Making Stretcher Tables Work in Your Facility


Tips to maximize the impact stretcher tables have on OR performance.

By now you've probably heard a lot about how stretcher tables let your patients stay on the same surface from pre-op through the OR to recovery. Because you don't have to transfer patients to and from your OR tables, you can reduce your staff's exposure to occupational injuries (saving backs) as well as increase the number of procedures that you can perform in your surgery center or hospital (saving time). But as you'll see in this article, realizing improved throughput means more than just replacing your old OR tables with stretcher tables.

Stretching out the system
When patients arrive and leave the OR on the same operating surface, you cut the time interval between procedures by eliminating the need to gather staffers to transfer the patient and to apply leads and monitors as they were applied during pre-op. And you no longer need a staffer to clean and prepare the OR table for the next patient because the stretcher table is cleaned during its journey between the recovery and pre-op areas instead of in the OR. The end result: less non-operative time.

Based on published results and our experience, we estimate that a facility that switches to stretcher tables from traditional OR tables and stretchers can shave about 10 minutes from non-operative time for short cases performed under general anesthesia. If you administer regional anesthesia outside the OR for patients who hop on and off the table before and after cases, the savings won't be that significant.

To find out how much time you can save, compare how your processes will run both with and without stretcher tables. Here's how to do that:

  • Figure out how many tables you need. As a general rule, assign three stretcher tables to each OR. In the middle of a usual day, you'll have one patient in pre-op, another in the OR and a third in recovery. If your procedures take longer than the recovery time plus the pre-op time, you may be able to get away with two per room, provided you have an extra surface, such as a bed or a spare stretcher, in the recovery room. If your procedures are very brief, you'll need more than three tables per OR.
  • Pick someone to clean and prepare them. You must clean and prepare stretcher tables after they've left the recovery room and before they're returned to the pre-op area. Designate a person and a place to perform this task.
  • Designate storage space. At the start of each day, you should have one stretcher in pre-op, but none in the OR, so you'll need to figure out where to park the rest of the stretchers overnight. Also, assign someone to move the tables from the storage spot to the pre-op area as the day progresses.

Look for more opportunities to save time once you have these points under control. Consider having the tasks performed during non-operative times done in parallel, which may mean reallocating some responsibilities and abandoning some old processes. For example, if the circulating nurse usually gets the patient from the pre-op, think about having a member of the anesthesia team do this instead. Or if the circulator usually accompanies the anesthesiologist to the recovery area, have her stay in the OR to help set up for the next case.

Wheeling them in
So if you've found your facility can accommodate stretcher tables, it's time to go shopping through the wide range of options available. You'll have to decide which models have the features and capabilities your surgeons need and, ultimately, if you can justify the price. After that, it's time to think about how the staff will react when you incorporate the stretcher tables into your facility.

Many of your workers may be comfortable with the old systems, so you'll need to size up your staff's ability to handle change as you introduce new methods. Here are some ways you can make them appreciate the advantages stretchers offer as compared to the traditional tables:

  • Involve everyone — the physicians, nurses, administrative staff and ancillary staff — when making the purchase decision.
  • Have them help design a new end-to-end patient flow. This must include mapping how the old process ran, how the new one will run and a definition of individual rules for participants.
  • Perform end-to-end dry runs. Put a staffer on the table in pre-op to test for comfort and what it's like to move this "patient" on the table. Make sure that all the staffers are familiar with their (possibly) modified roles. Check how long it takes to clean and prepare the table for the next patient, and make sure your plans for storing the tables and accessories are feasible.
  • Appoint someone with clout to own the process and to take the lead in making any changes that may be necessary.
  • Decide how you'll measure performance. This includes putting more emphasis on non-operating time instead of turnover time as a whole (see sidebar).
  • Let everyone know how the system's working. That lets them know that their efforts have paid off and encourages them to continuously improve performance.

???Non-Operative Time' Is What You Want to Reduce

Turnover time, the interval between the departure of one patient from the OR and the arrival of the next, is traditionally used as a measure of productivity in ORs because many people think that little can be done about surgery's other intervals.

For example, there's not much anyone can do to reduce a surgeon's operative time because it reflects the complexity of the procedure, the patient's primary and co-morbid medical problems, and the surgeon's normal pace. It was also thought that you couldn't reduce OR anesthesia time (the interval from the patient's arrival in the OR to the time the patient is turned over to the surgeon) and OR emergence time (the interval from the conclusion of surgery to the patient's departure from the OR). But this reasoning doesn't take into account that these two intervals, under the control of the anesthesia team, include the time to move the patient onto and off the OR table.

Since stretcher tables eliminate these transfers, the interval that captures the full impact of stretcher tables on OR throughput is known as the non-operative time. As the graph above shows, you can also save turnover time by eliminating the cleaning of the OR table in the OR.

— Dan Krupka and Peter Logue

Sizing up the benefits
Now that your facility has stretcher tables and knows how to use them, you'll likely see benefits that could make everyone, from patients to the administrative board, happier.

While you may be counting the time stretcher tables save in minutes per procedure, you could reduce your non-operating time enough to add additional cases each day. But keep in mind that you'll realize no financial benefit unless your case volume grows enough to take advantage of the increased capacity.

Eliminating or greatly reducing patient transfers will surely please your staff. They'll appreciate not having aches and pains from picking up patients. They also stand to gain from cutting the non-operative time because even if the reduction isn't large enough to add an additional case, at least they can go home sooner.

Stretcher tables will also cut down on your laundry bill because you'll only have to worry about washing one set of sheets per patient. Under the traditional system, the patient gets a new set in the pre-op, another in the OR and a third in the recovery area.

Last but not least, patients will almost certainly be more satisfied. They won't have to deal with the jostling that comes from being lifted or the shock of being taken from a warm surface and put on a cold OR table. And while introducing stretcher tables may not eliminate the unpredictability of wait times, reducing the non-operative time will make those wait times less volatile.