The 4-minute mile was thought to be an impossible feat. Hopelessly out of reach, said the experts. But in 1954, a University of Oxford medical student named Roger Bannister ran the first-ever 4-minute mile and proved the experts wrong. Just as milers have been striving against the clock for years, surgical facility leaders have been struggling to bust through the barriers preventing them from achieving faster room turnovers.

But a 3-minute turnover? Just like a 4-minute mile, humanly impossible, right? Don’t tell that to Lilah De Vito, RN, BA, CVOR, CNOR, who saw firsthand what 3-minute turnovers looked like when she worked at a large academic facility.

“Even on big cases,” says Ms. De Vito, today an OR nurse at Dignity Health Dominican Hospital in Santa Cruz, Calif. “It was fun, seriously. We treated it like a pit stop in a car race.”

It became a race against the clock, a competition. A man from environmental services they called Coach stood at the OR door with a stopwatch. But he didn’t measure wheels out to wheels in. He started his stopwatch the second the turnover team descended on the room and stopped it when the room was restocked and ready for the next patient — whenever that might be.

Put an asterisk next to 3-minute turnovers if you will, but a turnover team can only control how fast it runs its leg of the relay race. Among other things, opening after cleaning will depend on your cleaning products (aqueous-based remove blood faster than alcohol-based agents), your disinfectant dwell time (look for a 1-minute kill time) and factors out of a turnover team’s control.

“The reality is each OR is encased in a facility ecosystem that may or may not support the gained efficiencies of a fast turnover,” says Ms. De Vito. “The entire system needs to be primed to load a new patient into the room: sterile processing, robust picklists, case carts, trained break staff, equipment availability, site marking, check-in and pre-op holding.”

Assigned zones

You want 3-minute turnovers? “Then there needs to be hands with cleaning rags,” says Ms. De Vito. At a minimum, you’ll want a 4-person turnover team consisting of environmental services, anesthesia techs and aides. Don’t ask the OR staff to pitch in. Let the tech take his dirty cart out and prepare for the next case. Let the RN take her patient to PACU, give a report and check-in the next patient.

Assign each member of the turnover team a defined zone for the day to clean so they know what they’re going to lay hands on before they enter the room. Divide the room into 4 zones: anesthesia, lights/bed, furniture and floor. If there aren’t enough team members to serve each zone in 3 minutes, then you’re not going to see success, warns Ms. De Vito. If a particular zone takes longer than 3 minutes to clean, consider splitting it into 2 zones, she says.

“Each zone is a person. Add a zone, add a person,” says Ms. De Vito. “Trained hands on defined zones hone speed.”

Train all staff about zone cleaning so anyone who enters a room to join in the fray will know the routine. Reassign zones if a staff member isn’t able to do it well. For example, don’t assign a short person to tall equipment. As a general rule, everyone moves from the highest point of cleaning in the room to the lowest point. And whatever you do, don’t cross zones. Otherwise, you risk repeated motions and cleaning the same surface twice. Four words you never want to hear: “Did you wipe this?”

When not doing turnovers, the same staff can work the central core, restock, or prepare specialty beds and equipment according to the schedule. “People shouldn’t sit around,” says Ms. De Vito.

Patient team out, turnover team in

By itself, a 3-minute turnover is relatively easy to do. It’s the rest of the system that will slow the OR schedule, says Ms. De Vito, like a central sterile tech being late with the case cart or a nurse being delayed with the patient in PACU. And, of course, you won’t have enough bodies to cover multiple rooms that come out at the same time. (“If a room comes out at the same time, it’s really not a biggie. It’s 3 minutes,” says Ms. De Vito.)

Perhaps the worst sin a turnover team can commit is jumping the gun: starting to clean while the patient is still in the room.

“It would be like your waitress cleaning and setting your table for the next customer while you are still sitting at the table,” says Billie Kucharo, BSN, the surgery scheduler at the VA Hospital in Des Moines, Iowa.

It’s ok, however, for the turnover team to gather at the starting gate before the patient exits the room. As the case is ending, the circulator should make an overhead announcement so the team is at the door, armed with rags and mops and ready to charge.

Put me in, coach

The Coach with the stopwatch played a key role. He was a senior environmental services staffer. “The team accepted his authority,” says Ms. De Vito. “He wasn’t a clipboard person who never got his hands dirty.”

When the coach saw that the team had missed a spot, he’d fetch fresh cleaning fluid, wipes and cloths. He listened for new rooms coming out, interfaced with management, and gave out high fives and attaboys. He even jumped in as needed for a particularly messy room, says Ms. De Vito.

It also helped that the turnover techs were adrenaline junkies who view the 3-minute challenge as a dare. “Working fast is exciting,” says Ms. De Vito. “Staff left the room feeling successful.” OSM