Archive March 2000 I, No. 3

Tips for Faster OR Turnover

Judith Lee

BIO

From the initial patient contact right through to sending patients home, surgical facility managers are finding new and creative ways of turning over ORs and seeing more patients in less time. Here are some ideas that could save you several minutes per case - adding up to valuable hours per week.

1. "Block" the schedule.

Place similar surgeries all on one day, or in one part of the day. "This way, the surgeons and staff get into a rhythm, and they move more quickly," says Sue Nowell, RN, Nursing Manager for Bay Area Surgery, Corpus Christi, Texas. This practice also minimizes movement of equipment: "You don't want to have a GYN following an orthopedic procedure. The staff will have to re-equip the OR between turns," notes Lucie Owens, RN, Facility Administrator for Alpine Healthcare, LLC, Los Gatos, Calif.

2. Provide transportation.

This is somewhat costly, but if late patients are slowing you down, it could be a good investment. "You've got to have the patients there when they are scheduled to be there," says George Violin, MD, a partner in Ambulatory Surgery Centers of America, Norwood, Mass. Ms. Nowell's ASC does not offer transportation routinely, but it does when the staff suspects there's a problem.

3. Gang up on room turnover.

If slow room turnaround is slowing your entire facility down, try the following:
- Make sure your staff understands that it's everyone's job to pitch in. If an orderly isn't handy, almost anyone can grab a mop, says Ms. Owens: "We don't go for that 'it's not my job' attitude." Ms. Nowell says up to five people help out with turning rooms over at her facility.
- Use floaters, particularly on heavy days, to help with room turnover, advises Robert Dehn, RN, Nurse Manager for IWV Surgery Center, Ridgecrest, Calif. "The person does not have to be a nurse, surgical assistant or scrub tech. This person will bring in a table or clean the table and put on fresh linens, remove the old table and instruments - whatever," says Cindy Stanson, RN, Director of Nursing at the HealthSouth Exeter Surgery Center in Reading, Pa.

4. Use foam instead of scrubbing.

Antiseptic foam is quicker and easier on the surgeon's hands. "If the surgeon is doing back-to-back procedures, it can save three to four minutes per case," says Dr. Violin.

5. Grab and go.

Here's an idea for speeding cold sterilization. In Mr. Dehn's ASC, the supply person gowns up and retrieves supplies that need to be soaked as soon as the surgeon is finished with them. "It takes 30 minutes to soak the arthroscopy scope and camera. If the supply person gets it while the surgeon is wrapping the leg, it can essentially save 10 minutes of soaking time," Mr. Dehn explains.

6. Ditch the booties.

Paper booties may not cost that much, but they are unnecessary and it takes time to change them. Ask all staff and surgeons to keep a pair of shoes that never leave the ASC. It's best to choose a style without laces to save time, Dr. Violin says.

7. Have patients visit the restroom.

When the patient arrives or just before prepping, ask him or her to visit your facilities. This way, the patient won't have to visit the bathroom after entering the OR.

8. Be redundant.

Whenever possible, purchase at least two of everything, so that it's never necessary to wait for clean-up, sterilization, or service. "This way we can do all knees one day, or all shoulders," says Mr. Dehn.

9. Invest in surgical packs.

Although these can be expensive, they can pay off in valuable time savings, ensuring that everything the surgeon needs is available and ready to go, advises Pam Ertel, Facility Administrator at HealthSouth Exeter Surgery Center.

10. Make surgeons adjust their own chairs.

"Surgeons love to have staff adjusting their chair. But this just wastes time," says Dr. Violin. If the chairs you have don't allow the surgeon to do this, buy new ones, he advises.

11. Prep outside the OR.

Shave the patient, start the IV and administer any blocks prior to entry into the operating room. The reason is simple: "You can turn a room over fast, but is the next patient ready?" asks Ms. Ertel. A corollary: The techs should do the draping before the surgeon enters the room, suggests Dr. Violin.

12. Tell it on the mountain.

At IWV Surgery Center, a staff member announces the ending of each case over the PA system. system, "This alerts recovery that a patient is coming, and pre-op that we'll be taking another case," says Mr. Dehn.

13. Preprint all notes and orders.

Keep writing to a minimum by creating forms that are easy for staff and doctors to fill out. "This includes surgical notes and orders, discharge notes and prescriptions," says Dr. Violin.

14. Find and eliminate time-wasters.

Ms. Nowell says these include lab work delays, patient transportation problems, and surgeons who get "lost" in the lounge. "We try to plan ahead and make sure needed lab work is done, the patient arrives on time, and the surgeon is there when we're ready," she says. One way they keep surgeons in the building is by supplying a breakfast and lunch buffet for them.

15. Think mobility.

Keep the patient as mobile as possible. Do not oversedate, and when possible, employ anesthetic agents that allow patients to wake up quickly, and enable staff to move patients sooner. "You don't want the patients waiting in the OR until they can maintain their own airway," notes Ms. Owens.

16. Use special measures for eye cases.

There are several ways to save time with this most common of outpatient procedures:
- Use a stretcher, not a table. Many facilities, including Bay Area Surgery and HealthSouth Exeter Surgery Center, place ophthalmology patients on litters rather than tables. This way, staff can wheel the patient in for the procedure and then wheel them out for recovery without having to move the patient on and off a table. You can convert a regular stretcher by adding a headboard.
- Allow these patients to keep their street clothes on. Just have patients remove their clothing from the waist up and don a surgical gown. "With elderly patients, this saves incredible amounts of time," says Ms. Ertel.
- Instead of using drops during pre-op, cut up Weck Cel sponges, soak them in the medication, then place them inside the lower eyelid. This saves several trips back to administer drops prior to the procedure, advises Ms. Ertel.

17. Design for efficiency.

You can't always affect the design of your facility, but when you get the opportunity, a few decisions can save a lot of time:
- Make each OR identical to its fellow in as many details as possible, so that there's never any confusion.
- Place cleaning supply closets next to each OR. "Don't waste time looking for supplies. Keep everything right there," says Ms. Owens.
- Set up patient flow in a "U" pattern, with short distances between the holding room, the ORs and the recovery room, advises Ms. Nowell. This will eliminate "backtracking."
- Eliminate private offices, phones in closets, and other hideouts, recommends Dr. Violin. "Don't give surgeons a private place to call their broker," he says.

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