6 Ways to Decrease Operating Room Turnover Times

Melodie Garrobo, CASC, administrator of Golden Ridge Surgery Center in Golden, Colo., discusses six ways surgery center administrators can lead their physicians, staff members and anesthesia providers in decreasing turnover times.

1. Figure out an appropriate goal for your center.
When Ms. Garrobo's center decided to tackle turnover times, many of her physicians wanted to hit the 15-minute benchmark they'd seen at other centers. While benchmarking against other centers can be useful to determine your center's position, don't assume that a 15-minute turnover time is right for every center. Depending on your specialties, you may need more time to turn over a patient. "Maybe with what we're doing, it's not safe to have that fast of a turnover time," Ms. Garrobo says. She decided to ask the staff for their opinion on a safe goal for turnover times. At this point, the center's average turnover time is 19 minutes, with some cases meeting and sometimes surpassing the 15-minute mark. Ms. Garrobo says involving her staff members in deciding an appropriate benchmark was essential; once they had set a goal for the center, they were more invested in meeting it.

2. Map out the turnover process.
In order to determine how to cut turnover times, Ms. Garrobo invited a Six Sigma black belt into the facility to map out the turnover process. Before laying out the process, she says staff members were inclined to point the finger at other departments. "We were pointing the finger at anesthesia, pointing the finger at pre-op, pointing the finger at the front desk — nobody had a good grasp of everybody's role in the process," she says. "By mapping it out, people could see where the fat was, and they could see that their perception of their own perfection really wasn't the case." If your center is aiming to decrease turnover times, start by writing down every aspect of the patient's experience, from the front desk to discharge. You will most likely find a few areas of "fat" in every department, rather than one area that slows down the whole process.

3. Determine whether you need more staff. If you ask your surgical staff members for ideas on how to improve turnover times, they will probably say you need more staff. Small centers often feel understaffed when case volume is high and staff members are asked to fill multiple roles, but don't hire more people before you assess whether — and where — they are needed. Ms. Garrobo found that her center was understaffed, but she could fill the gaps without adding skilled staff. She hired several certified nursing assistants to help her nurses, especially on the first cases of the day. "If we've got four rooms going and all those individuals really working to make sure those first cases of the day get off to a good start, the rest of the cases [go well too]," she says.

4. Talk with your anesthesia providers. While it can be more difficult to involve anesthesia providers in meeting center benchmarks, make sure to talk to your anesthesiologists about any perceived delays in their work. In Ms. Garrobo's ASC, most patient receives a regional block, and the anesthesiologists wanted to start performing those blocks using ultrasound guidance. "We were worried that would take a lot of additional time. Since we perform those blocks in pre-op, not in the OR, we were afraid of adding more turnover time" Ms. Garrobo says. "Anesthesia providers received additional training to improve their proficiency."  

5. Improve patient tracking in the business office. In dissecting the turnover process, Ms. Garrobo's business office noticed inefficiencies in keeping track of patients. When a group of patients arrived at the center's 7:00 a.m. start time, the business office would often lose track of which patients were on time, which were early and which had not yet arrived. Ms. Garrobo assisted the office in implementing a patient tracking system to make sure no time was lost getting patients ready for surgery.  

6. Promote punctuality.
Lateness can be frustrating for surgery center staff, especially when staff members are ready to start and anesthesia providers or physicians have not arrived. Ms. Garrobo's anesthesiologists noticed that turnover times could be standardized and improved if they enforced a standard of punctuality. "They started coming in sooner," she says. "If we had a 7:15 a.m. start, they weren't showing up until 7:00 a.m., and if it takes 15 minutes to do the blocks and five minutes to get dressed, they're already late." She conducted a time study that measured how long it took the patient to get through the door and into pre-op to determine where the inefficiencies existed.

Read other coverage about how to improve OR efficiency:

- Anesthesia Protocol for Nurses Starting Early IVs: Q&A With Dr. Thomas Wherry and Cindy King of Health Inventures

- Study: Basic Surgical Skills Testing Lacking in Residency Programs

- Robot in Hospital OR Means Quicker Recovery Time, Less Invasive Surgery

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