5 Steps to Bring Teams Together for More Efficient & Effective OR Turnovers

Your Practice: Use these tried-and-true tips to get your turnovers on track.

In the four decades they’ve each spent working in ORs, challenges with room turnover have always been an issue, according to perioperative consultants Patricia Mews, MHA, RN, CNOR, and Paul Wafer, BS, MBA, RN.

With the current staffing shortages and influx of new members to the team, they say every OR can likely use a turnover tune-up. However, breaking down turnover practices to determine areas for improvement can be complicated because any turnover is so interdependent on outside factors, such as preoperative patient readiness, EVS availability and SPD operations.

Wafer and Mews shared these five steps leaders can take to bring teams together for more efficient and effective room turnovers.

Step 1: Get a Clear View of Your Metrics

“Be careful not to make general comparisons, because different case duration could skew your data,” Wafer cautions. That’s why he suggests breaking down room turnover metrics by procedure.

It’s also important to look at the elements of the turnover time to make sure you are viewing your data accurately, such as “patient out” to “patient in” numbers and “patient in to start” numbers. This can help understand timing from when the patient is brought into the operating room to the time surgery starts.

Valuable metrics: In addition to turnover time, look at numbers for turnaround time—surgeon time (the time from closure on one patient to incision on the next) to make the events surrounding the turnover more visible for those analyzing efficiency metrics.

Step 2: Analyze Who is Doing What

Compliance with completing specific turnover tasks is essential to room turnover efficiency and safety, Mews says. Wafer agrees, adding “you don’t want three people cleaning the same area and everyone missing one high-touch area that could increase the risk for infection.” That’s why they stress the importance of training each turnover team member in a standardized role for specific tasks, such as cleaning, staging, or instrument/equipment readiness.

Turnover training keys:

• Document standardized roles and share it in paper or electronic format.
• Let new staff members shadow their turnover role with a very efficient turnover team.
• Cross-train turnover roles every quarter across specialties to build proficiency.

Step 3: Standardize Cleaning Steps

The safest way to clean the OR is to start at the periphery and move toward the bed. To achieve this with multiple team members cleaning at the same time, standardized cleaning steps ensure optimal cleanliness, Mews suggests. One helpful approach is to stagger cleaning by zones, Wafer advises. These zones can include outer tables zone, anesthesia zone, bed zone and floor zone.

Useful tool: Learn more about turnover cleaning in the AORN Environmental Cleaning Tool Kit, which includes education and tools such as a Sample Cleaning Checklist: OR, Preop, and Postop.

Step 4: Work Smart When Staging

To smoothly stage the next case, case cart prep is key, and it starts with having a good preference list that is complete and updated frequently, Wafer says. “If it is a good list, the entire case cart—with exception of meds—can be picked by somebody from SPD or a central core tech.”

Scheduling tip:  Consider how cases can be scheduled to prevent extra time with different equipment needs. For example, group left hip surgeries and then right hip surgeries to save time with having to move equipment back and forth to different sides of the bed before each surgery.

Step 5: Enhance Communication Between Key Players

“Governance is key to looking at the big picture for improving turnover, whether it’s analyzing turnover data, setting rules, or even having conversations with physicians or other team members about arriving to the OR on time,” Mews acknowledges. She suggests developing an overarching perioperative council with a performance improvement committee focused on patient flow and case process that includes a focus on turnover.

Wafer suggests electronic tools such as a dashboard linked to the electronic health record system can help teams track activities across multiple rooms. “You need communication tools in place to know when a case is almost finished, when the OR can be turned over, and when the next patient and team are ready for a new case.”

Coordination key: Use a daily huddle to gather team representatives from all relevant areas to review the next day’s schedule and preempt issues that could create turnover delays.

Find more ideas from Mews and Wafer in their recent webinar on Perioperative Efficiency: Patient Safety, Workflow and Quality and earn 1.5 C.E.