THE NEED FOR SPEED It helps to envision your turnover team like a pit stop crew.

Is room turnover at your facility a well-choreographed performance or a chaotic fire drill, with staff crisscrossing the room and repeating tasks that have already been performed or, worse yet, not completing a required cleaning step because they thought it had already been done? Check out how a few of your colleagues have reduced their turnover times.

1. NASCAR pit crew
In nothing flat, a NASCAR pit crew leaves nothing undone. No wasted time, no wasted motion, they get in, they get out so the racer can get on his way. Each team member focuses on a specific area: one attending to each tire, one fueling the car, another wiping the windshield. Could the pit-crew concept help turn over an operating room? It sure has at Enloe Outpatient Center in Chico, Cal., where each of the 4-member turnover team is assigned a zone, says Teresa Wahl, CRCST, manager of sterile processing.

Zone 1 covers the bed to the booms, the lights, booms, IV poles and bed wiped with a disinfectant. Zone 2 comprises the perimeter of the room, including the prep stand, circulator station, ring stand, back tables and kick buckets. Zone 3 entails mopping, stocking towels and pillowcases, and taking the trash and used linens to a pickup point near the door. Zone 4 is the anesthesia area, disposing of used circuits, tubing and canisters, and wiping the machine with disinfectant.

"We did that so people wouldn't forget to take care of everything in their particular zone, like a pit crew," says Ms. Wahl. "We didn't want anyone worried about anyone else's zone; just their own zone."

Why only 4 members of the turnover team? "With more than 4, it's just chaos and confusion," says Ms. Wahl. "Before, we had 6 people asking each other, 'Did you get this?' People were running into each other during room turnover, uncertain as to who was doing what, what was getting done and what wasn't. Some things were duplicated, others weren't getting done. So the rule became we could have no more than 4 people in the OR getting it ready."

Average turnover time: 5 to 10 minutes. Ms. Wahl also credits her facility's sizable investment in turnover aids — fluid waste management solutions, turnover kits, boom systems, procedure packs and disinfectant wipes — for helping to lower turnover times.

DIVISION OF LABOR Turnover team members grab an assignment card in the order that they arrive.

2. Assignment cards

To Patti Paxton, RN, the videotape didn't lie. Looking for ways to shorten the 25- to 30-minute turnover times at St. Luke's Magic Valley Medical Center in Twin Falls, Idaho, Ms. Paxton videotaped staff turning over rooms. She captured several flaws.

"People were awfully busy chit-chatting during turnover," says Ms. Paxton, unit-based educator at St. Luke's. And while some surfaces weren't being wiped down at all, others, like the operating table, were being wiped down 2 or 3 times. "That helped us recognize wasted movement. We didn't have a systematic process for who did what tasks," says Ms. Paxton.

Ms. Paxton's team was able to cut turnover times in about half for most cases, down to 10 to 15 minutes. She and staff members posted specific room turnover tasks on 3 laminated cards that are stored in slots outside of each of the 10 ORs. Turnover team members grab the assignment cards in the order that they arrive; if more than 3 people are available to help turn over the room, the cards note the responsibility of the additional helpers (clean the anesthesia equipment and take dirty linen to the trash room, for example).

Ms. Paxton says the 3-card system is especially helpful when transitioning from a more involved case to a simpler one, like from a spine procedure to a shoulder arthroscopy, because you have a different bed and equipment requirements. Those types of turnovers have been cut from around 45 minutes to 25, she says.

3. All hands on deck
At the 6-OR St. John Macomb-Oakland Hospital in Madison Heights, Mich., 2 surgical support techs are tasked with OR turnover. One cleans the bed area and mops, while the other removes the instruments, trash, laundry and suction container before wiping the surfaces and table. Two other staff members, a nurse and tech, are on a sort of turnover "standby" in the hall, filling any gaps that may arise with a particular case. They can help turn the room over if extra cleaning help is needed. They also provide breaks.

The night before, techs and nurses pull all instruments and supplies for the next day's cases and place them on a cart that can hold 3 cases, says Pamela Borello-Barnett, RN, BS, CNOR, clinical nurse manager of perioperative services, who in a pinch will pitch in.

"The biggest thing was getting people to have a mindset that it's OK for them to help with room turnover — it's everybody's responsibility," says Ms. Borello-Barnett. "I even have some surgeons who will help turn a room over. They know how hard we work, and they want to do more cases. They know we have quick turnover and they like to bring cases here because we keep things moving." OSM