Rapid Room Resets

There's a lot riding on turning over operating rooms quickly between cases. It ensures high-volume surgeons start their surgeries on time, patients pass through pre-op without delay and the surgical schedule remains packed with profitable procedures. Banner Baywood Medical Center in Mesa, Ariz., has become a model of efficiency since 2016, when the orthopedic service line established a new performance indicator: Surgical staff had to lower their average turnover times from 28 minutes to 22 minutes. Achieving that goal demanded new thinking, a bit of creativity and plenty of teamwork.

The medical center's staff members know what roles they play in the turnover process and have bought into efforts to work more efficiently. Surgical techs are in charge of breaking down the back table and disassembling instruments before sending them to sterile processing. Circulating nurses keep the turnover process organized by assigning responsibilities to available team members, so tasks aren't repeated and everything that needs to get done is covered.

"If two people are working on cleaning up and removing garbage, they'll say, 'You take the garbage,' and, 'You go wipe down the anesthesia equipment,'" says Karen Tjelmeland, BSN, RN, CNOR, Banner Baywood's nurse manager. "They delegate roles."

Team members who clean OR surfaces follow AORN's recommendations and cleaning products' guidelines for kill times. Staff receive specialized training related to OR cleaning, which is reviewed and tested annually. An emphasis on teamwork is promoted by removing the presumption of "business as usual," an effort that involves engaging surgeons and anesthesiologists to be part of the process. "The anesthesiologists got onboard with the quicker turnovers," says Ms. Tjelmeland. "They oversee nurse anesthetists, who meet with patients in pre-op to ensure they're ready for surgery as soon as rooms are finished."

Preparing ahead of time also helps the team work efficiently between cases. They participate in daily morning huddles with OR schedulers, the OR manager, supply chain personnel and the sterile processing lead. "During the huddle, we review the schedule to make sure we have no conflicts with requests for equipment, and that we have all necessary instrument trays available for the next day's cases," says Ms. Tjelmeland.

Staff always check their rooms' equipment carts first thing in the morning to see what their needs are and communicate with the sterile processing department about which instruments will be needed to be turned over quickly for upcoming cases. OR assistants anticipate when rooms will ready for cleaning and plan accordingly by, for example, placing mops and buckets outside rooms before cases end. This teamwide organization contributes to keeping efficiency high and room turnover times low.

Banner Baywood's leaders speak about their team's accomplishments by emphasizing that implementing change is where the challenge lies. They say it takes commitment from leadership in all areas to own their part in the process, accept the responsibility for their team's role and embrace and support the changes necessary to improve room turnover times. The methods they implemented to improve room turnover times were designed to be easily replicable in other facilities. Instead of isolating the improvements to orthopedic surgery, Banner Baywood's leadership decided to incorporate their methods across the entire hospital and nine other facilities within its health system.

The facility's staff and management are proud of the improvements they made. Change did not happen overnight, however. The effort involved investing time and energy into streamlining processes and channeling patients in and out of the OR in an efficient manner. "It takes a lot of work," says Ms. MacDonald. "We put forth the vision, but we also engaged the team to make it happen." OSM