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Operating Room Turnover Times: How the OR and SPD Can Help Bridge the Gap
By Sara Freiberg

 

The operating room is a significant cost center and revenue generator for the hospital, accounting for approximately 40% of the total overall revenue. According to a recent study in a New York hospital, 1 minute of surgical time equates to approximately $150 in costs. As time is critical, a model that reduces room turnover time to less than 20 minutes is ideal. The average turnover time of an operating room depends upon many factors: the setting of the facility (ambulatory versus hospital), the type of procedure performed (endoscopy versus cardiac surgery), equipment readiness, surgeon arrival, and the proper supporting staff.1

If one process or item is delayed at the first surgical procedure, it can cause a domino effect for the remaining surgical procedures throughout the day. Most surgeons are on a strict timeline, and they need time to return to their offices to see additional patients. It is for these reasons that hospitals pay a close attention to the efficiency of their operating rooms and are constantly looking for ways to decrease turnover time.

It is estimated that 15% of the total OR time is wasted each month due to poor patient preparation, surgeon unavailability, insufficient staffing, congestion of the post-anesthesia care unit (PACU), and equipment and sterilization issues, which can create transport delays.2

Prolonged turnover times diminish patient and surgeon satisfaction and ultimately affect the facility’s bottom line. Room turnover processes may appear to flow seamlessly; however, there is always room for improvement. There are several important steps in preparing an OR for the next patient, and this requires a close-knit team of individuals to ensure everything is prepared and ready for each patient.

Once the patient is wheeled out of the room, the turnover timer begins. A member, usually the surgical technologist, removes the dirty case cart of instrumentation and transports it to the SPD. Meanwhile, a housekeeper or float staff removes all trash and linen, cleans and disinfects high-touch areas (OR beds, back tables, and anesthesia units), mops the floor, and makes the bed. The circulating nurse interviews the next patient and ensures all paperwork (surgical consent), site markings, and surgeon and patient signatures are present. The surgical technician gathers the new case cart with all instrumentation and supplies, opens items, scrubs in, and prepares the back table with instruments, supplies, and medications. The surgical technologist counts all items with the circulating nurse and the next patient is wheeled into the room to receive anesthesia and is prepped for the surgical procedure. Any surgical case that enters the room after its original scheduled time is documented as a delay.3 Turnover time must strike a balance between efficiency, patient safety, and surgeon satisfaction.

Reasons for delays fall into many different areas. The prior surgical case could have gone over the allotted scheduled time, causing staff to feel rushed to make it for the next patient’s arrival. The patient assessment may be incomplete and lack pertinent information (e.g., surgeon’s signature missing on the consent form, surgical site lacking its markings, or markings placed in an incorrect location). Surgical instruments might not be ready from sterilization. Sterile wraps may contain a tear or a hole, forcing the OR staff to search for a similar set to complete the case. Anesthesia may be prolonged if the patient is receiving a spinal, causing the procedure to take longer than anticipated. A piece of equipment could be faulty, and the staff has to call for a replacement. The list goes on. Every second matters to address patient safety and timeliness. 

Increasing efficiency and communication
The SPD and OR managers could benefit from reviewing the following day’s surgery schedule each morning, as well as before the day shift is completed because the schedule can quickly change. This proactive review can greatly reduce potential equipment conflict (e.g., loaner trays), instrument tray turnover concerns, special request items, and staffing concerns. It also alerts managers if cases are added on, overbooked, or canceled, allowing them to plan accordingly with their OR and SPD teams to improve the daily surgical case flow. 

The OR staff can ensure that the surgeon’s preference cards are current and that all items are pulled in preparation for the following day’s procedure. If the department is using an automated instrument-tracking system, everything on the surgeon’s preference cards should match in the tracking system. If a preference card is not current, staff might try to recall by memory and could run the risk of delays in surgery, causing upset patients and surgeons.4

If an item or instrument set is unavailable or missing, it should be noted on the case cart and staff should verbally share the information with the SPD and OR managers immediately so they can make arrangements to accommodate accordingly, and in time for the procedure. At times, this may involve borrowing items from a nearby facility or having to rely on immediate use steam sterilization to support back-to-back procedures.

It is best to establish department goals to ensure everyone understands their responsibilities for a timely room turnover. Incorporate a trained staff member to oversee process observations and document any areas in need of improvement. Collect all data weekly and have a short meeting to discuss any barriers or challenges. A transparent system that holds its staff accountable is key; therefore, establishing a workflow that promotes teamwork and accountability is imperative for the department. Implement new changes and celebrate successes. It is important to celebrate successes with staff. Although a facility may see only a few moments of improvement in turnover time, every moment saved is a success and can be improved upon until the time goal is achieved.

The operating room is a highly organized environment where patient safety and surgeon satisfaction are top priorities. Working as a team, reviewing and preparing all items and processes in a timely and efficient manner contributes toward patient care and produces optimal patient outcomes. Our patients’ time is valuable, and asking them to wait longer than necessary brings about frustration. Additionally, our surgeons should be recognized for their need for efficiency in the operating room. Teamwork is imperative to support process improvement and bring long-term success for everyone involved. When healthcare staff come together as a team, it benefits patients, surgeons, and the hospital’s bottom line.

References

  1. https://www.annalsthoracicsurgery.org/article/S0003-4975(19)30002-5/fulltext
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994460/
  3. file:///C:/Users/default.DESKTOP-KJ2MU9L/Downloads/AORN-Perioperative-Efficiency-Tool-Kit-Webinar%20(3).pdf
  4. https://www.infectioncontroltoday.com/materials-management/spd-or-staff-play-equal-roles-ensuring-case-turnover-and-transition

 

 

 

 

 

Sara Freiberg, CST, CBSPDT, CER, has more than 15 years experience working as a certified surgical technologist, with five of those years spent traveling to various operating rooms across the U.S. Following Sara’s time in the clinical arena, she worked as a surgical technology didactic and lab instructor at Rasmussen College. Sara holds bachelor degrees in science and business and marketing, which led to her work with various medical device companies as a clinical specialist, product manager, and clinical training manager. She has experience working on quality and regulatory teams, monitoring patient-adverse events, and postmarket surveillance activities.

Sara currently works for Northfield Medical as a clinical education manager where she provides education which is based on current manufacturer and regulatory guidelines regarding various healthcare topics for SPD, OR, and GI staff. Training entails the care and handling of medical devices to ensure patient safety, as well as targeted education addressing departmental cost concerns. Her passion is working with SPD, OR, and GI departments; providing assessments; and sharing best practices with respect to patient and staff safety, surgical instruments, and medical devices. Sara is a voting member of the AAMI ST/WG84, ST91 flexible endoscope committee, and she has developed several CEU presentations approved through CBSPD, CBRN, NCCT, and IAHCSMM. Sara also authors a biweekly healthcare article for Ultra Clean Systems.

Sara is currently studying for the Certification Infection Control (CIC) exam through APIC.

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