Ask: ‘Why are we doing it this way?’
Ask: Why are we doing it this way?’
Cut turnover time by questioning your processes
As same-day surgery managers look for ways to improve efficiency and decrease the cost of performing different procedures, the solutions are often a matter at looking at what you do and asking why it has to be done that way.
"We used to make the anesthesiologist keep the patient in the hallway until the scrub nurse had the room completely ready," says Lynne McGrath, RN, BSN, patient care manager of the operating room and post-anesthesia care unit at Bryn Mawr (PA) Hospital. "Now we look at the activities as parallel processes that can be done at the same time without compromising patient care." The result? An average reduction in turnover time of 10 to 15 minutes, she says.
Scrub nurses kept the anesthesiologist and the patient outside the operating room because they thought that too many activities going on at one time would prevent them from getting the room ready for the surgeon, explains McGrath. The reality is that when the anesthesiologist was told the patient couldn’t enter the room, he or she would go off to do something else, and there could be a delay when the room was ready while the staff found the anesthesiologist, she explains.
Now, the scrub nurse is gowned and gloved, and he or she continues setting up while the anesthesiologist brings the patient into the OR, she says. Setup itself has been simplified as a result of a project that streamlined kits for different procedures, McGrath says. "We reviewed the amount of time and number of instruments used in different procedures, then looked at our kits to see if we were setting up instruments that were unlikely to be needed," says McGrath. "If we never used a particular retractor or if we used it less than 70% of the time, we took it out of the kit," she says.
If the procedure was to be performed by a surgeon that uses an instrument not included in the kit, the nurse simply picks up the extra instrument, she adds. The need for an extra instrument occurs infrequently enough that the streamlined kits make setting up easier and faster, she says.
Sometimes reduction of turnover time starts the afternoon before surgery, says Jon Carter, OR business manager at Danville (VA) Regional Medical Center. "We used to focus only on the day of surgery, but we now have one person who is responsible for looking at the next day’s posted cases to make sure we have the instruments and equipment we need," he says. "For example, if there are six laparoscopic cholecystectomies scheduled, we know that we’ll need extra hand pieces. If there are not enough instruments available, we have time before surgery to get an old scalpel looked at and prepared by biomedical engineering."
That situation on the day of surgery means delayed procedures that tie up staff, physicians, and patients needlessly, he adds. You also should evaluate the type of cases you do frequently and make sure you have enough instruments to handle the volume, Carter says. "We do [more than] 250 tonsillectomies each year, so we purchased six sets of instruments for the procedure. This means we can do a number of cases without having to flash the instruments between cases," he says.
Reducing turnover time is important at Danville Medical Center’s same-day surgery program because staff have seen a 16% increase in volume over the past three years, says Carter. Using quality assurance teams that include a variety of staff members to look at turnover times has proven beneficial, he says. "The nonclinical people add just as much to our improvement as clinical people," he adds. "We had one housekeeping employee ask why every operating room was wet vacuumed after every procedure. Now, we use a mop and change the mop head between cases," he says.
Cross-training employees helps with turnover time, says McGrath. Her operating room assistants that serve as orderlies are also trained to scrub and hold retractors. Another classification of operating room assistants serve as anesthesia techs who can scrub, hold retractors, and help the anesthesiologist clean the room, she explains. "This helps with turnover time because you have more people who are in the operating room to help prepare and clean," she adds.
Another key to reduction of turnover time is to continually talk about it, says Carter. "We post turnover times, talk about them in our staff meetings, and have pizza parties to celebrate reductions," he says. Everyone in his same-day surgery program is committed to reducing turnover times, he says, and they remind each other of progress they make or suggest new ideas that will help. "It’s the same as reminding your children to brush their teeth," Carter says. "You tell them to do it every day because it is important to their health. Turnover times are important to our financial health in same-day surgery."
Sources
For more information about reducing turnover times, contact:
• Lynne McGrath, RN, BSN, Patient Care Manager, Operating Room and PACU, Bryn Mawr Hospital, 130 Bryn Mawr Ave., Bryn Mawr, PA 19010. E-mail: [email protected].
• Jon Carter, OR Business Manager, Danville Regional Medical, 142 S. Main St., Danville, VA 24541. Telephone: (804) 799-2242. E-mail: [email protected].
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