168 - Dedicated OR Turnover Team: Decreasing Turnover, Increasing Satisfaction
Description: A multi-disciplinary team was created in late 2018 after several surgeons had concerns with the length of turnover times. Goal was set to decrease average Operating Room (OR) turnover time to 35 minutes through increased efficiency and creation of a dedicated turn over team. A plan was developed that would conduct a current state assessment through a review of baseline data, process, and roles; identification of pain points and barriers that were used for root cause analysis. Through evidence based practice research, potential solutions were identified that could be adapted and provide the foundation to develop an improved process that is supported through clear role definition, expansion of duties as appropriate, and tools to facilitate the improved process. A test of change was conducted to test solutions for effectiveness and determine if solutions would meet the targets. The final step will be full scale implementation of the successful solutions with tools developed for ongoing monitoring and continuous improvement. The baseline OR turnover time in Q1 – Q3 of FY2019 was approximately 53 minutes between wheels out to wheels in for consecutive OR cases. During the current state assessment it was identified that there were activities that could be done out of turnover cycle time to prepare for wheels out. The team members tended to be very task focused but not efficient nor effective in sequencing and parallel processing. Recommendation for creation of a dedicated multi-disciplinary OR Turnover Team. Each member of the team has clear roles and responsibilities for cleaning and prep of the OR room from the case finishing through entry of the next patient. A checklist was created for the OR doors that ensures each member of the team completes their designated tasks and outlined which equipment needed to leave the room, new equipment needed for the next case, and bed position or room set up special instructions. Pocket cards were created for quick reference for each member on the team. The OR turnover team pilot has yielded benefits including staff dedicated roles for turnover and tools to help them prep outside of the room for efficient set up after room cleaning. A reduction of turnover time has been observed and next steps identified that will expand gains. Implications for perioperative nursing: In the fast-paced environment of the operating room, every minute counts. Not only do prolonged turn over times lead to dissatisfaction of patients and surgeons, they also lead to overtime and loss of revenue. Clear delineation of roles and parallel processing have strengthened relationships throughout the team. In a Cancer Center with extremely complex procedures, a change between cases could include moving multiple pieces of equipment, preparing for IRB protocols, and multiple sterile set ups. It is imperative to include all members of the team and begin planning ahead for the next case early.
Co-Authors: Amy Altomare, Denise Mazzarella, Jo Bilbao, Eddie Paez, Laritza Hernandez