Efficient OR Turnovers Without Increased Infection Risk: Here’s How

Create a comprehensive system that keeps both administrators and infection preventionists satisfied.

Most facilities struggle with turnover times that are higher than leadership would like. For Martin County Hospital in Stanton, Texas, however, the issue wasn’t so cut and dried. At 17.5 minutes per case, its average turnover time in 2024 was good. So good, in fact, that its board of physicians questioned whether the low turnover times were an aberration or if something was missing.

Under the hood

When the hospital took a deeper dive into its turnover times, the exercise provided a host of benefits for its staff. “Our cataract cases skewed our numbers,” says Amber Cervantes, MSN, RN, director of surgical services for Martin County Hospital. Because the hospital performed so many cataract cases, those numbers influenced the turnover totals in a way that didn’t give a clear picture of the complexity of its case mix.

Specialty-specific goals

In addition to cataracts, Martin County performs standard GI procedures such as colonoscopies and more complex GI and abdominal cases, and it recently added orthopedics to the mix. The facility also provides simple pain management procedures. Obviously, there are major differences between a cataract surgery and a total joints case. Ms. Cervantes knew her turnover process needed to reflect those disparities while ensuring that every critical infection prevention protocol was met.

That’s why she implemented a turnover-by-specialty system. “I take our average turnover time, and then I break that down into categories to make separate goals for the staff, such as seven minutes for cataracts, 15 minutes for routine GI cases and 25 minutes for our bigger cases,” she says. “Our turnover time goal for ortho starting out will be 30 minutes, but I may need to adjust that goal up or down.” Martin County does not include pain management procedures in its turnover time average.

Balancing act

Martin County Hospital is a prime example of one of the most difficult challenges facing busy outpatient facilities: The need to marry speedy turnovers with proper terminal cleaning and infection prevention processes.

Surgical leaders must ensure that everything from surfaces to portable equipment is thoroughly cleaned and disinfected between every case in a way that keeps even the most stringent infection preventionists satisfied but also moves quickly enough to keep executives and owners happy with the pace and throughput.

Like a good recipe, turnover requires the right mix of ingredients blending together harmoniously to create something wonderful from the combination. “Efficient turnover means adequate staffing, teamwork, clear communication and leadership that is always willing to jump in when needed,” says Ms. Cervantes.

Proper staffing, of course, is central to turnover success regardless of the facility or case mix. From an infection control standpoint, Ms. Cervantes says the turnover in EVS, a department Martin County had major difficulty keeping adequately staffed, was a major issue that produced plenty of trickle-down effects to other areas of the hospital. “People were coming in at night, and they weren’t doing acceptable work,” she says.

That made everything more difficult for staff the following day, so Ms. Cervantes hired a surgical aide who was specifically tasked with terminal cleaning and helping with room turnovers. “I trained her myself, and I had her working during surgeries to get that hands-on training,” she says. “I showed her how to perform terminal cleaning just like I was trained — where everything is taken out of the room, then the walls and surrounding areas are cleaned, and then everything is brought back in.” As an added layer of protection, whole room disinfection is performed in Martin County’s ORs at night with UV light.

“Efficient turnover means adequate staffing, teamwork, clear communication and leadership that is always willing to jump in when needed.”
Amber Cervantes, MSN, RN

To ensure compliance, the hospital uses daily infection logs, which hold staff accountable for following and documenting that all the protocols were taken and followed to the letter. It also performs regular infection rounding and does SWOT (Strengths, Weaknesses, Opportunities, Threats) analyses of its practices.

When reviewing turnover processes, Ms. Cervantes urges facility leaders to pay extra attention to how commonly used items are stored and replenished. “CMS is big on expired items right now, so it’s important to focus on rotating supplies,” she says. “Focus on keeping the oldest items up front and stocking the newest supplies in the back.” To ensure this oldest-item-first stocking method occurs, reminder signs are placed in the areas where supplies are stored.

Priority list

Running a successful surgery center will never be an easy job. It requires many diverse skills  — and an almost superhuman ability to juggle competing tasks all at once. Keeping surgeries on track can feel overwhelming for administrators and other facility leaders who wear so many different hats, but Ms. Cervantes has a simple process for conducting the complex symphony that is surgery.

“Focus on infection prevention and patient satisfaction first, and then focus on the surgeon,” she says. The approach has worked wonders for her, her staff and her patients. “I love what I do, and I have an amazing staff,” she says. “I’ve seen this place grow from nothing to the top-performing multispecialty facility it is today.” OSM

Note: This three-part article series is supported by Ansell.