The Endoscopy Center of Lodi and Lodi Outpatient Surgical Center Administrator, Kippy Pogue, and Director of Nursing, Heather Bickford, along with Regent Surgical Health Director of Clinical Operations, Ann O'Neill, as an advisor, work diligently to improve the turnaround times in their operating rooms. "Turnaround time" is defined as the time between when one patient leaves the OR and the next patient arrives. The ability to decrease this time starts before the patient has even been admitted to the facility. As with all aspects of nursing you must first assess the situation, create a care plan for the patient, implement the plan and evaluate if you met your objectives.
Endoscopy procedures and eye surgeries are generally short cases with fast turnover times. A minimal amount of equipment and supplies are used (in relation to larger cases), but the need for the exact same attention to detail with regards to safety and infection protocols is tantamount. Listed below are some of our best tips and tricks to shorten turnover times without compromising patient care from Ms. Pogue, Ms. Bickford and Ms. O'Neill:
Patient orientated tips
Pre-admission:
• The process begins as soon as a patient is booked for a procedure. The nursing staff makes a pre-op call to the patient to gather patient history and to educate the patient prior to the day of the procedure. This streamlines the admitting process on the day of surgery and ensures all patients are on time for their procedure. It also gives staff time to iron out any difficulties prior to the patient arriving at the center.
On the day of the procedure:
• Procedures are fast and it is important to have patients ready on time to prevent any delays. Patients are scheduled in half hour blocks, with the first two patients prepped and ready prior to the physician's arrival.
• If a patient arrives a little late or requires extra assistance getting into bed two nurses are assigned to "tag-team" the patient. One nurse will take vital signs and start the IV, etc., while the second nurse will complete the necessary paperwork. Even though speed is important to maintain efficiency, be mindful of the patients feelings and do your best not to make them feel rushed.
• The order of patients may not always stay as scheduled. Patients who are extremely late will fall into line behind patients who arrived earlier. This keeps a harmonious flow of patients.
Regarding staff
• Staff are educated on the importance of a quick turnover, and challenged to maintain excellent turnover times, or improve lackluster ones, while maintaining a safe environment. Communication is key.
• On very busy days an additional staff member is brought in to assist with room turnovers or washing scopes.
• Staff are cross trained to enable them to help in any situation and in any area to keep the flow moving forward. For example, whenever necessary the Director of Nursing rolls up her sleeves and jumps right in.
Regarding physicians
• Physicians are encouraged to pay attention to turnover times; to stay on target and not become distracted with issues beyond the OR during their time at the facility.
Equipment and supplies
• Supplies for each case are pulled at least a day in advance to ensure all the correct supplies are available and nobody is looking for equipment or supplies at the last minute.
• Planned maintenance is kept on schedule to ensure all equipment is in the best working condition. A notification form is filled out for any equipment malfunction so management can arrange for timely repair.
• Supplies are standardized which, apart from having practical purchasing benefits, makes it easier for staff to assist with cases. Staff (especially new staff) do not have the potential misfortune of opening the wrong supplies for a particular doctor. Supply carts are set up the same in each room so no matter which staff member is working in any given procedure/operating room they know where to locate what they need.
• Sufficient equipment is purchased so the operating rooms are kept running without having the delay of waiting for equipment to be sterilized. At the end of 2012 the endoscopy center bought two new towers and we ensured we had enough scopes to keep two procedures rooms running. We also have a double re-processor, allowing us to clean two scopes at once.
Measuring and monitoring
• Data is tracked in order to quickly analyze any (in)efficiencies. We installed business software where we enter all our patient related times, allowing us to run a report to track turnover times. This helps us to check if we are keeping on track or if we have strayed a little. If one room or doctor has a change in turnover times we dig a little deeper to ascertain what the issues were, or what we were doing better. We can then formulate a plan, if necessary, to steer us back on course.
Of course, all of these tips are only workable with a focused team, where each participant knows his or her role and understands the reasons for each step in the process. Expedient case turnovers lead to happy patients and happy physicians. In turn, staff morale improves when there is a culture of teamwork and a sense of a job well done. Efficiency and all around satisfaction of key stakeholders is a winning combination for any ASC.
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