Race Against Time
Turnover Tip: Divide the OR into 4 Zones
To help speed OR turnovers between cases, we divide the OR into 4 zones, which staff attack between cases. One staff member is assigned to each zone, ensuring that everyone knows which tasks he's responsible for completing.
- Zone 1. Assist with the patient's post-procedure transfer to the bed. Remove and dispose of the linen and the disposable patient safety bed straps from the OR table, and disinfect the OR lights and booms. Lock the OR table after they've made the bed and replaced the patient safety bed straps. We use packets known as the "bed rolls" (they contain the OR sheet, a half sheet, the patient safety bed straps, 3 trash bags and 2 green towels) to expedite the turnovers.
- Zone 2. Disinfect all exterior flat surfaces. Check exterior walls for bioburden and disinfect if needed.
- Zone 3. Remove all supply items not used during the case and place them in a bucket that's returned to sterile processing. Disinfect equipment not needed for the next case and remove it from the OR. Remove closed waste disposal system (if at capacity) and dock it for cleaning; otherwise, disinfect its surface with wipes. Environmental services staff assist Zone 3 by removing the trash and linen, and mopping the OR floor.
- Zone 4. Change out the anesthesia circuit and suction tubing, and collect the trash generated during the case. Disinfect the following with wipes: the anesthesia machine, the automated medication storage unit, the blood pressure cuff, the pulse oximeter and the EKG leads.
Before implementing this NASCAR-inspired approach, turning rooms over required 6 to 8 staff members. That led to confusion about which tasks were performed and which weren't. While some tasks were repeated, others were passed over entirely. Today, our turnovers require a maximum of 4 staff members and our average turnover time has decreased by about 7 minutes.