Why do we obsess over turnover time? It's simple: Time is money and highly resource-intensive OR time is incredibly expensive. And besides being a source of lost revenue, room delays can frustrate surgeons, staff and patients.

We all want to lower our turnover times, but what exactly are we measuring?

Depends on whom you ask. For your nurses, turnover time is typically "wheels out" to "wheels in," meaning from when one patient leaves the OR until the next patient enters. For your anesthesiologists, turnover time is typically from when one patient is transported to PACU and report is given until the next patient's anesthetic induction. And for your surgeons, turnover time is typically from closure of one patient's wound until the next patient's incision. If you want to better your turnover times, the first thing you must do is get everyone to agree to a single definition. Think of it as syncing your watches.

If you don't have a sense of your average turnover time, get out your stopwatch. Then figure out an appropriate goal for your facility. Too low of a goal is not necessarily better. After all, you don't want to put your patients at risk, and you don't want to drive your staff away. In fact, this might be a good time to include your staff — ask them for their opinion on a safe goal for turnover time. Staff who help decide a goal for turnover time are likely to be invested in meeting that goal.

Now that you've settled on a definition and set a goal, you're ready to put a plan into action. These tips might come in handy.

1. Start small. Don't try to change every OR at once. Choose an area where similar cases are following one after another. If it's the same surgeon following himself, all the better, as one surgeon performing consecutive cases has been shown to positively affect turnover time. Develop some success that you can then translate to other ORs. Different doctors and specialties will have unique challenges.

2. Who's doing what? You need the right number of staff assigned to clearly defined tasks to minimize any confusion about the turnover process. You can create a task list that identifies each team member's role during case breakdown and setup. You'll be able to see if you need more (or fewer) staff involved and where. If too many people are cleaning the room at once and no one knows their particular tasks, some surfaces will be cleaned more than once and some surfaces not at all. Who is assigned to remove unnecessary equipment and bring in needed equipment and connect it for the next case? Can this be someone other than the scrub tech or the circulating nurse?

3. Map out the turnover process. This next step requires a bit of choreography. Make a list of everything that needs to be accomplished and place it side by side to each team member's assigned tasks. Visualize which activities can safely be conducted simultaneously. You may see areas where one team member may be of assistance to another to close a gap and save some valuable time. Look at how the work of several individuals may dovetail. Nothing feels quite so good as when a plan comes together.

4. Communicate, communicate, communicate! Everyone needs to take responsibility for strong and clear communication. If a case is completing early, the circulating nurse needs to be responsible for communicating with the next case's stakeholders via the front desk. That way, she can notify everyone involved in the next case so that they can turnover the room immediately upon completion of the case. Meanwhile, the next patient can be readied and the case can proceed smoothly. Or you can provide walkie-talkies to the cleanup crew. This way, they can better communicate among themselves, increasing their efficiency and better aligning their resources for room turnover. Note: If the surgeon is going to leave the OR between cases, be sure you know how to contact him.

5. Hold a team huddle each morning. A 3-minute meeting with your turnover squad before the day's cases can reinforce team spirit. You might, for example, share the turnover times: where you started, where you were yesterday, where you need to go. Pump up for today. Thank everyone for their effort and their hustle. H-U-S-T-L-E!

6. Establish a core tech position. The core tech's responsibilities could include ensuring case cart accuracy, placing case carts outside the appropriate OR, and ensuring readiness/availability of appropriate equipment. That way, equipment issues are no longer the responsibility of the circulating nurse, which would free up the nurse to focus on patient readiness as a first priority. Adding the core tech doesn't necessarily require additional FTEs. Instead, better realignment of existing staff within either the OR or central sterile processing could help staff the position.

7. Check out your disinfectant solution. What are the contact and drying times of the cleaning solution you're using? Faster times matter. There are cleaning solutions out there with a 10-minute contact time and a 10-minute drying time, and then there are those with a 5-minute contact time and a 1-minute dry time. It's up to you what product you choose, but the surface disinfectant you use can cut 5 or more minutes off your turnover times. ?

8. Use turnover kits. OR turnover kits contain all the supplies you need to clean the room together in one place, eliminating the need to leave the room to gather any supplies, including microfiber mops and cloths, table sheets, lift sheets, armboard covers, head positioner cover, trash and laundry bags, and kick bucket liners.

9. Manage the back table. It's a good idea to regularly review pack contents and physician preference cards to eliminate seldom or never-used items and to, in turn, streamline setup and teardown times. Another tactic is to standardize instrument sets and limit doctor-specific trays as much as possible. At the same time, you can review instrument trays' contents and attempt to eliminate seldom or never-used items. In addition, whenever possible, leave instruments in their trays to avoid wasting time setting them out individually.

In sync

The OR is a complex environment where good outcomes depend on the successfully coordinated efforts of a team of individuals — especially when it comes to room turnovers. Hopefully these 9 action steps will streamline setup and teardown, thereby shaving seconds and minutes off your turnover times. OSM