pager (3%), and intercom (2%). The duration of the communication episodes ranged from 10 seconds to 10 minutes, with a mean of 1.13 minutes and a mode of 1 minute. 76% of the communication episodes were between 30 and 60 seconds in duration.

There was a relationship between the target person of the communication and the purpose of the communication (Chi Square, p<.001). For example, 78% of communication with surgeons was to schedule or re-schedule surgery, while 50% of communications with floor nurses was to coordinate patient preparedness. Table 1 ▶ . lists the target person of communication by the most frequent purpose of the communication.

Target Person of Communication by the Most Frequent Purpose of the Communication

There was a significant relationship between the purpose of the communication and the mode chosen for that communication (Chi Square, p = .002). While the vast majority of communication was face-to-face (67%), 39% of phone communications were to schedule or re-schedule surgery and 26% to coordinate patient preparedness.

Also significant, was the relationship between mode of communication chosen and the target person of that communication (Chi Square, p < .001). 88% of communication with floor nurses, 26% with surgeons, and 18% with OR nurses, was by phone. Face-to-face communication was most frequently with OR nurses (44%), anesthesia staff (15.6%), and surgeons (15%).

The purpose of OR charge nurse communication is to coordinate the activities of the operating room. Information is collected, processed, and finally represented on the OR board, a public display. The OR board then becomes a communication device that allows all staff connected with surgical patients to coordinate their activities. However, the fixed location of the board limits the staffs’ ability to access and interact with the device. Therefore, the charge nurse becomes the collector and author of coordination information on the display board. At times, this interferes with the charge nurses’ ability to coordinate other activities and they become ‘tied’ to the public display. The implementation of an electronic display of the OR board, via an internet or intranet, would increase the ability of the staff to access and update the board and free the OR charge nurse for other coordination activities.

An electronic representation of the OR board displayed on the hospital floors would decrease the need for phone communication with floor nurses. Coordinating patient preparedness currently represents 88% of the phone communication between charge nurses and floor nurses and 12% of the total communication with surgeons. Generally, this is to establish if the patient is ready for the OR or if the OR is ready for the patient. Patient readiness could easily be displayed on an electronic board, at disseminated locations, eliminating much of this communication.

Scheduling and re-scheduling surgery are other categories of communication that could be decreased with the implementation of an electronic board. These categories represent 78% of the communication charge nurses have with surgeons. Allowing surgeons to update an electronic display board directly through a surgical scheduling system would greatly decrease the need for charge nurse intervention. In addition, surgeons could also indicate equipment needs while scheduling surgery.

Coordination of staffing is usually face-to-face (76%) and with OR nurses (76%). However, we observed that this communication generally involved the OR nurses’ discussing the status of surgical cases and their next room assignment. Again, disseminated electronic displays of the OR board might be utilized to decrease this communication.

As previously stated, the majority of communication was face-to-face (67%), however observation showed that usually this communication was initiated when staff came to view the OR board. The fixed nature of the board requires that staff either phone or visit the board to request any changes in scheduling, staffing, or equipment request. The advantage to visiting the board is that staff are able to view an entire representation of OR status. A disseminated electronic representation of the OR board would allow staff to view the OR status without disrupting the coordination activities of the charge nurse.

Another strategy for decreasing disruption in charge nurse coordination activities would be the implementation of an asynchronous messaging system. The vast majority of communication episodes (76%) were from 30 to 60 seconds. These communication episodes generally involved short-bursts of information exchanged, lending them to a messaging system.

Nevertheless, due to the unpredictable nature of surgical workload in a trauma center, the charge nurse would still need to be constantly aware of the OR board status. Electronic alerts to changes in scheduling or equipment needs could be communicated to the charge nurses’ and require their confirmation prior to OR board update. This would decrease the need for the charge nurse to be in the proximity of the board to be aware of and coordinate changes in workload.

While this discussion has proposed technological solutions for decreasing communication, more information is needed on the character of the communication episodes, before these proposals can be implemented. For example, coordinating activities in the OR requires negotiation. OR and hospital staff negotiate surgical and staffing schedules with the charge nurse. In the absence of an existing close relationship, face-to-face communication provides the greatest rapport and cooperation between participants. 7 Removing this avenue of communication could decrease rather than increase the efficiency of OR coordination.

Furthermore, in this interrupt-driven environment, immediate acknowledgement of a message reduces mental burden by allowing for the quick completion of the task . This is especially true in this environment where the consequences of communication errors can be so significant; workers need explicit acknowledgement that a communication has been received . Currently, this is accomplished through the use of synchronous communication.

Finally, further investigation is required into the amount and type of peripheral information gained during communication episodes initiated for another purpose. We have observed that this information is frequently in the form of a ‘heads up’, or information concerning upcoming events. Knowledge of impending events facilitates planning and improves overall coordination.

Communication and coordination in the OR is the primary role of the OR charge nurse. This role must be understood prior to suggesting any technological solution designed to enhance OR coordination. The examination of OR charge nurse communication described in this paper is a portion of a larger study designed to explicate the communication and coordination practices of a large trauma center. Under study are those activities practiced by individuals and teams in trauma care. While a limited number of communication episodes were recorded in this portion of the study, we have demonstrated the usefulness of this methodology in practice. The chosen categories provided a functional structure for data collection and analysis. Through an understanding of these practices technological applications will be designed to facilitate coordination of patient care and decrease the potential for human error.

Acknowledgments

We would like to acknowledge the patience and cooperation of the OR charge nurses observed for this study. Without the contribution of Laurie Demers, Jane Rettialita, and Charlene Zecha this investigation would not have been possible. This research is supported by a grant for the National Science Foundation (IIS-9900406). The views expressed here are those of the authors and do not reflect the official policy or position of the funding agencies.

Reprinted from the Proceedings of the 2001 AMIA Annual Symposium, with permission.

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Operating Room Equipment: A Complete Guide

History of operating room equipment.

The history of operating room equipment is expansive, and varies depending on the piece of equipment. Some of the earliest operating rooms, also known as operating theaters, were used in the early 1800s. Surgeries were performed during daylight hours as there was no electricity. Additionally, candles were often used for extra lighting. 1

In the United States, sterile technique was not used until the 1890s and surgeons only washed their hands after the surgical procedure. 1

By the 1900s, asepsis, or the prevention of bacteria from entering a wound or sterile equipment, became practice. Operating equipment could be made sterile through boiling, using autoclaves, and chemical antiseptics. Physicians started to wear white coats, and beds and operating tables were made with clean linens. 2

Types of Operating Room Equipment

Operating rooms are designed for surgeons and surgical staff to perform surgical procedures that require time, patience, focus, and safety. Various pieces of equipment are required for use in the operating room.

Surgical Lights – High-quality surgical lighting is essential for performing intricate procedures in the operating room. Surgical lights are designed to provide bright white light to illuminate the surgical site and eliminate shadows, all while keeping the surgical staff cool. LED lights  or halogen lights are two types of surgical lights. Surgical lighting is transitioning away from incandescent technology to LED technology due to the many benefits of LED: pure white color, less heat in the surgical field, more accurate color rendition, and improved shadow control. 3

Operating Tables – Operating tables, also known as surgical tables, are essential to any operating room. A patient lies on the operating table during a surgical procedure. The purpose of the table is to keep the patient in place while the surgical team operates, and may aid in moving parts of the patient’s body using surgical table accessories . General operating tables are designed to perform a wide range of procedures while others are designed for specific procedures, for example orthopedic tables.

Surgical Booms – Surgical Booms, also known as equipment booms or equipment management systems (EMS), are designed to constrain the electrical cords from various pieces of equipment in the OR that can lead to tripping hazards for staff. By removing the clutter from various cords, surgical booms increase the amount of working space in the operating room. Booms also provide housing for various pieces of equipment and allow that equipment to be positioned to best meet the patient and surgical team needs. Booms are suspended from the ceiling and move easily throughout the operating room. Booms come in various designs. The design chosen by the facility may depend on the space requirements of the OR.

Surgical Displays – Minimally invasive surgery requires surgeons and surgical team members to visualize intricate patient anatomy on surgical displays. They also provide visualization of the procedure to all team members. Surgical displays, including wall displays and large format displays, mount to surgical light arms, equipment columns, or a wall and are used to display a close-up, crisp view of the surgical site. Newer surgical displays may offer high-definition  or 4K visualization .

Operating Room Integration Systems – OR Integration is the connection of image and video in the operating room to improve workflow, procedure guidance and peer collaboration. By allowing OR equipment to communicate with each other via technology, OR integration allows OR staff to coordinate and collaborate real-time. Additionally, integration allows for remote control of multiple pieces of equipment and may decrease traffic near the surgical field. Further reduction in room traffic may be achieved as integration allows for remote viewing and communication by those that may otherwise enter the surgical site. This traffic reduction may decrease the risk of surgical site infections.

Blanket Warmers – Blanket warmers, also known as warming cabinets, are used to store and warm intravenous (IV) fluid, linens, and blankets. Keeping fluids and linens warm for patient use help to decrease the risk of hypothermia. Maintaining normal body temperature during surgery can be challenging. This technology not only provides comfort but serves to assist in the maintenance of normal body temperature. Normal body temperature has been linked to improved patient outcomes. Blanket warmers may have one, two or three chambers and may be mobile or stationary.

Scrub Sinks – Washing hands and forearms with a surgical scrub before performing a procedure is vital to preventing infection in the surgical environment. Scrub sinks are used by OR staff to “scrub in” before a surgery. Hand washing remains one of the most important ways to prevent the transfer of bacteria. Scrub sinks provide hands-free operation , thus reducing the risk of contamination during the hand washing process.

Nurse Documentation Stations – Nurse documentation stations are used by OR nurses. Documenting the pertinent medical information related to the surgical case is vital to keeping a patient’s medical record up to date and accurate, allowing care providers access to patient information. These stations can house electronic equipment, and provide a desk for reporting  and charting purposes. Nurse documentation stations offer the convenience and organizational tools nurses need to effectively manage patient information.

Explore our Operating Room Equipment

Operating Room Equipment Uses

Which medical equipment is chosen for an operating room depends on the facility and patient need. For example, high-complexity operating rooms may require a sophisticated, cutting edge OR integration system. Small Ambulatory Surgery Centers may have a smaller budget, which could impact their purchase decisions. Regardless of the facility or use, each piece of equipment serves its own vital purpose in the OR:

• Surgical lights are used for the lighting of a surgical site
• Operating tables are used for a patient to lay on during a surgical procedure, and may be adjusted for depending on the procedure
• Surgical booms hide electrical cords attached to various pieces of equipment in the OR to reduce tripping hazards. They can house equipment rendering it mobile and able to be positioned in a variety of locations around the room
• Surgical displays are used to display a detailed view of the surgical site for clear visualization
• Operating room integration systems allow OR staff to coordinate and collaborate on medical decisions through video and imaging connections
• Blanket warmers are used to store and warm intravenous (IV) fluid, linens, and blankets
• Scrub sinks are used by OR staff to “scrub in” before a surgery, reducing the risk of infection
• Nurse documentation stations are used to house electronic equipment, and provide a desk for reporting and charting purposes

Where to Buy Operating Room Equipment?

Quality, durable medical equipment is vital to a safe and productive OR. Surgical and other facility staff should research available products from various medical equipment manufacturers and make their purchasing decisions based on equipment quality, after-purchase service support and price, among other factors. Because choosing the right operating room equipment is typically a long and well-thought out decision, purchasing equipment is typically through a Sales Representative or Distributor. Building partnerships with sales representatives and/or distributors can ensure a seamless experience from the initial decision throughout the lifecycle of the product.

1 History of Pennsylvania Hospital 2 History of Surgery 3 Clinical Benefit of LED Lights

Article Categories

  Infection Prevention

  Sterile Processing

  Surgical Equipment

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Chapter 14:  Positioning the Patient

Karen Porter

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Introduction, step 1: transferring the patient to the or table, step 2: placing sequential compression devices (scds) to the patient’s legs, step 3: positioning of the asleep patient, step 4: moving the furniture around.

• STEP 5: WHAT HAPPENS AT THE END
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Positioning a patient for surgery is much more intricate than you might think ( Figures 14.14 , 14.15 , 14.16 , 14.17 ). The following series of steps must occur.

In order to transfer the patient from their bed to the OR table, both beds are pushed together and locked in place. The surgical team works together to safely transfer the patient, usually with a basic roller board. The surgeon and/or resident and the circulator verify the safety of the patient. The patient is NEVER left unattended through this process, particularly once anesthesia has been induced.

These leg-warmer-like wraps are wound around the patient’s legs, secured, and connected to a machine that creates a squeezing action on each leg. The squeezing action of the SCDs assists with blood flow and prevents blood clots. This is a priority action for patient safety and they must be on prior to anesthesia induction.

Many basic positions exist for patient positioning for operative cases. Some of the most common are supine, prone, low lithotomy, and lateral decubitus. Correct positioning of the patient is one of the basic essential functions of every case. It can be done well when the OR team works together to ensure the safety of the patient. The patient is positioned in the most anatomically appropriate position for the surgery, safety straps are applied, pressure points are padded, and genitals are checked. Padding and positioning can be enhanced by the use of gel pads, pillows, foam pads, blanket rolls … there are numerous options. Anesthesia verifies that the head and neck are in correct alignment and that there are no pressure points on the face or neck. The patient’s ultimate position depends on what needs to be done, but access to the surgical site and comfort/safety of the patient are paramount. Because the patient is unable to move during surgery, it is critical that we check for potential circulatory, musculoskeletal, and neurological injuries that could occur. The ultimate goal is to have no postoperative injuries or complications due to positioning.

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Chapter 1. Infection Control

1.6 The Operating Room Environment

The operating room (OR) is a sterile, organized environment. As a health care provider, you may be required to enter the OR during a surgical procedure or to set up before a surgical procedure. It is important to understand how to enter an OR area and how the OR area functions to maintain an sterile environment.

Members of the surgical team work hard to coordinate their efforts to ensure the safety and care of their patients. The surgical team is in charge of the OR and makes decisions regarding patient care procedures. The OR environment has sterile and non-sterile areas, as well as sterile and non-sterile personnel. It is important to know who is sterile and who not, and which areas in the OR are sterile or non-sterile.

Sterile OR Personnel

• Surgical assistant
• Scrub nurse

Non-sterile OR Personnel

• Anesthesiologist
• Circulating nurse
• Technologist, student, or observer

There are specific requirements for all health care professionals entering the OR to minimize the spread of microorganisms and maintain sterility of the OR environment. Prior to entering the OR, show your hospital-issued ID and inform the person in charge of the purpose of your visit. Refer to Checklist 10 for the specific steps to take before entering an OR.

Critical Thinking Exercises

• Why should the sterile field always be kept in sight by the scrub nurse or circulating nurse?
• Name three health care providers who are considered sterile in the OR area.

Clinical Procedures for Safer Patient Care Copyright © 2015 by Glynda Rees Doyle and Jodie Anita McCutcheon is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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