Reduce your turnover time to as little as 5 minutes
Want to keep your physicians efficient and happy? Reduce your turnaround time. That’s the advice of same-day surgery managers, some of whom have reduced their turnaround time to as low as five minutes. That time compares dramatically with 20 years ago, when turnover times were as long as 20 minutes.
"If it takes half an hour to turn over the room, the physician is wasting time as far as being productive medically and surgically," says Roger Pence, president of FWI Healthcare, a surgery center development and management company based in Edgerton, OH. FWI Healthcare manages the multispecialty Centre Community Surgical Center in State College, PA, which performs 300 procedures a month, predominantly orthopedics, and had a turnover time this past quarter of 6.8 minutes.
"One of the facility’s goals is to meet the needs of our customer, and the physician is our customer," Pence says.
One warning, however: Some physicians may feel rushed with an extremely short turnover time and may complain that they don’t have time to talk to families, says Stephen W. Earnhart, MS, president and chief executive officer of Earnhart and Associates, an ambulatory surgery development/management company in Dallas.
Earnhart recommends doing a weekly or monthly select audit to determine the average turnaround times for the surgical teams. "Ask the doctors if that turnaround time is appropriate," he says.
Or, without telling physicians the turnaround time, ask them how the turnaround time has been and whether it meets their demands and expectations, he advises. "If they say it’s perfect, then it’s perfect."
For those same-day surgery programs that want to reduce turnover time, consider these suggestions:
• Hire staff who take pride in their work and are willing to work as a team.
Hire staff who take pride in their work, suggests Kathy Brinkman, RN, BSN, CNOR, coordinator of ambulatory surgery at Sentara CarePlex in Hampton, VA. The average turnover time at her facility is five minutes. Sentara CarePlex performs all types of surgery, including ENT, gynecologic, orthopedic, and general, with the average case lasting 40 minutes.
When the center opened two years ago, she hired two nurses from the hospital who had received excellent evaluations there. "They care about their jobs," Brinkman says. "They’re not just here to put in their eight hours."
It’s critical to hire team players because "turnover times can really vary according to the mood of the person or the stress in the room, and the type of cases to follow they may not want to do," Brinkman says. "We just don’t have that problem here."
Pence agrees that teamwork is the most important factor in reducing turnover time. "There are a number of ways you can cut a few minutes here or there, but unless the entire group wants to reduce the time, it won’t be accomplished," he says.
At Centre Community Surgical Center, all staff pitch in to clean instruments, repackage them, and pick up papers and leftover materials in the room. Even the anesthesiologists and anesthetists help transport patients. "It’s part of the teamwork concept," Pence says. "Why do we have to have separate jobs for everyone?"
At Sentara, technicians pick cases, perform technician duties, and help clean and turnover the rooms. "That allows for there to be essentially no turnover time, just five minutes, because the case is picked correctly," Brinkman says.
• Clean only what is necessary.
Look closely at the level of cleaning in the operating room to determine what’s necessary and how much time it takes, Pence says. With minimally invasive cases, little cleaning is needed, "so why would it be necessary to mop the room between each case?" he asks.
In cases in which blood or body fluids are spilled, the center examined how much cleaning is necessary. Should just the blood or contamination be cleaned up, or the entire room?
The center determined that with cases involving a minimal amount of blood or body fluids, only those materials needed to be cleaned up. "That saves a considerable amount of time," Pence says. For cases involving a significant amount of blood or body fluids, significant cleaning is done in the room.
Brinkman uses the same philosophy. "We concentrate on exactly what needs to be cleaned," she says. "For example, we may just mop around the bed."
• Have a clear definition of start time.
It’s critical for the surgeon to understand the definition of start time, Pence emphasizes. "When we say a case starts at 7:30, does it mean the patient is ready for the incision at 7:30? The surgeon is scrubbing at 7:30? Arriving at 7:30?" Pence asks. The answer: "7:30 means that’s the time for him to be working."
And what about those physicians who are habitually late? "Tell [them] the cut time is 7 a.m.," Pence suggests. In some cases, when a surgeon is often late and has no excuses, it may be necessary to take punitive actions, he says. "If he’s late consistently, he will find one or two cancellations."