Room Turnovers: Life in the Fast Lane

Turnover time is money. And when you're looking at your bottom line, everything comes down to one big question: How fast can you get the room ready for the next case while maintaining the highest standards of patient safety?

It's a delicate balancing act, but it's one every OR team needs to be thinking about. Improving turnover time takes collaboration, critical thinking and an honest evaluation of all the things you could do better once a patient has left for recovery and another patient heads into to the OR. Here are 6 tips that will help keep those turnovers moving:

At Regina Hospital in Hastings, Minn., administrators noticed their room turnovers seemed a bit disjointed. The problem? Each staff member had a role and was essentially irreplaceable. The RN circulator had a role, the scrub tech had a role, anesthesia had a role and housekeeping had a role. If any of those staff members got called away or were delayed, it held up the whole process. That kind of inefficiency won't help your turnover.

Last year, they took on turnover from a new angle, and it has made a difference. They did away with the rigidity of their old system and went with "zones" in the OR, assigning turnover tasks based on areas of the room. As soon as the patient has left the OR for recovery, the members of the turnover team head to their zones.

• In Zone 1, which includes the bed and lights, the first staffer in the room cleans the handles and any visibly soiled areas of the overhead lights. He also cleans the bed, including the remote, the wheels if visibly soiled and the mattress, lifting it up and wiping both the top and bottom.
• In Zone 2, the scrub tech or the second person in the room cleans the anesthesia machine and all its knobs, handles and cords. That person disinfects the scanner, keyboard and mouse of the computer, and the keyboard, flat surface and drawers of the medication cart. He's also responsible for the IV pole and the forced-air warming unit, top to bottom. Lastly, he cleans the handles and doors of the cabinets, the tops and bottoms of the tables (including the wheels if visibly soiled), the razor, door and trash bins.
• In Zone 3, the nurse or last person in the room after the patient leaves cleans the nurse's station. That includes the door and handles, the patient board, phone and light switches; the front, back and knobs of the fluid suction device; the cautery machine and cords; the broom machine; the OR tables top to bottom, including the wheels if soiled; and the back door.

"The goal of implementing the zone system of room turnovers was to have more of a consistent process," says Jason Bainbridge, RN, BSN, MBA, patient care manager/surgery center at Regina Hospital, part of Allina Health.

As soon as the patient is out of the room, a staffer lays disinfectant wipes on everything that needs to be cleaned. If a staffer walks in and sees the wipe on something, that confirms the task has yet to be completed.

"When anybody walks into a room, they know what's not done. That saved us some minutes on room turnover," says Mr. Bainbridge.

In the first quarter of 2018, the average room turnover time at Regina Hospital was 22.1 minutes. After implementing the zones, the average turnover time had dropped to 19.3 minutes by the third quarter of 2018.

Before the turnover team gets to work, your staff should have already set aside all the materials they'll need for the day in the OR.

Typically, turnover times are counted as the time when one patient leaves the room and another one enters — wheels out, wheels in. For simple cases, the turnover time should be from 7 to 10 minutes. For more complex cases where you have to mop the floor and clean a lot more equipment, those may take 20 to 25 minutes.

That's why the proper preparation of the room is critical, says Anne Dean, RN, BSN, LRM, co-founder and CEO of The ADA Group, a consulting firm specializing in ambulatory surgical development and regulatory compliance. Make sure the physician's preference/procedure card is current and pull exactly to that card leaving nothing out. Pull everything you need for each case the night before and set up a case/cupboard cart system outside the OR, pulling everything you need for case 1 and placing it on shelf 1, everything for case 2 on shelf 2 and so on.

Then add a room turnover kit, adds Ms. Dean, which you can either purchase commercially or assign your staff to assemble during down time. The kit should include things like draw sheets, an OR table sheet and kick bucket liners.

It's a good idea to mop the floors after each case, as they do at the Advanced Family Surgery Center and at Regina Hospital. The Joint Commission doesn't require you to clean the walls after each case, but if they are soiled by visible splatters, then you'll have to wipe them down. A terminal clean at the end of the day and a cycle clean weekly, or as needed, should be part of your routine, says Mr. Bainbridge.

Nobody on the team is more important than anyone else. Housekeepers are as essential as circulators.

"A housekeeper can help prevent infections. A housekeeper can do a whole lot of things that can help with turnover time, general efficiency and patient safety," says Ms. Dean. "Doctors can grab a mop and help turn the room, not because they're trying to make anybody look like they're not hurrying, but because we all have the same goal in mind."

There shouldn't be any "this isn't my job" mentality among your team members, according to Ms. Dean. "If a floor needs to be mopped, somebody can grab a mop. Everybody pitches in to do everything."

Teamwork is an essential component to cleaning rooms efficiently, effectively and quickly, without sacrificing the most important thing — patient safety.

"Everybody has to be on board. If I have a room down, then it's all hands-on deck to get to that room and help the crew turn it over," says Ms. Norman. OSM