Teamwork keeps turnover time low
Even in a managed care environment, surgeons and patients often have some choice in deciding where an outpatient surgery will be scheduled. For this reason, it is important that you make your program as attractive as possible to both patients and surgeons.
Make your day-surgery program attractive to surgeons by ensuring their time will be spent making money, not wasting time, says Jeffrey Love, RN, staff nurse at Saddleback Memorial Medical Center in Laguna Hills, CA.
"A surgeon is making money when he or she is in surgery, so it’s important for times between surgeries to be as short as possible," he explains. Turnover times between surgeries have dropped steadily at Saddleback since 1993 when Love’s facility, which handled inpatient and outpatient surgeries in the same OR, began tracking and posting turnover times for cases classified as minor, major, and extended major.
Day-surgery cases fall into the categories of minor, such as cataract and hysteroscopy, and major, such as laparoscopic cholecystectomy and shoulder arthroscopy, says Love. Turnover times for minor cases dropped from an initial goal of 20 minutes to an average time of 17 minutes. Turnover for major cases has dropped from an initial goal of 30 minutes to 20 minutes. "We post the average times on the door to each operating room so staff members and physicians can see how we are doing," he says. The circulating nurse for each case logs the turnover times. The averages for each category are posted each quarter.
"We find out how one person is lowering times and share that information to help everyone turn over the rooms more quickly," he adds.
The program to log turnover times began when staff reductions reduced the number of housekeepers assigned to the operating room, explains Love. Turning over a room meant even more teamwork, with everyone picking up trash, keeping the room neat during surgery, and moving equipment in and out as needed, he adds.
"By having the trash bagged and sitting at the door, all the housekeepers had to do was wipe down and mop the room, so they could have it ready much quicker," he explains.
Anesthesiologists are using their wastebaskets, and spills are cleaned up during surgery if at all possible, explains Love. "By keeping the room clean during surgery and taking care of some cleanup while the patient is being awakened, we shorten the amount of time to get the room ready for the next patient," he says.
While her staff do not log turnover times on an ongoing basis, Nancy Burden, director of Trinity Outpatient Center in Port Richey, FL, says that periodic surveys of times show that they average five to 10 minutes for procedures such as ear tubes, pain management procedures, or cataracts. Turnover for arthroscopies average 12 to 15 minutes, she says.
One way her staff keep turnover times so low is to set up two rooms for the same procedure and keep the surgeon moving from one to another. "If we have several arthroscopies of the knee scheduled for one day, we alternate the left and right knee procedures in the schedule so we have one room set up to do left knees and one set up for right knees," Burden says.
Once the surgeon has finished the procedure on one patient’s left knee, the surgeon goes to the room that has another patient with a right knee prepped. This eliminates the need to move equipment around the room after each procedure. The same practice is used for cataract surgery, she adds.
While the decision to reduce the number of housekeepers in the operating room was the impetus for Saddleback’s program to look at turnover times, Love says the use of teamwork actually resulted in increasing the housekeeping staff. "When a productivity expert looked at the efforts of the nursing staff to clean rooms, he suggested that a better use of the nurses’ time would be to focus on other areas of turnover. We have the housekeeping staff back to full strength, but we still bag trash and do what we need to keep turnover times low," he adds.