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Patient Safety Tip of the Week
Reducing Traffic
in the OR
Another of our favorite topics: how do you
reduce unnecessary traffic in the OR? Foot traffic in and out of the OR clearly
has patient safety implications. It raises the risk of surgical site infections
(SSI’s). It can lead to interruptions and distractions that lead to errors. And
it may have a detrimental effect on team communication.
AORN Journal recently summarized some studies
addressing the issue of OR traffic (Fischer 2024). A study on automated traffic monitoring of
neurosurgical operating room (Schafer 2024) showed that average OR traffic with direct observation was 20 people
per hour, and that 87% of the
time the door opened, only one
person entered or exited the OR.
On average, door opening occurred 18 times per hour, or every three minutes and
18 seconds. Automated monitoring using a door sensor showed an average of 31 people
entering or exiting the OR per hour but was probably less accurate than direct
observation. These numbers far exceeded estimates made by OR staff.
Observed reasons for door opening included:
·
Supplies 18%
·
Hand hygiene
5%
·
Clear task 16%
·
No task 59%
Schafer et al. conclude that, despite its
limitations, coupling an automated monitor with regular feedback to staff and
implementing staff-suggested interventions would reduce OR traffic. We’ve often
mentioned that “black box” video monitoring in the OR, which has multiple
applications, can also provide estimates of OR traffic.
A study by Hamilton et al. (Hamilton 2018) found that simply monitoring door
opening did not reduce OR traffic in total joint arthroplasty cases but, after
a novel educational seminar given to all personnel, they were able to
significantly reduce the incidence of operating room door openings.
Low-cost interventions like placing a
noticeable sign on the door prohibiting nonessential traffic, along with
retractable tape that creates a small barrier to opening the door, may increase
awareness. Perhaps the most effective intervention is ensuring
that necessary equipment and supplies are in the OR before the start of the
procedure. That requires proper planning and knowledge of needs for individual
surgeons and/or anesthesiology staff. That’s where pre-op huddles may be very
important. And post-op debriefings can identify supplies or equipment that can
be incorporated for future cases. Proper planning to schedule staff breaks
should also help reduce unnecessary door opening.
Alternative means of communication, such as
using phones or the intercom, has also been suggested as a way to reduce OR door opening. However, we would
caution that such audible means could also create distractions or interruptions
that could be detrimental. Perhaps more directed silent methods (like texting)
would be less likely to distract multiple members of the OR team. Keep in mind
we have also written frequently about the dangers of cell phones and texting in
the OR.
Unless you have a good understanding of why
the OR door is opening, you are unlikely to have a successful intervention. In
several of our columns we’ve advocated keeping a log where staff are required
to log in every time they leave and enter the OR for each case. To counter your
staff’s objections that this might be time consuming, use a voice assistant like
Amazon’s “Alexa” to simply add each reason to a list.
As in the Schafer study, your OR staff
probably significantly underestimates how often those OR doors open and close.
The first step is getting an accurate estimate and identifying the common
reasons for such. Increasing awareness and understanding why it is important to
reduce unnecessary OR traffic is just a first step. You then need to tailor
your interventions to address the specific reasons at your facility.
Our
prior columns focusing on surgical OR foot traffic and door opening:
·
March
10, 2009 “Prolonged Surgical Duration and Time
Awareness”
·
January 2010 “Operative Duration and Infection”
·
August
26, 2014 “Surgeons’ Perception of Intraoperative Time”
·
December
30, 2014 “Data Accumulates on Impact of Long Surgical
Duration”
·
November 24, 2015 “Door
Opening and Foot Traffic in the OR”
·
July 26,
2016 “Confirmed:
Keep Your OR Doors Closed”
·
December
2017 “A
Fix for OR Foot Traffic?”
·
April
23, 2019 “In and Out the Door and
Other OR Flow Disruptions”
·
June 8,
2021 “Cut OR Traffic to Cut
Surgical Site Infections”
·
January
11, 2022 “Documenting Distractions in
the OR”
·
October
4, 2022 “Successfully Reducing OR
Traffic”
·
August 20, 2024 “Air Traffic Control for the
OR?”
References:
Fischer
L. Reducing Traffic in the OR. AORN J 2024; 120: P4-P7
https://aornjournal.onlinelibrary.wiley.com/doi/10.1002/aorn.14253
Schafer
M, Dixon H, Palladino K, et al. Automated traffic monitoring of neurosurgical operating
room. Am J Infect Control 2024; 52(6): 630-634
https://www.ajicjournal.org/article/S0196-6553(24)00055-5/fulltext
Hamilton
WG, Balkam CB, Purcell RL, et al. Operating room traffic in total joint arthroplasty:
identifying patterns and training the team to keep the door shut. Am J Infect Control 2018; 46(6): 633-636
https://linkinghub.elsevier.com/retrieve/pii/S0196655318300075
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