Towards a Model of Safety and Care for Trauma Room Design

Principal Investigator: Sara Bayramzadeh, Ph.D., Kent State University, Kent, OH 
AHRQ Grant No.: HS027261 
Project Period: 09/30/19-09/29/24 
Description: This learning lab sought to improve trauma room safety and efficiency by examining how the physical environment influences clinician workflow, technology use, and sensory factors. The lab team used a human-centered, systems engineering approach to examine interactions between people, tasks, technologies, and space in the trauma room.

The specific aims were to:

1. Identify physical environment factors that influence patient safety and efficient care in trauma rooms.
2. Develop a novel, autonomous, and privacy-preserving video system to capture observational data on trauma room workflows.
3. Design evidence-informed solutions to reduce interruptions, improve layout, and enhance future adaptability.
4. Test proposed design strategies through simulation.
5. Develop a trauma room design guide to support safer, more efficient emergency care.

To achieve these aims, the PSLL project produced an integrated body of work that includes a real-time monitoring system, simulation-tested room layouts, and a Trauma Room Design Guide. Researchers conducted simulations in physical and augmented reality (AR)-based mockups to test design strategies under realistic conditions, engaging clinicians from multiple disciplines.¹

A major innovation was the development and validation of a privacy-preserving surveillance system that uses artificial intelligence to detect people in real time, track movement, and protect individual identities. The system achieved high accuracy while maintaining ethical and legal compliance, setting a benchmark for visual data use in sensitive healthcare settings.^1,2

Simulation-based evaluations revealed several improvements in trauma room performance. Design strategies—such as decentralized storage, centralized supply access, color-coded layout zones, smart personal protective equipment (PPE) dispensaries, and multifunctional trauma beds—enhanced workflow, reduced interruptions, and supported technology integration.^1–3 The team also addressed negative impacts from sensory stimuli, such as glare, noise, and temperature fluctuations, by introducing solutions like noise-buffering anterooms and anti-glare lighting systems.^2-4

The Design Guide, grounded in findings from both simulations and literature reviews, offers practical guidance on room layout, visual connectivity, equipment placement, and sensory control—addressing challenges like crowding, alarm fatigue, and workflow disruptions.¹ Notably, the lab demonstrated how AR tools can engage frontline clinicians in iterative design, enabling them to test new layouts, provide feedback, and refine solutions before construction.⁴

This PSLL also resulted in a series of publications covering real-time observation methods,⁵ environmental effects on teamwork,⁶ and comprehensive literature reviews that define the links between trauma room design and patient safety.³ These findings offer practical implications for architects, clinicians, and healthcare leaders. For example:

• High noise levels and poorly integrated equipment can distract clinicians and delay care.
• Poor lighting and glare reduce visibility during critical procedures.
• Proximity to key resources (such as supplies and imaging equipment) improves workflow and reduces delays.
• Visual displays and monitoring tools enhance team situational awareness.

The surveillance and analysis model developed by the lab may also benefit other high-acuity settings, such as emergency departments, intensive care units, and surgical suites. The project illustrates how digital monitoring and human-centered design can work together to improve safety, efficiency, and staff performance while safeguarding patient privacy.^1,5

To date, this PSLL’s work has resulted in at least 11 peer-reviewed publications, with at least 117 citations in other publications. It has also resulted in two awards and at least 19 conference presentations, from national to international in scope. 

Publications

2025

• Bayramzadeh S et al. Redefining interruptions: events, causes, and impacts in trauma rooms. J Pat Saf.
• Estejab H et al. (2025). The application of full-scale mock-up in simulation-based design evaluations of trauma rooms. Int J Qual Health Care 2025 Jul 3.
• Estejab H, Bayramzadeh S. The application of augmented reality in simulation-based design evaluations of trauma rooms. HERD 2025 Jan;18(1):70-85.

2024

• Aghaei P, Bayramzadeh S. Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study. Facilities 2024 Mar 12;42(5/6):524-36.
• Bayramzadeh S, Ahmadpour S. The impact of sensory stimuli on healthcare workers and outcomes in trauma rooms: a focus group study. HERD 2024 Apr;17(2):115-128.

2022

• Bayramzadeh S, Chiu LY. The impact of design on workflow: a comparative case study of level I trauma rooms. Facilities 2022 Mar 4.
• Ren Z, Ghazinour K, Gua Q, et al. A privacy preserving video surveillance system for trauma rooms. 2022 IEEE Smartworld, Ubiquitous Intelligence & Computing, Scalable Computing & Communications, Digital Twin, Privacy Computing, Metaverse, Autonomous & Trusted Vehicles. 2022.
• Ren Z, Yang Y, Ghazinour K, et al. Demo: A multi-perspective video streaming system with privacy preservation in trauma room. IEEE/ACM 7th Symposium on Edge Computing. 2022 Dec.

2021

• Bayramzadeh S, Aghaei P. Technology integration in complex healthcare environments: a systematic literature review. Appl Ergon 2021 Apr 1;92:103351.
• Bayramzadeh S, Ahmadpour S, Aghaei P. The relationship between sensory stimuli and the physical environment in complex healthcare settings: a systematic literature review. Intensive Crit Care Nurs 2021 Dec:67:103111.
• Bayramzadeh S, Anthony MK, Sterling M, O’Donnell K. The role of the physical environment in shaping interruptions and disruptions in complex health care settings: a scoping review. Am J Med Qual 2021 Nov 1;36(6):449-458.

References

1. Bayramzadeh S. Final Report: Towards a Model of Safety and Care for Trauma Room Design. K.S. University, Editor. 2025, AHRQ: Rockville, MD. p. 1-20.
2. Bayramzadeh S, Ahmadpour S. The impact of sensory stimuli on healthcare workers and outcomes in trauma rooms: a focus group study. HERD 2024 Apr;17(2):115-128.
3. Bayramzadeh S, Ahmadpour S, Aghaei P. The relationship between sensory stimuli and the physical environment in complex healthcare settings: a systematic literature review. Intensive Crit Care Nurs 2021 Dec:67:103111.
4. Estejab H, Bayramzadeh S. The application of augmented reality in simulation-based design evaluations of trauma rooms. HERD 2025 Jan;18(1):70-85.
5. Bayramzadeh S, Aghaei P. Technology integration in complex healthcare environments: a systematic literature review. Appl Ergon 2021 Apr 1;92:103351.
6. Bayramzadeh S, Anthony MK, Sterling M, O’Donnell K. The role of the physical environment in shaping interruptions and disruptions in complex health care settings: a scoping review. Am J Med Qual 2021 Nov 1;36(6):449-458.