Welcome to the new Outpatient Surgery website! Check out our login FAQs.
Flip This Room: The Value of Turnover Kits
Provide your staff with the supplies they need to clean and set up rooms.
Daniel Cook
Publish Date: July 9, 2015   |  Tags:   Financial Management
turning over rooms ON THE MOVE Seconds count when turning over rooms in high-volume facilities.

When your very survival depends on your ability to do more cases, you run 2 ORs simultaneously and you turn rooms over faster than before. And if you're the Surgical Eye Center of Morgantown (W.Va.), you give your turnover times and teams a boost by investing in turnover kits, so that items such as disinfectant wipes and custom procedure packs are there when they need them.

The eye-only center invested $15,000 to $20,000 in turnover kits as well as stretcher beds to hasten patient transport. The returns they've realized in added case revenue have more than made up for what they spent, says Heather Hoffman, RN, CNOR, the administrative director of the Surgical Eye Center of Morgantown, noting that her facility's case volume increased by nearly 20% between 2010 and 2014. "We had to do to it to stay alive," says Ms. Hoffman, referencing the stagnant reimbursements of eye cases — the facility's lone source of revenue. "The physicians simply had to do more cases."

How quickly do you flip rooms at your facility? Like Ms. Hoffman, are you providing staff with the tools they need to move patients, wipe surfaces and pull supplies as quickly as possible? Investing in solutions that improve between-case efficiencies might not take the place of coordinated hard work, but it can help an already fast team work even faster.

Keeping pace
"On days that we use 2 ORs, our turnover time is essentially zero," says Ms. Hoffman, whose busiest surgeon is also the fastest. "The surgeon finishes in one OR, goes to recovery to see the previous patient and returns to the second OR, where another patient is already sedated, prepped and draped, ready for the next procedure to start."

Take the stretcher beds, for example. Patients are placed on the beds in pre-op, wheeled into the OR for their procedure and wheeled to PACU for recovery. There's no transferring of patients from surface to surface between phases of the perioperative process. The facility has 4 stretcher beds now, but will soon purchase 2 more as they prepare to bring another OR online.

Ms. Hoffman's staff used to spray and wipe OR surfaces during room cleaning, which added 10 minutes to the process, most of it spent waiting for the spray to dry. Removing one of those steps, thanks to the addition of disinfectant wipes, has resulted in more effective, faster cleaning, says Ms. Hoffman.

Dennis Lott, BSN, RN, CNOR, manager of Benefits Ambulatory Surgery Center in Great Falls, Mont., is opposed to spraying and wiping because of the aerosolized fumes you invariably inhale. At a previous job, he used a spray with a 10-minute kill time. It was an effective product, but the dry time didn't allow for quick room turnovers. When he arrived at Benefits Ambulatory Surgery Center, he made the switch to a wipe with a 3-minute kill time. He says the time saved and benefit to staff safety have "been well worth the additional pennies it costs to stock them."

Cherokee (Iowa) Regional Medical Center added disinfectant wipes earlier this year, says OR Manager Dondee Halverson, RN. She says surface cleaning is more effective and goes a lot faster — they've saved about 10 minutes per room turnover since they began using them.

Outpatient Surgery Magazine Reader Survey

Benchmark Your Turnover Times

We asked readers about what they use and how much they spent to improve OR turnover times. Here's a sampling of what we found out.

  • 30% say their average room turnover time is less than 10 minutes.
  • More than 70% have invested in disinfectant wipes or custom procedure packs to help speed room turnovers.
  • 46% use fluid waste management solutions.
  • 27% use turnover kits.
  • 34% say they've invested less than $5,000 in turnover aids.
  • 33% say they've invested more than $20,000 in turnover aids.

Source: Outpatient Surgery Magazine online reader survey, June 2015, n=104.

Grab and go
"We used to use bins almost as big as a shoebox, and fill them with supplies needed for a case," says Ms. Hoffman. That's not an efficient way to work. The procedure packs she invested in shave minutes off room turnovers, says Ms. Hoffman, who's revamping her cataract packs to eliminate the opening of individual items (except for gowns and gloves). The packs run about $30, which Ms. Hoffman says is a more cost-effective option than buying supplies individually. She's preparing to add another 8 to 10 items to the mix, which will increase the per-pack cost by less than $2.

Ms. Halverson's staff of 4 nurses (including herself) and 1 tech amazes surgeons with the speediness of their room turnovers. They handle pre-op, post-op and every aspect of patient care, and still find time to keep rooms humming with endoscopic, laparoscopic and orthopedic procedures. Custom procedure packs help them ready rooms as quickly as possible. "The packs take 5 minutes to open and set up, compared with the 15 to 20 minutes it would take us to pull and open the supplies individually," she says.

Mr. Lott's staff also benefits from customized procedure packs. The correct supplies are already in each pack, which reduces mid-procedure runs for missing items or the returning of redundant supplies to storage at the end of cases. "After a busy day of surgery, you don't have to waste another hour restocking, which is really nice," says Mr. Lott.

Turnover kits are also a big part of Ms. Halverson's fast-paced success. The kits contain clear trash bags, red bags for regulated waste, armboard covers for the OR table and pillowcases — all ready for staff to pick up and use.

Mr. Lott opted for turnover kits to help solve storage issues associated with the use of reusable linens. His kits contain an impervious sheet that covers the OR table; 2 armboard covers with arm straps; a soft, non skin-shearing lift sheet for the table; an anesthesia breathing circuit; a mop head; and a clear trash bag.

He pauses when thinking about the environmental ramifications of sending throwaway cleaning supplies to the landfill, but believes water consumption related to the laundering of reusable textiles levels the going-green equation to some degree. Mr. Lott can't quantify the saving associated with using turnover kits, but he says they contribute significantly to his staff's ability to clear a room and ready it for the next case in about 5 minutes.

turnover kits PACK MENTALITY Turnover kits provide staff with all the supplies they need to clean and set up rooms.

No slips or trips
Cherokee Regional just remodeled its ORs, expanding the size of the suites and adding boom systems. It was a major rehab that helps staff turn over cases faster than ever before. The booms mean staff "don't have to push equipment in and out of the rooms and cords no longer stretch across the floor, which makes moving around easier and safer as we're cleaning and setting up cases," says Ms. Halverson.

The latest fluid control devices can also help you shave a few minutes off of turnovers, especially after particularly messy cases. Mr. Lott invested in 3 closed-system disposal units, and he's a big fan. "I would quit and join the Peace Corps if it was taken away from me," he jokes.

Fluid waste is contained as soon as it leaves the surgical site and collected in the closed system. It's a self-contained 20 L system with an additional reservoir on top of the unit, so Mr. Lott's staff suck up fluid during approximately 15 arthroscopies without emptying it. When it does need emptying, staff members touch only the system's handle as it's guided to a direct-to-drain docking station, which sanitizes the waste and flushes it into the city's sewer system.

Using the system means floors remain bone-dry during fluid-heavy procedures, including the numerous orthopedic cases Mr. Lott's facility hosts. He's happy that nurses aren't at risk of back injuries from hauling heavy suction canisters away for disposal and staff's exposure to blood and bodily fluids is essentially eliminated.

Add-on revenue
Speedy room turnovers are obviously essential to increasing case volume, but it also impresses the docs who bring revenue-generating cases to your center, says Ms. Halverson. "The more cases they can perform in a day, the better they feel and the more procedures you'll host," she says. "It's a clear win-win."