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Turning an OR into a Gold Room
Something special happened when this hospital designated a single operating room to be a model of production and efficiency.
Scott Gonzales
Publish Date: October 10, 2007

Here at Beverly Hospital, we've designated one of our operating rooms the Gold Room, an exclusive suite where surgeons enjoy our fastest turnover times, best technical support, finest staff, and superior anesthesia and administrative services. The Gold Room represents the best our hospital has to offer in terms of surgical services. Our goal is to make our surgeons want to bring their cases to our hospital over other facilities in the area and for each of our ORs to emulate the Gold Room.

In exchange for this level of service, our staff expects the surgeons to mark the surgical site, be punctual, and submit history and physical/orders/ consent three days before surgery. Most of all, we expect the surgeons to respect the staff - we won't tolerate abusive verbal behavior. We want to build a culture of cooperation and friendly atmosphere in all our ORs, which will in turn lead to retention of superior staff and surgeons.

You know how they say that a rising tide lifts all ships? We've found that when you upgrade the services in a single OR to offer your surgeons the best of everything your facility has to offer, your entire surgical department improves.

Working in parallel
It all starts with flow. A major facet of the Gold Room is the working-in-parallel model, a patient-flow pattern we feel is an improvement over conventional patterns. Traditionally, the OR nurses set up for a case before meeting the nurse anesthetist in the holding area to bring the patient into the OR. The OR nurse assists the anesthetist with the induction of anesthesia and then calls the surgeon in for the case. We call this process working in series.

In contrast, here's how our working-in-parallel model works. The surgical team decides how long it will take to set up our Gold Room, then discusses an appropriate time for the next case to start with the surgeon. The surgeon is then expected to be in the OR at that time. Our hospital hired an additional anesthesia technician so that the anesthesia staff could bring the patient into the room while the OR nurse and scrub tech set up the case. More importantly, our surgeons know that the entire OR staff is working diligently to create a productive and efficient OR.

Involve leadership from anesthesia, nursing, surgeons and facility administration. We used many people to educate the staff, including the president of the hospital, the nursing director and the anesthesia chief. The education needs to touch on two levels: the leadership of your facility - PACU nurses, nurse managers, surgeons, anesthesiologists - and the rest of your staff who handle patients on a day-to-day basis. Our primary educational effort consisted of a hospital-wide morning meeting where the leadership team presented the process to the staff.

The success of the Gold Room concept also hinges on using quality personnel - you need dedicated employees. In our case, staff concerns had more to do with making sure the appropriate number of people were available to make a parallel process possible.

Overcoming hurdles
Like any new practice, build in a trial process to work out the kinks and to develop the best process for your facility. We tested the Gold Room concept once a week for a month using the same surgeon, nurses and anesthetists until we had a team and process in place that we were happy with. We also measured improvements by analyzing turnover times as well as listening to feedback from the surgeon who participated in our pilot.

I wish I could tell you the exact moment we felt the Gold Room was ready for an official launch, but it was more of a feel thing. When the surgeon involved in the pilot came back to the leadership team with consistently positive feedback, we felt comfortable proceeding.

So far, we've had to overcome two big hurdles. The first involved getting buy-in from the staff. People get used to a certain process, and change is difficult - even change for the better. A continued effort at educating your staff is essential, but so is listening to the feedback they give about the changeover. Staff will adapt to most anything as long as no one feels left out of the process or feels his voice won't be heard.

The second hurdle involved the equipment we use in the Gold Room. For the concept to work, you must eliminate delays resulting from missing or malfunctioning equipment. To achieve this goal, we designated a senior nurse to make sure the equipment is primed, ready and always available before every case. The idea is to free up the surgical tech and OR nurse to concentrate solely on room turnover, while keeping in tune with the working-in-parallel model. In assigning a senior nurse to check on the condition of the equipment, we ensure that a malfunctioning scope won't delay the surgery, while also keeping as many hands free as possible for the critical room turnover.

Slow and steady
We currently have one of our ORs dedicated as a Gold Room. Our plan is to slowly upgrade our other rooms and staff to bring every OR up to the Gold Room standard. We'll concentrate on making one room work, then build on the process as the concept catches on. Our hospital's leaders have a wait-and-see approach with respect to when we'll transform other ORs, but our goal is to have four Gold Rooms in the next three months. And over time, we will have improved the entire culture of the surgical wing.