It Takes the Entire Team to Streamline Turnover Times

Seven areas that determine the efficiency of your process.

It’s not unusual for the turnover team at a surgery center to be compared to a NASCAR pit crew — a group of people working together quickly and efficiently to achieve the best results.

Know your role

The key to keeping your turnover times low and your day on schedule? When every member of the team knows exactly what it is they’re supposed to do — and does it. “I know when I go in that room my job is to get the trash or to wipe down the areas,” says Kathy Beydler, RN, MBA, CNOR, CASC, former ASC administrator and managing partner at Strategic Surgical Solutions in Nolensville, Tenn. “Whatever my job is, if I know it, and everybody agrees beforehand. It makes a big difference in turnover time.” Ms. Beydler says building a foundation for an efficient turnover team centers on buy-in from staff and training them from Day One. If they get in the habit of doing things right, it becomes second nature. “OR people are creatures of habit and if they get in and can get used to what they’re supposed to be doing, they’ll get it done,” she says. “People will get the turnover done correctly, done by standards and by policy and they’ll be out of that room and ready to open for the next case.”

Modifiable factors

At Asante Rogue Regional Medical Center in Medford, Ore., Laura Christensen, RN, BSN, CNOR, manager of the Surgical Services Center, recently studied turnover times and discovered seven modifiable factors that can be used to streamline turnovers.

“It’s really a team effort. Your surgeon, anesthesiologist, nurses, scrub techs and ancillary staff, we all want to make our day go smoothly and those rooms go quicker,” says Ms. Christensen. “If everyone is onboard, then you get those better turnover times.” Those seven factors include:

• Make sure your preference cards are correct. If the card is correct, the case is always going to start more quickly, and you’ll be in a better spot.

• Check that the staff member who is picking up your case cards does them correctly. Confirm that everything on that preference card is ready and available and included on the case cart.

• Doublecheck that all cases are scheduled correctly from the doctor’s office. Asante uses a platform called Doc Halo, a medical messaging platform that is an all-inclusive system that keeps and encrypts Protected Health Information within the application. Messaging content, critical labs, photos, videos, voice memos, imaging studies, Clinical Team information, and schedule data are not exportable to a user’s personal device. “It’s like a text message. We ask our nurses that when they get their assignments for the next day, to go ahead and message the doctor with the cases that they have. That way the doctor can review it and determine if anything needs to be changed,” says Ms. Christensen.

• Determine when to send to your room at the correct time. Check how far away staff are from the short-stay area is or whether the patient is in holding getting a block. Is your patient 10 minutes from the room? You need to send word when you have 10 minutes left to set up. Is your patient five minutes away or is the patient an inpatient and an hour away up on the floor? Know when the correct time is to start getting the patient toward the OR.

• Ensure there are enough adequately trained staff members for the turnover. Are there enough people to come in and mop, wipe and do everything the things necessary to clean the room to set up for the next case? Asante uses surgery aides to turn over rooms and it has one per room.

• Start cases on time. A huge factor, according to Ms. Christensen, that played into all turnovers was starting everyone on time. And the rooms that started consistently on time had better turnovers throughout the day. “I think because they already were on time, they stayed on time. For whatever reason, if they started an hour late, those rooms that already were late continued to be late. Their turnovers took longer,” she says.

• Prep the patient appropriately and have them ready in the pre-op area. Make sure they are shaved, the consent is done, the orders have been completed, their IV is in. You can go as fast as you want but if you go to get the patient and they aren’t ready, things are going get jammed up.

Turnover times can be affected by staff experience. Before COVID, the average years of experience for the operating room nursing staff at Asante was 13.7 years at the hospital. After COVID, the average experience of the nursing staff was 1.5 years.

“You have a new nurse, and they don’t understand how long it takes to get from one area to another or they’re a little less sure in their skill-set,” says Ms. Christensen. “They want to have the room completely finished when a more experienced nurse says, ‘I have about five minutes of work left, it’s time to send for the patient.’” According to Ms. Beydler, knowing the preferences of the team also helps keep things on track. For instance, she says, once the room is clean and turned over, then team members — nurse, tech and first assistant — start opening the supplies for the procedure.

“Sometimes you’ll run into a nurse or a tech who wants to absolutely open their own supplies and make sure they have what they need,” says Ms. Beydler. “That’s perfectly fine as long as they can get it done in a timely manner.”

Products that aid the process

If you’re looking for a little extra help, turnover packs can be purchased from different distributors and can be customized for your needs. Whether you need a disposable sheet for the bed or a mophead, the right packs will have you covered.

Many turnover packs will include covers for the armboards and a cover for the headrest, it just depends on what you want. The nurses and the techs as a group can and should decide what is included in the pack. For maximum efficiency, use disposable microfiber mopheads and pads, instead of using a regular mop that attracts and retains the dirt. You want things that dry quickly, however, you need to make sure that what you’re using is EPA-approved for that practice. It may be using something with bleach in it, and the dry time may be two minutes. So you need to make sure that it stays wet for two minutes.

The purpose is to make sure that the product decontaminates the surface. Ms. Beydler prefers using a product with a one-minute dry time, but sometimes people don’t want to use the one-minute product because it will have an adverse effect over time on the table pad. “You just have to look at what’s important to you,” she says.

When it’s over

When the room is clean — trash out, surfaces wiped down and decontaminated, anesthesia machine turned over and circuits changed — and every box is checked, only then can the team walk out. They must make sure they’ve hit every surface that’s potentially been used in that case.

Collaboration is truly the best way here. “Turning over rooms really is a team approach,” says Ms. Christensen. “If everyone is on board and wants to do better, then you get those better turnover times.” OSM