Speed Up Room Turnovers

Any patient arriving on the day of their surgery is going to be anxious. That anxiety will only grow, and their satisfaction will decline, if their surgery is delayed because of inefficient room turnover times. Getting ORs ready for the next case is not just about speed; it must be done properly to maintain patient safety by ensuring surfaces are properly disinfected.

Our high-volume orthopedic ASC has eight operating rooms and a procedure room. Most rooms are full of cases from early morning until late afternoon, Monday through Friday. Surgeons perform about 30 procedures on a slow day, and more than 80 when we are at our busiest. To keep pace with a packed surgical schedule, we’ve developed a successful room turnover process, defined as the time the patient is wheeled out of the OR to when the next patient is wheeled in. Our turnover times range from six minutes for smaller cases to no more than 18 minutes for larger cases such as total knees, total hips and total shoulders. By developing this successful process, we’ve enhanced patient satisfaction and patient safety, promoted teamwork and reduced the cost of delays in the operating room.

It’s important to have a standardized method of communication to alert team members that an OR is ready to be cleaned and prepped for the next case. When the surgery is finished and the patient is waking up, we call out “status two.” (“Status one” signifies at the start of the case that the patient is in the room and being anesthetized and “status three” is used when the patient is ready to be transported to recovery.) The status two call notifies our perioperative tech and any available staff members that the patient will be going to recovery, and we will need all hands on deck to help clean and turn over the room.

Establishing a methodical approach to room cleaning with clearly defined steps — and educating every staff member on the process — will help your team turn over a room efficiently and correctly. Upon completion of the surgery, task a surgical tech with immediately taking the dirty instruments to the decontamination area while other members of the surgical team stay in the room and start cleaning. After a nurse takes the patient to recovery, they should also assist in the turnover process upon returning.

Clean the OR from the outside in, from the cleanest to dirtiest areas. This system also works well because no one is getting in each other’s way or cleaning the same surface twice and wasting time. It also lets any staff member who comes in and asks if they can help to know exactly where the team is in the room turnover process and what still needs to be done. 

Members of our turnover team work their way into the center of the room, wiping down surfaces with a quick-drying cleaner that has a dwell time of one minute. The team then wipes down the surgical table before cleaning the floor. Mopping can be time-consuming, so make sure you allow enough time for the floor to dry before wheeling in the next patient to ensure no member of the surgical team slips and falls.

To help speed up room turnovers after messy arthroscopy cases, we use an absorbent floor mat during the procedures. We also use a self-contained, self-cleaning closed suction device that collects fluid continuously throughout the case. When the case is over, we roll the mobile suction unit to the docking station, where it automatically empties and cleans itself. We have been looking at options for adding UV lights as an additional disinfecting step, but nothing can take the place of effective and diligent manual cleaning.