5 Steps to Improving OR Turnaround Time
Publish Date: 8/22/2012
Thomas Jefferson University Hospital is a 957-bed acute care system in urban Philadelphia, housing 58 OR suites. The system performs more than 38,000 procedures a year in its four campuses.
In October 2008, a perioperative working group sought to improve ENT case turnaround time (TaT). At the time, ENT was the system’s fastest growing service line. If the hospital could more efficiently schedule and complete cases, volume, profitability and patient satisfaction would increase.
“One of the major concerns for residents, surgeons, anesthesiologists and nurses was that we had so much idle time,” said Joanne Grace, MS, RN, CNOR, clinical specialist at TJUH. “Rooms were running later and later in the day, and the need for overtime was extensive.”
Here’s how the nurse leaders tackled the problem in eight months, relying on the Lean:
- Define the project and it stakeholders: Initial research showed that TJUH’s average ENT case TaT was 73 minutes, 74 percent higher than the industry average of 42 minutes. The goal, then, was to cut that number in half. The team defined a turnover opportunity as an OR case scheduled to follow, and calculated OR turnaround time as patient “wheels-out to wheels-in.”
As an initial step, the team then identified and surveyed the project’s customers or stakeholders: patients and their families; surgeons, anesthesiologists and residents; sterile processing staff and vendors; and administrators. The survey was intended to get stakeholders’ view of the problem and related processes, as well as ideas for solutions.
- Measure: From the survey, the team developed tools to measure OR workflow processes.
- Analyzed: Team members formally observed the OR workflow to identify waste that impeded the workflow. They also interviewed staff to uncover root causes. The outcome was a fishbone diagram that maps the processes and activities to bring a patient to the OR. We learned, “it takes a village to bring someone to the OR,” said staff nurse Susan Holmes, BSN, RN.
- Identify and prioritize opportunities for improvement: Using the information gathered from observations and measurements, the team targeted actions that could speed TaT.“We established a choreographed process relationship between key team members to eliminate duplication of tasks and to increase efficiency,” explained Holmes. Among the steps in this dance were:
• making supplies more available and closer to the OR;
• optimizing the case cart system by minimizing the need to store items in the OR suite;
• updating surgeon preference cards to eliminate guessing;
• revising patient tracking systems;
• communicating assignments and expectations to OR staff; and
• creating visual cues and “checklists” to help team members fulfill their roles.
- Control: By the middle of 2009, TaT dropped to between 28 and 31 minutes. “You want to continuously monitor the process to ensure sustainability is achieved,” Holmes said. Today, service line supervisors monitor TaT and report numbers at monthly meetings.
For more information about reducing turnover time, attend the AORN eCongress education session on “Solve the Puzzle: How to Attain Best Practice for Quality and Safety Using Lean Six Sigma.” Learn more or register here.