World-class OR turnaround times: secrets uncovered

AORN Journal,  May, 2007  by John Olmstead,  Peggy Coxon,  Deborah Falcone,  Lisa Ignas,  Pam Foss

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When nurses enter a career in the perioperative area, they quick-learn that the three aspects of OR service most important to surgeons are availability of convenient OR times, quality surgical equipment, and fast OR turnaround times. If service on these three vital issues cannot be met, the hospital risks losing the surgical procedures and revenue gained from these physician customers to competing hospitals or ambulatory surgery centers (ASCs). It is especially frustrating for perioperative RNs that the OR team can only affect one of these three vital service functions--OR turnaround times--because the other two service functions are controlled by hospital administrative personnel.

In improving the service provided to physicians, a perioperative nurse's attention is focused mainly on ensuring efficient OR turnaround times. Simple improvements, such as having a housekeeping turnover team available, can be implemented easily. Occasionally, a surgeon will request the use of two separate ORs with two separate OR teams so that when the surgeon finishes a procedure in the first OR, he or she may immediately begin a procedure in the second OR, effectively eliminating turnaround time. Although this approach can be very effective, it also is extremely expensive and unrealistic and is not mentioned in current literature as an effective technique for reducing turnaround times.

Better coordination of the OR team's specific duties can greatly reduce turnaround times. The process used at the Community Hospital, Munster, Ind, by the OR team working with one surgeon, Martin Hall, MD, SC, has consistently produced cost-effective, ASC-like turnaround times in a community hospital setting.

The Community Hospital is a 350-bed, acute care hospital serving the northwest Indiana region. The hospital performs more than 9,000 surgeries annually, and more than 70% of these are inpatient procedures. Another 8,000 outpatient procedures are performed annually in a physician/hospital joint venture ASC physically connected to the hospital.

Dr Hall is an orthopedic surgeon who has been practicing at the Community Hospital since the late 1980s. As his practice increased in volume over the years, Dr Hall worked with anesthesia care providers and perioperative staff members in the Community Hospital surgery department to improve OR turnaround times by continually modifying their approach to turning over an OR. Although the OR team for Dr Hall views their current turnaround approach as routine, the results are impressive (Table 1). The average turnaround time for Dr Hall's procedures (ie, 12 minutes) is faster than that for all other orthopedic surgeons in the hospital; the next fastest average turnaround time for an orthopedic surgeon is 24 minutes. In fact, the only surgeon able to consistently generate faster turnaround times is an oral surgeon whose procedures involve minimal clean-up and set-up time.

TURNAROUND PROCESSES

Most surgeons at the Community Hospital use the traditional turnaround process (Figure 1). At best, this process delivers average turnaround times ranging from 20 to 40 minutes. Common factors that slow the traditional turnaround process include the following.

* Physicians often do not remain in OR area, causing staff members to spend time locating surgeons to alert them that the OR is ready for their next procedure.

* The process leaves no opportunity for parallel processing, which has been identified as a key factor in quick turnaround time. (1,2)

[FIGURE 1 OMITTED]

The turnaround process used by Dr Hall is parallel processing, which allows different members of the team to perform various functions simultaneously (Figure 2). In the traditional OR turnaround process, only one function is performed at a time. For example, most perioperative RNs can relate to this scenario:

   The perioperative team anxiously
   waits in the wings as the surgeon,
   who has just finished speaking with
   the family of patient #1, speaks with
   patient #2 in the preoperative holding
   area. After the surgeon's inter
   view with the patient is complete, the
   perioperative RN and anesthesia care
   provider rush in to complete their interviews,
   then rush back to the OR to
   ensure room readiness, then rush out
   to gather the patient, then once again
   return to the OR so anesthetic induction
   can begin.

[FIGURE 2 OMITTED]

Even when performed as quickly as possible, this one-step-at-a-time process can only be performed as fast as each separate step can be completed. Parallel processing arrangements, on the other hand, allow for several steps to be completed simultaneously. This coordination results in dramatic reductions in turnaround times.

STRENGTHS OF THE EFFICIENT OR TURNAROUND PROCESS

The impressive outcomes from the parallel process used to turn over ORs for Dr Hall are derived from a study of every step involved in the perioperative process. Focus on the various perioperative roles, order for scheduling procedures, and traits exhibited by members of the perioperative team has led to identification of the strengths that enable this perioperative team to perform efficient surgical procedures and quick OR turnarounds.