NEED FOR SPEED No matter how fast your turnover times, part of you always wants to do a little better.

Are you satisfied with your turnover times? If you’re like most (82.2%) of the surgical facility leaders we surveyed last month, yes, you’re pretty pleased with how quickly your turnover team readies the room for the next case. We use the term team loosely, however, because only about 1 in 5 of our respondents actually has a dedicated turnover team. In most cases, the OR staff working the case does the cleaning, with an assist from floaters roaming the hallways or hanging (hiding?) out in the lounge. “It’s everyone’s job, from anesthesia to RNs to techs to nurse’s aides,” says Kathleen Tafoya, RN, the clinical nurse manager of the Saginaw (Mich.) Valley Endoscopy Center.

Today’s ORs aren’t sitting idle for very long between cases. Of the 84 facilities we surveyed, 25 reported sub-10-minute turnover times, 21 reported 10- to 15-minute turnovers and another 14 said they were ready for the next patient in 15 to 20 minutes. Not bad. But you’re not alone if you wouldn’t mind seeing your ORs turned over a minute or 2 faster. (Note: We define turnover as the time from patient-out to patient-in.)

“There is always room for improvement,” says Danielle DeWolfe, BSN, the clinical manager of the Surgery Center of Chevy Chase (Md.). “Yes, they could always be better,” adds Beth Herring, RN, MSN, CNOR, the OR educator at River Oaks Hospital in Jackson, Miss., who says managers shouldn’t be afraid to pitch in by mopping a room, making a bed or removing dirty bags. “Work waits for no one. Everyone’s hand fits a mop.”

Maureen Simpson, CNOR, the nurse manager of the OR and PACU at the Rye (N.Y.) Ambulatory Surgery Center, agrees that you should all lend a hand. “On busy patient days I try to put the administrative part of my job aside and stay in the OR to facilitate the turnovers,” she says.

Most of our survey respondents are either “very satisfied” (40.5%) or “somewhat satisfied” (41.7%) with their turnover times. For 17.8% of respondents, room turnover is a problem, sometimes taking so long that the surgeon is delayed (and dismayed).

The pit crew of surgery
The turnover team is the pit crew of surgery, the hustling housekeepers who rush in after the patient’s been sutured shut and wheeled out to ready the room for the next case. Armed with mops, spray bottles, trash bags and fresh linens, they’re in and out in a matter of minutes, but it’s never fast enough, is it? “There are smaller cases where the turnover could be faster, but we get hung up on the sign-off process in the computer,” says a survey respondent.

“We would like to consistently be at 12 minutes. We’re currently at 14 minutes,” says Kathy Van’t Hof, RN, CIC, CNOR, the clinical supervisor of ambulatory surgery at McLaren Northern Michigan-Cheboygan Campus. Those extra 120 seconds would be precious found time you could convert into more cases. Like Ms. Van’t Hof, you know that the faster you can turn a room over, the more OR time is available, which translates into greater surgeon — and patient — satisfaction and more revenue.

“Our team is engaged in the goal of providing the best service for our surgeons, whom we affectionately refer to as our No. 1 customer,” says Nancy Tonetta, BSN, OR charge nurse at the Advanced Surgical Institute in Sewell, N.J. “Engaged employees take ownership of their jobs and this leads to increased performance.”

Dedicated turnover team?
If you have a dedicated turnover team, you’re one of the fortunate few. Only about 1 in 5 (22.7%) of our respondents have a dedicated turnover team. Most centers employ assistants or extra scrub techs to assist the OR team with turnover, an all-hands-on-deck, many-hands-make-light-work approach. The Camp Lowell Surgery Center in Tucson, Ariz., for example, has 2 OR assistants, each covering a hallway to assist the techs and nurses with turnover. “They pull the next day’s cases, assist with breaks and run for things as needed, including turnover of rooms,” says Administrator Barbara Marco, BSN, MS.

“The entire OR staff helps with turnover. Nobody sits around, ever,” says Kimberly Malchow, the office manager at the Grossmont Outpatient Surgical Center in La Mesa, Calif.

A drawback to not having a dedicated team: You don’t always know who’ll show up. “We call room turnover as a page and anyone available shows up. Usually 3 to 5 people will show up,” says Joy Prendergast, RN, the surgery supervisor at Salina (Kans.) Surgical Hospital.

Not enough bodies can inflate turnover times. “We would like our turnover times to be under 15 minutes, but we do not have turnover teams,” says Kristi Plank, BSN, the perioperative educator at Cartersville (Ga.) Medical Center. “We have 1 environmental employee who is responsible for keeping the whole department clean — pre-op, PACU, the lounge.”

Your anesthetist could also hamper turnover times. If the patient takes a while to wake up after surgery, you have to hurry up and wait before you can turn the room over. “We aren’t supposed to wipe down the room until the patient is out of the room,” says a nurse manager.

ALL HANDS ON DECK “The entire OR staff helps with turnover. Nobody sits around, ever,” says one of our survey respondents.

Many moving parts
Cleaning the room and emptying the trash are only parts of a successful turnover equation. There’s much more to it.

• Alert the members of your turnover team that a room is ready to be cleaned. For starters, the turnover team must respond quickly to the room that needs cleaning. Whether it’s an overhead page, putting the call light on when you’re ready to take the patient out of the room, ringing a bell, a surgeon rising from the table (if the staff in the room are the ones who clean the room between procedures) or, in the case of small facilities like the Rye ASC, “opening the OR door and calling out for help,” you must somehow signal the turnover team to jump into action. The Scripps Mercy Surgery Pavillion in San Diego, Calif., has 4 ORs arranged in a horseshoe. “Our 1 housekeeper is very vigilant and is always present during turnovers,” says Director of Nursing Donna Cooley, BSN.

At the Jack C. Montgomery VA Medical Center in Muskogee, Okla., they’ve programmed a string of beepers to page all members of the turnover team at once. The circulator enters “222” for room 2, “333” for room 3 and so on. “This notifies our housekeeping staff, OR charge nurse and PACU staff that the patient is coming off the table,” says Patricia Huber, MA, RN, the nurse manager of perioperative services. The turnover team, plus any roamers, converges on the OR that is coming out to assist with turnover. “Our PACU staff also appreciates the heads-up that a patient is coming,“ says Ms. Huber, adding that they’ve lowered the average turnover times from 42 minutes to 28 minutes since they began using this beeper idea.

• The job’s not done once the room is cleaned. The turnover team must serve as orderlies and furniture movers, transporting patients to surgery, helping position patients, and moving needed equipment and instruments into the room. And you must motivate them to do their jobs with great care and speed. Remember, though, that it can be tough to sell your staff on the merits of faster room turnovers. For them, the reward for a job well done is simply more work. It might help to remind them that low turnover times are also one of the key indicators of operating room efficiency. “Surgeons who come from other facilities say we have the best turnovers,” says Sara Schaefer, CST, at Fairview Lakes Medical Center in Wyoming, Minn.

At the 3-OR Kettering (Ohio) Memorial Hospital, 1 or 2 “float” staff are responsible to help turn over rooms. They have many other responsibilities as well, such as pulling supplies, gathering equipment and instruments, covering for breaks and lunches, and helping to position patients. However, room turnover takes precedence over all those other duties. “We have prioritized that when a room is turning over, that is where at least 1 float goes,” says Nurse Manager Barb Dunkin, RN.

SPEED BUMPS
10 Roadblocks to Speedy Room Turnover

What can get in the way of speedy room turnovers? Plenty, according to our panel of surgical facility leaders.

• Breaks. “During the turnover is when we provide the scrub staff a break. Sometimes it is hard to allow that break if the RNs are busy.”
• Slow-moving staff. “Slow response from orderlies, or they’re tied up in another room and not available. Some staff members don’t see it as their job to assist.”
• No dedicated turnover team. “We don’t have a housekeeping team, so the nurses and techs are responsible for cleaning the rooms, gathering equipment and supplies, and opening up for their next case. It is a lot to do in a short amount of time, but as long as there is teamwork, we can get it done.”
• Dry time. “Kill-time for the cleaning solution on surfaces and floors before opening for the next case.”
• Multiple rooms at the same time. “Not having enough staff, but also the variable of how often the rooms turn at the same time.”
• Change. “Going from a carpal tunnel to a shoulder scope, or converting a shoulder table to a knee table.”
• Site marking. “The physician not seeing the next patient to mark the surgical site before he talks to the current patient’s family.”
• Anesthesia. “The patient is too sleepy and needs to stay in the room longer until he’s stable.” Adds another: “We aren’t supposed to wipe down the room until the patient is out of the room.”
• Wet floors. “Our greatest challenges are the arthroscopy cases with irrigation fluid on the floor.”
• EMRs. “Computer documentation limits the circulator’s availability for turnovers.”

— Dan O’Connor

Shaving seconds
Besides teamwork and having enough hands and help, here are 4 strategies our panelists say work well for them:

• Plan ahead. Make sure you have everything for your next case. At the Advanced Surgical Institute, they spend time the day before arranging the schedule to keep heavy equipment on the same side as much as possible, says Ms. Tonetta. “We’ll do all right knee scopes, then all left knee scopes,” she says.
• Custom or procedure packs (supplies in pre-configured packs) can reduce the amount of time spent unwrapping supplies.
• Tell physicians to mark the next patient before talking to the family of the just-finished case. “This way, you can transport the patient to the OR, position and anesthetize him. The physician can come in to verify the position and then can go scrub while the nurse is prepping the surgical site,” says Melissa Becker, RN, BSN, CNOR, the OR clinical coordinator at the Buffalo Surgery Center in Amherst, N.Y.
• Excuse the circulator from turnover duties, says Traci Oswald, BSN, the OR supervisor at Piedmont Atlanta (Ga.) Hospital. You’ll cause delays in your schedule if the circulator is helping in the room instead of interviewing the patient and assisting in bringing the [next] patient back, she says.