IS FEWER BETTER? Some say the only thing worse than a turnover team with not enough able-bodied bodies is one with too many.

Many hands make light work, but some say less is more when it comes to turning a room over after surgery. "Sometimes more people is not better," says Cynthia Loomis, RN, CNOR, of Carroll Hospital Center in Westminster, Md. "We used to assign each staff to a particular task when they arrived to do turnover: tables, lights, bed. But it didn't work. It was chaos and then you kept asking, 'Did you get the lights? Did you get the ?'"

Ms. Loomis favors a leaner approach to readying the OR for the next case: deploying 2 environmental services techs to work in tandem with the RN and tech from that room. "It's also helpful," she says, "to have an anesthesia tech to take care of the anesthesia end of things."

A 10-minute turnover is the goal at most surgical centers, but there aren't always enough people to roll up their sleeves and pitch in, say facility leaders who favor an all-hands-on-deck approach. "At times employees forget that everyone should assist with room turnover," says Margaret Chappell, RN, MS, CASC, a senior vice president of operations with Ambulatory Surgical Centers of America. "Our housekeeping attendants do a good job, but we need more of them," says a nurse manager.

One of the things that stood out in our survey of nearly 100 nurse managers about the challenges of OR turnovers is that staff will sometimes go to great lengths to, ahem, avoid cleanup duty. A favorite stall tactic of nurses is milking the time it takes to chart a case. Surgeons who use the computer in the OR when the RN circulator needs to close out the case and call for housekeeping unwittingly delay turnover and the start of the next case. "Physicians need to carry a laptop or the OR needs 2 computers," says a respondent.

HIT SQUAD Only 20% of the surgical facility leaders Outpatient Surgery Magazine surveyed have a dedicated turnover team.

While many respondents say it's difficult to have speedy and thorough turnover without a dedicated turnover team, only 20% of respondents have such a hit squad. More often, a combination of housekeepers, OR assistants and RN/scrub staff pitch in — whoever's willing and whoever's available. "Usually it is done by [environmental services] with the help from any free support staff and the OR staff from that room," says Ms. Loomis.

"Each member of the surgical team has their own responsibility in room turnover," says Marcia Conley, RN, BSN, director of nursing at the Cataract and Laser Center in Crossville, Tenn. "Even our surgeons are involved in some aspect, such as moving foot pedals and the microscope when needed."

The Tripler Army Medical Center in Honolulu, Hawaii., has a dedicated turnover staff. "The entire team works together," says Tiffany Chance, MSN, ANP-C. "There are rewards for not having delays. The core team has all case carts stocked and ready."

Clean your room
Turnover time and surgical specialty are closely related. Take endo vs. ortho, for example. At the Community Endoscopy Center in Indianapolis, Ind., a circulator floats in the procedure hallway, helping the scrub nurses turn over the 4 procedure rooms between cases — typically in less than 10 minutes. "This person has other duties as well, though. She's not specifically dedicated to turnover only," says Tammy Richardson, RN, BSN, MHA, the center's director. Meanwhile, at the orthopedics department at New Hanover Regional Medical Center in Wilmington, N.C., turnover time is closer to 30 minutes for heavily soiled orthopedics cases. "We need to thoroughly clean multiple pieces of equipment," says Barbara Earp, RN, BSN, CNOR, the orthopedics coordinator.

Nearly one-third (30.9%) of our respondents have an average room turnover time of less than 10 minutes; one-fourth (25.5%) average 10-15 minutes; and one-fifth (19.2%) average 15-20 minutes. Fewer than 10% take longer than 30 minutes on turnover. Guthrie County Hospital in Guthrie Center, Iowa, is one such facility.

"We only have the one big OR, so no more surgeries until the room is turned over!" says OR Manager Doris Terwilliger, RN. "Our OR staff is only 5 people, so everyone has to stay on task to get the room turned over."

Nearly three-fourths of our respondents are "almost always" (51.1%) or "often" (21.3%) satisfied with their turnover time.

"Physicians are never happy with turnover times," says Selita J. Humbles, BSN, RN, CNOR, clinical educator at Central Louisiana Surgical Hospital in Alexandria, La., who reports a 10-15 minute average turnover time.

The start of a case is delayed because the room's not ready sometimes (22.6%), often (6.5%) or almost always (3.2%). When that happens, the whole schedule backs up, resulting in dissatisfied surgeons, disgruntled patients and frustrated staff. "Then the day seems to fall apart," says Melissa Willms, BSN, RN, CNOR, surgical services manager at Fayette County Hospital in Vandalia, Ill.

When to start?
When do you begin cleaning the room — while the patient is still in the room or only after the patient leaves the OR? More than half (56.5%) of our respondents wait until the patient has been rolled out to begin cleaning, while 40.2% get a head start by removing supplies and equipment when the patient is being aroused from anesthesia. One facility starts to bag up the trash and remove the linens from the OR bed, "but no wet cleaning begins until the patient exits the room."

At Central Louisiana Hospital, cleanup begins when the patient is being aroused from anesthesia, says Ms. Humbles. The scrub remains sterile at the sterile field while the circulator and other free team members help remove waste bags and gather cleaning materials, she says.

"The surgical back table is often cleared in the very late stages of a routine case once the surgeon has given the okay to do so," says Ms. Conley.

"There's no reason that cases can't be cleaned up while the patient is being aroused and the dressings are on. Everything except wiping down the table can happen," says a respondent.

About two-thirds of respondents (65.9%) mop the floors between cases — only when there is visible soil, most say. More than half (55.2%) of respondents move the OR table between cases. "For non-bloody cases, the OR table is moved and mopped beneath and a mop-width around the table," says a respondent.

Slow + steady
We started with one saying: Many hands make light work. We'll end with another: Slow and steady wins the race. A 10-minute turnover time is great, but in the quest to beat the clock, the danger is that the faster things are being done, the more things are missed. Sherry Rogers, RN, CNOR, CASC, the CEO of the Tullahoma (Tenn.) Surgery Center, speaks for many when she says, "It is not just one person's responsibility to turn over the room — it's everyone's. All staff members must work as a team." OSM