Turnover times...

  1. Hey guys,
    How long is turnover time where you all work, and do you have trouble meeting it?
    Our director has told us that turnover is expected to be 15-20 min. Turnover meaning from the time patient A leaves the room to the time patient B enters the room....oh, please, it takes 10 min just to clean the room and that's if all the attendants come as soon as we call it overhead.
    Honestly guys, I almost always have all my stuff together and ready for the next case but the only times I can make that 15-20 min turnover is when I do the super simple cases. All the other times, even when I have my instruments/gloves/suture/meds ready to go, I still have to reverse the bed or balance the microscope or change out the bed altogether or move equipment, all stuff I couldn't do ahead of time. And we are chroncially short-staffed so there isn't a third body to help with turnover.
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  2. 19 Comments

  3. by   shodobe
    The only way the time could be met is if everybody does their job, meaning porters, anesthesia techs and scrubs all have to work together. If this can't be done then your director is living in a fantasy world. The one thing I can't stand is to bring a patient back to the room just to find it still being cleaned! Waste of time, looks unprofessional to the patient. There was one time when 15 minute turnovers were no problem, long time ago. The director has to be realistic and make sure everyone knows what is expected out of them. Good luck, Mike
  4. by   grimmy
    [font=book antiqua]a lot depends on the kind of case, what following what? of course, any droplet/airborne precaution room takes at least 35 minutes. if the room is a godforsaken mess (a really bloody burn case) it takes a little bit longer to clean. there's got to be a little lee-way. i think a great day is when turnover is about 20 minutes, average. this is predicated on having a perfect case cart pct's helping out and having all the equipment available :lol_hitti ...doesn't always work out that way. none of us live in a perfect world, and the sooner admin can accept that, the better. let us not even discuss a pacu hold...
  5. by   nurselily3
    Our turnover times are 38 minutes average..shorter for the smaller cases (15 to 20)...because we are doing the same thing, having everything thats possible to be ready - ready for the next case. If I didn't have to hunt things down, or call a million times for a tech, or wait on anesthesia to get their **** together....I'm sure it would be a heck of a lot faster. See my thread on mopping your own room. They think turnover time will be better if we eliminate housekeeping and mop our own rooms in ADDITION to our other duties.
    If you guys are doing it in 20 minutes....AMEN....and HOW??? What am I doing wrong?? How could I make it faster?? I'm already neurotic about picking up the room and keeping it neat, I already pull the trash bags and put the dirty linens in the bag for housekeeping to make it faster!!
    I hear ya ShirleyM.......I think they (mgt) are living in a fantasy world.
  6. by   Marie_LPN, RN
    Our average is 25 minutes. The bigwigs want to see 10 minutes, 15 at the most. Our asst. supervisor came in the room last week to see if we "needed some extra hands" to set up. This was her no so subtle way of saying "you all are not going fast enough". It took 10 minutes to clean the room after a messy vascular case, but what they were aiming for was for the room to be cleaned and an abdominal hysterectomy to be set up all in 10 minutes. Nevermind that case had lasted 4 hours and i needed to pee, our turnover time just wasn't GOOD enough.

    (To which i say "keep dreamin' ")

    The next person that comes in and says our turnover is too slow, i'll ask them "well, are you free to help right now?"

    Our anesthesia docs are the worst about this. They aren't aware that in the 15-20 minutes that they've been sitting on their *** in the break room, that we're busting our ***es in the room.
  7. by   ShirleyM
    Thank you to all those who replied to my thread. I never bothered to ask my co-workers how(or if) they keep their turnovers to 15-20 min, but now I don't feel so alone in not doing turnovers in that short of time, especially when the cases AREN'T hernia repairs/tonsils/eye cases, etc....
    I always knew my director lived in a fantasy world in regards to turnover time, all your responses just confirmed it . And I should've known anesthesiologists are pretty much the same across the board, walking into the room to ask if they can bring the patient back, all the while oblivious to the scrub and circulator busting their butts to set up the room.
    And of course the surgeons don't have a clue as to what it takes to set up a room for a case. They constantly complain of turnover times and management acts on that. I had one surgeon tell me that at Parkland(Dallas) they turned over his room in 9 min (including turnover of instr), from lap banding to another lap banding, plus it was only the scrub and circulator involved in turnover. I bit my tongue down really hard and pretended to listen (all the while being furious :angryfire ), but after that case I told my scrub he was clueless. You cannot do a 9 min turnover without extra bodies helping out, I'm convinced of that.
    Ok, I'm done venting out, thanks to all who 'listened' and responded.
  8. by   druse
    I think it really makes a difference depending on the type of cases you're doing, but there are some things that can be done to possibly help you achieve the fastest turnover time you are capable of. These things are (not implying that you are not doing any of these)
    1. Check all of your cases at the begining of the day, in order to be prepared for your last case as well as your first equally.
    2. Make a plan and communicate with your team members (circulator, scrub, anes, crew in the next OR, etc...)
    3. Keep your room picked up during the case in order to help the turnover to be as painless as possible.
    4. Thank other people who help you (others will help you if it's not like pulling teeth)
    5. Gather needed supplies early, don't wait until in between cases
    6. Stay organized as possible throughout the day
    7. Anticipate the possibilities of what could go wrong, (what if's)
    8. Communicate with the outside, (Pre-op, Recovery, Co-ordinator) to keep informed.
    9. Use your resources (ask for help if you need it, before you need it)
  9. by   grimmy
    Quote from shirleym
    thank you to all those who replied to my thread. i never bothered to ask my co-workers how(or if) they keep their turnovers to 15-20 min, but now i don't feel so alone in not doing turnovers in that short of time, especially when the cases aren't hernia repairs/tonsils/eye cases, etc....
    i always knew my director lived in a fantasy world in regards to turnover time, all your responses just confirmed it . and i should've known anesthesiologists are pretty much the same across the board, walking into the room to ask if they can bring the patient back, all the while oblivious to the scrub and circulator busting their butts to set up the room.
    and of course the surgeons don't have a clue as to what it takes to set up a room for a case. they constantly complain of turnover times and management acts on that. i had one surgeon tell me that at parkland(dallas) they turned over his room in 9 min (including turnover of instr), from lap banding to another lap banding, plus it was only the scrub and circulator involved in turnover. i bit my tongue down really hard and pretended to listen (all the while being furious :angryfire ), but after that case i told my scrub he was clueless. you cannot do a 9 min turnover without extra bodies helping out, i'm convinced of that.
    ok, i'm done venting out, thanks to all who 'listened' and responded.
    [font=book antiqua]uh...the only time i've had a turnover of less than 20 minutes was when the resident went and got the mop and mopped the room himself. now, this was a very rare case, and that resident is a gem. he wanted to get outta dodge as much as the rest of us, so everyone chipped in. the slowest part of the turnover is anesthesia, typically because they've got this huge, heavy cart, and our or is so huge, it takes a while to get around. you're so right...most surgeons haven't got a clue. the worst part? some anesthesiologist griping because i told the scrub to go ahead and go to the bathroom between cases!! :angryfire i had all i could do not to box his ears. they don't think that she/he has been standing for hours, with rarely a break...and nature does call, dammit.
  10. by   nurselily3
    I have been so upset lately about our turnover times and the possibility that they are going to make the RN's mop the floors between cases I did a little research yesterday. We were told in our weekly staff meeting that our AVERAGE turnover time was 38 minutes. That it ususally took 12 for the nursing/scrub staff, 5 for housekeeping (which they are getting rid of) and 9 for Anesthesia. We are still having problems getting the docs to update their H and P's and make sure the consent is proper...answer their patients questions and all that jazz.
    So, yesterday I was doing some Oral Surgery cases, Lefort 1's and Fractures. They are usually between 2 1/2 hour to 4 hour cases depending on the difficulty. I had all my stuff ready and my scrub nurse and I were ready in the designated 12 minutes. That was from first patient out, to second case ready to come back....and it still took anesthesia 40 minutes to get ready!!!! But clearly, the problem lies with the room staff. Ok, just had to vent about that.
    I agree...you have to have everyone on board with a common goal. THE PATIENT! Sometimes getting anesthesia to do that is like pulling teeth!
  11. by   druse
    Sometimes that's the hardest part, getting everyone on the team to be a part of the team all of the time. We will occassionally flip flop rooms to attempt to speed up our day, but it requires everyone to be on the same page of optimism. Some people are very opposed to flip flop and think it's a waste of time and will voice this opinion. This negativity undoubtably will effect others and cause skepticism which in turn will effect the efficiency of the outcome.
    Sometimes everyone is clicking together and it's like being a part of a machine, and that's when it's great.
    Believing helps, so hang in there!
  12. by   shodobe
    Even the bloodiest case should only take 10 minutes or less to do. Now I am only timing the cleaning of the room not the opening of the case and such. We all chip in and can have a room open ready to go in 15 minutes. I couldn't stand to work somewhere that took 30 to 40 minutes, waste of time. I think too much talking and screwing around and not enough "let's get it done" work. Sorry, it seems there is something missing in turning the rooms over in a timely matter.Granted anesthesia can be the biggest culprit in good turnovers. Mike
  13. by   Rnn2003
    hi o.r. team members. last week i did an experiment with one of my doc and turn over....my shortest time was 20 min the longerst 35...this is what we did for that day.

    1. she marked 2 patients off the bat, placed h&p's on chart

    2. soon as she started closing i called day surgery told them she was closing and wanted her patient brought to holding. (this helped get antibiotics in quicker and getting the patient closer to the or suite) for some reason daysurgery always holds thing up with last minute preps.

    3. i always keep my room neat but this experiment i pulled the trash out of the cans for the pct's just to save one step. i called them as soon as she got on the last stitch told them to be ready to come in with the strecher.

    4. as soon as the patient was moved the sheets came off of the bed and it was wiped down and re-sheeted. clean trash bags back in trash cans as we were rolling out and the floor was mopped by the cst.

    5. i had my cst to bring two case carts at a time this way i could check the other one during the case outside the door. have sterile services bring what ever they left off.
    6. i took the patient to pacu gave report went straight to holding and picked up the next patient.
    7. back in the room in 20 min.

    admitted short cut
    [color=#00bfff]1. counted after pt was sleep but before prep. you do it when your on call all the time.
  14. by   suzanne4
    One facility that I worked back in Michigan, had a thirty minute turn-over time and this was on an open heart team. From the time the patient crossed the thresh-hold going to the unit, until the next patient was supposed to be on the table, was 30 minutes. And it got done and can be done. But only if everyone works together.

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