We've achieved an average turnover time of less than four minutes in our one-OR ophthalmic surgery center by using this approach:

• Assign two teams, each composed of one RN and one scrub tech, to work on alternating cases.
• While team No. 1 is in the OR, team No. 2's scrub tech sets up the instruments, gowns and gloves in a sterile prep area or treatment room.
• Upon completion of the case, RN No. 1 takes the patient to recovery while scrub tech No. 1 takes instruments to be cleaned and sterilized.
• As RN No. 2 wheels the next patient into the OR, scrub tech No. 2 enters the OR from the sterile area.

The key to making this work is having the scrub tech set up the case in a sterile area other than the OR. Our techs scrub, gown and set up in a sterile minor room. When the OR is vacated, the tech moves her Mayo stand from the minor room, through the front (non-work area) of the prep room and into the OR. She doesn't come in contact with anyone until she's in the OR. Using this system, we performed nearly 4,000 cases in one room last year.

John Wood, MD
Medical Director
Roanoke Valley Center for Sight
Salem, Va.
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Scheduling for faster turnover
Schedule cases so several of the same procedure, or several procedures needing the same equipment, follow each other in the same room. For example, schedule the same-side knee arthroscopies and the same-side hand cases in a row. This facilitates quick turnover times by limiting equipment movement.

Debbie Comerford, RN, BSN, CNOR
Director of Nursing
Orthopaedic Surgery Center of Northwest Jersey
Denville, N.J.
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Make suture packs on low-census days
To make the most of down time in our schedule, our staff create frequently used suture pack groups according to physicians' preferences for specific procedures. We store these in a file next to the procedure cards so we can quickly add them to the procedure packs if some suture is dropped or we have add-on cases.

Debbie Coffman, RN, CNOR
Director of Surgical Services
Covenant Hospital Plainview
Plainview, Texas
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Negotiate discount lunches
We order out for lunch on Wednesdays, our busiest day of the week. We'll have three ORs and a pain management room going all day long and nearly 30 people to feed. Because we order a lot of food, I've negotiated a 10-percent to 20-percent discount with some of the local restaurants to keep me under my $2,000 monthly food budget.

Terry Elquist, RN
Administrator
Rocky Mountain Surgery Center
Pocatello, Idaho
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A pre-op antibiotic routine
To comply with the recommendation that pre-op antibiotics be given 30 minutes before surgical incision, we now use our pre-op holding room for the administration. With our pharmacy department's help, we converted as many drugs as possible to IV-push administration. We bring patients with a physician order for pre-op antibiotics - usually those undergoing total joints and orthopedics and abdominal procedures - to the holding area 30 minutes before the procedure and administer the drugs there. This hasn't created extra staff time or costs - the RN simply draws up the antibiotic and administers it via IV push in the holding room.

Laurie Wensink, RN, BSN
Director of Patient Services
Columbia-St. Mary's Ozaukee
Mequon, Wis.
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A single prophylactic dose
For most procedures lasting two hours or less, a single prophylactic dose of antibiotics should suffice. Longer procedures may require an additional dose, particularly if the surgery lasts four hours or longer. There is no published evidence supporting excessively long courses of post-op prophylaxis. Some physicians routinely keep their patients on antibiotic regimens after surgery, sometimes until removing drains. Such regimens may even contribute to bacterial resistance and increased post-op infection rates.

Eric Chernin, RPh
Clinical Pharmacist
Sarasota Memorial Hospital
Sarasota, Fla.
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Double-check patient ID
To comply with the JCAHO directive to use two forms of unique patient identifiers, our endoscopy staff applies brightly colored labels to our nursing flow sheet. The labels read:

• STOP:
• Pt. ID verified X2
• Patient name, age, birth date
• by (RN/LVN).

I've made a similar label for our consent form to alert the surgical team to take the requisite time-out before starting a procedure. The first time I designed labels for the same purpose, they were white with black type, and nurses filled them out only about 60 percent of the time; now that I've added color and icons, our compliance rate is more than 90 percent. There's no extra paperwork and I didn't have to conduct an inservice.

Kathy Toolan RN, CGRN
Endoscopy/GI Lab
Tomball Regional Hospital
Tomball, Texas
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