Help!!! need OR indicators defined

mikethern · Sep 20, 2007

Please correct if I am wrong in my difinitions:
Patient Out - Pt. leaving the OR
Patient In - Pt. being brought into the OR
Surgeon Out - Surgeon has completed closing and leaves room
Surgeon In - ??? Actual procedure start time by surgeon OR does it mean time the surgeon enters the OR suite???

I've worked in 6 different O.R.'s and I've never seen "surgeon in" and

"surgeon out" times. Times are usually patient in, time-out, cut, skin closed, and patient out. You need to clarify the definitions of your facility with your boss.

I think my turnaround times are not too bad. My problem is we have the patient on the table ready to go and surgeon is talking on the phone, talking to family of the last case or seeing a consult patient... Is this a problem for any of you guys.

If a surgeon is consistently late to cases, call him early. For example, call him as soon as the patient enters the room.

OPCC · Sep 20, 2007

Thank you for your reply. What I am looking at is our turnaround time and how to make it faster. Three distinct processes exsist within overall turnaround time. 1) Surgeon out to patient out. 2) Patient out to patient in. 3) Patient out to surgeon in.

I am wanting to see how others would define the 3rd component, when looking at causes for delays. I want to think it should be the time he walks into the department as we are ready and he is messing around. How many times can you tell a surgeon you are ready.

Again thanks for your thoughts.

OPCC · Sep 20, 2007

Yes - we page the surgeon ahead of time. Many times we page him several times. When you are the only surgeon- as we are a rural hospital and the surgeon is an outreach surgeon - he seems to take advantage of the situation.

mikethern · Sep 20, 2007

Yes - we page the surgeon ahead of time. Many times we page him several times. When you are the only surgeon- as we are a rural hospital and the surgeon is an outreach surgeon - he seems to take advantage of the situation.

Your boss should make a new policy that patients are not to be brought into the room until the surgeon is in the operating room. Of course, the policy probably won't happen.

If the hospital wants to waste money by having long turnover times, that's their problem. You get paid by the hour so it doesn't matter. As a patient advocate however, you don't want your patient to be under anesthesia for longer than necessary. At the very least, the anesthesiologist should not intubate until the surgeon shows his face.

amberfnp · Sep 20, 2007

I work for an ambulatory surgery center and we keep a running log of turn around times. Not just the OR but also pre-op to discharge from the facility. We schedule 30 minutes between cases for room turnover but rarely need all 30 minutes. We do not have a "central supply". The OR staff and 1 substerile attendant maintain all the instruments for their cases. All cases are "pulled" the day before so all supplies are readily available for room set up.

Our biggest issue is doctors getting pre-occupied between cases, or just plain arriving late for the 1st case (well 1 doc in particular--we have 6 at this practice).

On our OR worksheet, the times we use are...

-patient in time (time pt left pre-op to go to OR)

-surgery start time (this can be defined by the facility as either time of initial injection of local or time of 1st incision)

-surgery finish

-anesthesia finish (this time is when patient is in PACU and anesthesia reports off to the nurse)

Not sure if I really answered your question but hope it helps!

Marie_LPN, RN, LPN, RN · Sep 21, 2007

Please correct if I am wrong in my difinitions:
Patient Out - Pt. leaving the OR
Patient In - Pt. being brought into the OR
Surgeon Out - Surgeon has completed closing and leaves room
Surgeon In - ??? Actual procedure start time by surgeon OR does it mean time the surgeon enters the OR suite???
I think my turnaround times are not too bad. My problem is we have the patient on the table ready to go and surgeon is talking on the phone, talking to family of the last case or seeing a consult patient... Is this a problem for any of you guys.

We don't take the pt. into the room w/o seeing the whites of the surgeon's eyes.

bifurcated · Sep 21, 2007

Not sure if I have what you want... In time: patient enters operating room. Surgery start time:knife to skin, Surgery end time: dressing on patient out time: when pt leaves operating room and enters PACU (this is the same time, if you have a long distance to go then it is pt out of operating room)Anesthesia start time is when the anesthesia care provider starts talking to pt. their end time is whenever they finish with pt.

as for a surgeon who is late or talking to pt. family etc. that is not black and white. We do not take patient into OR without the surgeon in the suite.If they get tied up after induction then I let them know that patient is asleep, prepped, draped and ready. You cannot control "all" do the best with what you've got. If surgeon is habitual then take it to your supervisor or talk to the surgeon.Hope this helped some.

OPCC · Sep 21, 2007

Are OR forms have the the same set of times that you mentioned. I am looking at ways to study our turnarounds and on paper identify the problem areas of the process so it is in black and white for all involved. Thanks you are great help and seem to be a very good information source.

Marie_LPN, RN, LPN, RN · Sep 21, 2007

Are OR forms have the the same set of times that you mentioned. I am looking at ways to study our turnarounds and on paper identify the problem areas of the process so it is in black and white for all involved. Thanks you are great help and seem to be a very good information source.

Maybe document in the nurses notes the time that the sugeon entered the room?

ebear, BSN, RN · Sep 21, 2007

OPCC,

The department should adopt a policy where the patient is not taken to the O.R. until the surgeon has spoken to the patient and is in the dept., then that will be your "patient in" time. The surgeon "in time" should be the time that he walks into the room scrubbed. As far as your turnaround time, you need to document "cause for delay" a. surgeon not in dept. B. consent issue c. medical clearance issue d. anesthesia not ready e. pt. ate , etc. That will cover your butt and explain case delay should the surgeon go to admin. about long turnover times

amberfnp · Sep 21, 2007

Ebear,

At our facility, we do not take the patient to the OR until anesthesia, the surgeon and a member of the OR team has spoken to the patient, pre-versed of course...But...that still does not always solve the problem of the patient waiting on the table, under anesthesia, for the doc to come in. Sometimes it's due to other patients being seen but sometimes they just want to eat lunch and socialize.

I do work in a privately owned ambulatory surgery center so I guess they feel they can do what they want and not really have to answer to anyone. But I tell ya, the staff and anesthesiologists are none too happy when this occurs, seeing as how the doc gets to leave after surgery but the rest of us get to stay until the last pt is discharged!