Role redesign turns around a timely problem
Role redesign turns around a timely problem
Anesthesia core technician cuts turnaround
When cases turned over at Children's Hospital of Philadelphia, a patchwork of employees with different skills began their jobs -- environmental services, nurses' aides, technicians, and nurses. Dividing the turnaround functions seemed logical, but it was inefficient. Children's Hospital took too long to prepare rooms for the next case.
By consolidating the turnaround team with multiskilled workers who share the same job function, Children's Hospital has reduced turnaround time by eight minutes, from 23 to 15 minutes. The hospital hopes to decrease turnaround further to just five minutes as the new "anesthesia core technicians" complete their in-house training and become more adept at their jobs, says Rebecca Berman, RN, MSN, the hospital's director of perioperative nursing.
'We have absolutely no downtime'
Employees no longer wait around for someone else to finish cleaning the room before they get involved in setting up the next case, says Kimberly McEvoy, RN, CNOR, who trains and supervises the new technicians. "Every one [of the anesthesia core technicians] is responsible for turning rooms over," says McEvoy, who outlined the role redesign last month at the annual Congress of the Denver-based Association of Operating Room Nurses. "We have absolutely no downtime," she says.
The anesthesia core technicians do it all -- from acting as a troubleshooter and liaison with biomedical engineering if equipment malfunctions to picking linens for cases. They handle the anesthesia machines, transport patients, and clean rooms.
"We had a vision of a diversified, multiskilled person that would help us reduce our turnaround time and be more efficient than the fragmented system we had," says Berman.
New skills gradually added to job
Transforming the turnaround team actually took several years for Children's Hospital to accomplish. The role redesign began in 1992 with the addition of a "core technician," who was trained to pick linens and instruments for each case.
"It used to take four nurses on a 10-6 shift to pick the cases for the next day [during their downtime]," says McEvoy. "We took the task those nurses were doing in the middle of the day and gave it to the one core technician."
Then, an anesthesia component was added to the core technician's job, as that person was now responsible for breaking down the anesthesia equipment after each case.
At about the same time, Children's Hospital began participating in a benchmarking process with 13 pediatric hospitals, which was conducted by Medical Management Planning, a health care consulting group based in Calabasas, CA. When the hospitals compared turnaround time, Children's Hospital was in the bottom half.
No more waiting around
Much of the turnaround problem was caused by role fragmentation -- which meant some employees waited around until someone else emptied the trash or dismantled equipment before starting their task, says Berman.
"At the same time I was thinking about this vision, anesthesia had recently lost some technicians," Berman says. "Their staffing patterns were a little tight, and they needed some help."
The anesthesia core technician position was phased in gradually, as the jobs of environmental services, senior nurse aides, core technician, and anesthesia technician were combined. Current employees were kept apprised of the plans and given opportunities to transfer to other parts of the hospital if they were not interested in applying for the new position, says McEvoy.
Applicants for anesthesia core technician were required to have at least one year of OR experience or related experience in a medical field. Anesthesia technician experience was preferred. For example, the current employees include six anesthesia technicians, a dental school dropout, a biomedical engineer, and a pharmacy technician.
The redesigned role attracted highly qualified applicants who immediately became effective members of the OR team, Berman says. "It offered a very competitive salary for a technical person," she says.
Training and orientation last a year
Creating the position of anesthesia core technician required Children's Hospital to invest in intensive training and education, say McEvoy and Berman. Because of the need to train employees in different aspects of the job, the position must be slowly phased in, Berman says.
"The problem is how do you run your OR and teach new skills at the same time," she says. She chose to add new tasks to the position over a three-year period. "We gradually added more responsibility and skill to the job."
Orientation began in March 1995 with a two-week intensive training program at the hospital. For example, a hospital-based respiratory therapy instructor gave instruction on anatomy, physiology, and oxygen therapy. Each week, the technicians participate in two inservice programs.
"The orientation itself takes about a year before they're fully competent in all the areas," says Berman. "Some employees have stronger skills in some areas than others. The education is tailored to them individually based upon their needs."
The anesthesia core technicians also are studying for the spring certification exam of the American Society of Anesthesia Technologists and Technicians in Kirkland, WA.
Although the new position hasn't reduced turnaround time as much as Berman would like, it has improved overall efficiency, she says. "Families and patients don't have to wait as long," Berman says. "We get the schedule done on time." *
For more information on the anesthesia core technician position, contact:
* Rebecca Berman, Director of Perioperative Nursing, Children's Hospital of Philadelphia, 34th and Civic Center Blvd., Philadelphia, PA 19104. Telephone: (215) 590-3261. Fax: (215) 590-4443.
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