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Title: Anaesthetic rooms : a systems approach to improving design and practice in the United Kingdom
Author: Velzen, Jeena
ISNI:       0000 0004 6351 3305
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2017
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The use of anaesthetic rooms as the standard site of anaesthetic induction in the United Kingdom has been criticised and debated over several decades, and yet practice has remained largely unchanged. The impacts of the anaesthetic room on cost, efficiency, patient experience, and patient safety are either conflicting or unknown. This research utilised a systems approach to evaluate the efficacy of anaesthetic rooms and make recommendations for the improvement of both the design and practice of surgical suites in the UK. The study incorporated mixed methods to investigate the qualitative and quantitative benefits of anaesthetic rooms for all stakeholders. A survey of consultant anaesthetists investigated current practice and attitudes regarding the use of anaesthetic rooms and the importance of various types of ‘evidence’ for affecting change in practice. This study revealed the wide diversity of current anaesthetic practice and the factors that influence the selection of the site of induction. A second study, which used interviews with anaesthetists and perioperative managers explored the decision making surrounding the continued use of anaesthetic rooms and the relationship between design and practice. Factors influencing the perpetuation of anaesthetic rooms were shown to exist systemically across individual, organisational, and external levels. Willingness to change and the relevance of evidence for decision making is discussed. In a third study, a modified participatory design Delphi was used to investigate the decision making priorities of multiple anaesthetic room stakeholders to reach a consensus for the design of theatres in a new fictional hospital. The novel Delphi technique presented conflicting research findings to participants in order to require them to evaluate and come to agreement regarding the incorporation of anaesthetic rooms. A critique of this method is presented along with suggestions for future application. A cost-benefit analysis of anaesthetic rooms was then conducted in one NHS Trust. This was supplemented by ethnographic observations of its surgical suites to provide context to the historical timing data gathered retrospectively for financial and productive evaluations. The cost-benefit analysis revealed that there are missed opportunities associated with anaesthetic rooms, as downtime and delay mean that the potential financial gain and return on investment of anaesthetic rooms cannot be realised. An investigation of patient experience with surgical anaesthesia was conducted through a multi-part questionnaire evaluating patients’ expectations, anxiety, and satisfaction with their anaesthetic care. The study focused on the impact of the site of induction on patient experience and revealed that anaesthetic rooms do not appear to have a significant effect on patient anxiety and satisfaction. Opportunities for improving patient experience were identified, with the majority of these being unrelated to the site of induction of anaesthesia. Through a number of separate studies, this research provides a complete evaluation of anaesthetic rooms. It has identified the contradictions between stated priorities for anaesthetic rooms that stakeholders report and the actual choices that they make for the use and design of surgical suites. The human factors methods and systems approach that has been taken to this thesis has shown that it is a valuable way of investigating deeply embedded practices in healthcare. In addition, this research has set forth a novel method for integrating four dominant paradigms of healthcare improvement. The integration of participatory ergonomics and evidence-based practice may provide a useful method for reaching consensus of contentious issues, aligning systems design with individual and organisational priorities, and encouraging evidence evaluation as a part of the decision making process.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RD Surgery