The race is on and the clock is ticking as soon as the surgical patient exits the room. There is a laundry list of tasks the OR team must complete in a short amount of time to successfully turn over a room. The RN is responsible for handing off the patient to PACU, dropping off any specimens, return unused medications and the list goes on. The surgical technologist must disassemble the back table, spray instruments with enzymatic cleaner & transport the soiled instruments to the decontamination room. Environmental services should be available to clean the room. If all of the end of case activities are not completed seamlessly, the turnover time drags on.
The Preference Card is Key
A correct preference card and accurately picked case plays a huge role for the surgical team to successfully turnover an operating room. This card should list the correct instrument trays, equipment, OR bed, disposable supplies, sutures, medications, positioning devices and special requirements in the comment section. Optimally, the picked case is validated for accuracy prior to the time of surgery.
Prior to brining the case cart into the room, it is important to validate accuracy by comparing the patient name listed on the pick sheet, against the OR schedule. Collect medication and any additional items that may be on the on missing list, identified on the surgery schedule or not appear on the preference card. If anything is missing, the team must waste valuable time tracking down the correct items, causing an extended turn over time.
Sterile Supplies at the Ready
The RN and surgical tech are responsible for spreading the room and opening sterile supplies. The surgical tech will perform a hand scrub and begin setting up the sterile field. The team must mutually validate the sterility of the items, along with the integrity of the wrappers and tray filters, prior to placing in the sterile field. Ensuring a sterile filed is critical and any deviations must be addressed, “when in doubt, throw it out”. Throughout the process, if there are missing or unsterile indicators, bioburden, holes in wrappers or expired products, action must be taken and the turn over time increases. When the surgical technologist and circulating RN are ready, the counting process will begin.
Patient Readiness & Wheels In
Frequently, the RN must leave the room for a walk to the pre-op area to visit with the next patient for validation of the consent, H&P update, site marking and pre-op surgical safety checklist. The balance of the team also needs to be rounded up for transport to the operating room.
If forms are missing or processes have not been completed, you can kiss the industry average 30 minute wheels out/wheel in time goodbye. You’re also staring down a day filled with surgeon and staff frustration and patient impatience due to even more delays.
So How Do You Accomplish this Herculean Task?
On an average day, the RN cares for four individual patients, without a minute to spare. It’s initially inconceivable that time could be squeezed out of the process. But what if the load of the RN is lightened AND surgical case turnover time is improved?
This can be achieved with a well-defined and choreographed workflow process. Case mapping through direct observation by a multidisciplinary team should be completed to identify activities performed within the time frame of “Patient A” dressing-on, to “Patient B” wheels-in.
Each activity should be scrutinized and compared with best practice. Does the activity need to be performed? Is it being performed by the correct person? Can it be performed at another time or location?
Tactics to decrease turnover time should be developed utilizing a team approach, allowing time for discussion and openness to new ideas. Turnover time goals should be established by the team, keeping in mind the procedures performed within the facility.
Any re-defined process should go through a pilot stage, monitoring phase and implementation, within a specified time frame. Provision of clearly articulated expectations, a demonstration that safety and quality will not be comprised and over communication to all team members will promote a successful modification in processes.
You’ve done it!
The outcome of an improved turn over time project is not simply gaining 20 more minutes of time at the end of the shift, but rather an exercise to define and optimize every aspect of the surgical environment. Reducing time is never a result of working faster, but rather of modifying inefficient processes.
As you’ve now seen implementing a turnover time improvement initiative is not about minutes, it’s about optimizing the entire perioperative experience.
