Tips for shrinking turnaround time

By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas

(Editor’s note: This is the second part of a three-part series on running an in-house ambulatory surgery program like a highly efficient freestanding facility. Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: surgery@onramp.net. World Wide Web: http://www.earnhart.com.)

Benchmarking as many of your operations as you can is critical to the success of your endeavors. You cannot change what you don’t know about. As I said in last month’s issue, efficient use of physicians’ time is a sign of respect for the job they do.

What is the definition of room turnaround time? So many are confused on this issue. All definitions are logically arbitrary, but my definition is the space of time between when one patient leaves the operating room until the time the next patient is on the table.

Assume that your turnaround time (that you have actually audited and know is accurate) is 40 minutes. This is probably the average for most hospitals. Sit down with the staff and tell them your goal. Find out what the challenges and impediments to reducing that time are. Make a list, and get input for all areas. Set an obtainable goal for the next day, week, month, etc. Adjust your team and procedures to allow you the opportunity to change your current method. Involve as many departments as necessary. Tell your surgeons that you are going to make every effort to become more efficient between their cases and to please help with suggestions.

Post your goal. If your current time is 40 minutes, try to reduce it to 30. Don’t attempt more than you can accomplish the first day. You probably will be unsuccessful, and everyone will become discouraged. Plus, you will lose the confidence of your medical staff.

After you reach that first important milestone, reduce it again to 25 minutes, then 20, which is a good benchmark. Keep going until you feel that you have reached your maximum attainable level. Keep flowcharts of your progress. Publish your results in a one-page newsletter to your physicians. Have a bar graph showing the time between cases before and after.

Clearly, your role in the operating room is not to set land speed records. You are there to provide a safe, quality environment for the patients. Increased efficiently should never replace that credo; however, we all know that we can do just about anything better and not jeopardize quality.

Target your start time

Surgical case starts is a no-brainer. Start time is when the patient is on the table, the staff are in the room, anesthesia is at the head of the table, and the surgeon is in the room.

We do many physicians’ interviews on this topic. Here are average start times for hospitals across the country:

• 7 a.m. posted time — 7:45 a.m. actual;

• 9 a.m. posted — 9:50 a.m. actual;

• noon posted — 1 p.m. actual;

• 3 p.m. posted — 4:15 p.m. actual.

Delays increase as the day goes on. There are many factors: emergency cases, cases that go longer than anticipated, tired staff, and staff disincentives. We can’t do too much about the first two, but you can address the staff issues.

One thing I hated about the OR was finishing our room early. It was always right around the time to go home, and they would add another case in our room because we broke first (or on time). It didn’t take long for all of us, anesthesia included, to realize that the longer it took to get the patient off the table and out of the room, the less likely we would get another case. Certainly that doesn’t happen at your hospital! But it might happen at some.

Another reason for cases starting late could be that people are just plain tired. If your staff aren’t rotated enough or have enough breaks, they are going to drag toward the end of the shift.

We all know how it happens. The circulators aren’t going to put the patients in the rooms because they know that anesthesia isn’t going to show up until the surgeon shows up. The surgeon isn’t going to get there on time because anesthesia won’t have the patient in the room anyway. The floor staff aren’t going to send the patients down to the OR because the circulators aren’t going to accept them until they can take them into the rooms. If you can break just one of those chains, you can begin to resolve the issue. Start with the easiest to control: your own staff.

Two ways to change behavior are to provide incentives or disincentives. Most staff prefer receiving a reward as opposed to the current punishment of starting another case as payment for efficiency.

How can you reward a person who doesn’t cost you your budget? First, establish the goal as you did for the turnaround time. Consider reducing the start time by percentages — just as the airlines do for on-time departures, etc. We are a much larger industry than the airlines. If they can do it, so can we.

Next month’s topic: incentiving your staff to make it happen.