Improving efficiency in the OR

[canesdukegirl, BSN, RN]

thanks for your responses!

[mercys]

What is the Nurse Manager doing. Hideing things,that should be a reason to get a warning and then out the door. Our Anest techs help with turnovers,at least clean and take out trash. Who is in charge of this OR and what are they doing. Sounds like the big problem is no management.We are fairly small,7 ors and a cysto room. Turnovers are about 20 min depending on the case. I do ENT and turn over while nurse get pt. I only clean bed and table and have all the smaller cases on one case cart. We have most of the time 2 housekeepers to clean.Even when we only had the 4 rooms,before remodling we had 2 housekeepers. They make so much difference.

[mrsilly]

mercys, i work with canesdukegirl and what she says is true. I think part of the problem is that management isn't really acknowledging the issues we have. They claim they listen, but when an idea is suggested, it gets shot down. I also feel there's a lot of favoritism (I'm not one of the favored), but this is probably in most hospitals. Unfortunately, I think part of the turnover issue is the ORAs. While some work hard, others are hard to find or act like they don't know what you're talking about. There are days when there are 3 guys cleaning a room and it takes them 1/2 hour! Of course in a perfect world, there would be a person responsible to make sure that case carts are correct, etc.. but that would me more money the hospital needs to spend on an employee. OK, I'll stop here.. don't mean to rant.

[canesdukegirl, BSN, RN]

Wow, I am so surprised, but feel a bit validated in the fact that someone knows what I am talking about. In the hospitals that I worked in as a traveler, we had a "sterile core" person who was responsible for picking all of the suture, gloves and extras that the case required. In the hospital that I am in now, the sterile core people could care less...they would rather sit at the computer and surf online. No accountability. There is one person in the core that works her fool butt off, but as a general rule, it is unheard of. They just don't want to be bothered. If we DID have a functioning core person, it would help tremendously.

[ScrubCap]

What process do you have in place for picking the cases for the next day? I have worked at a large teaching university/trauma center and also at a small private hospital - like you say, they are completely different environments.

At the larger institution, we had OR Techs who had the job of picking the supplies for the next day's cases and they would assist the "turnover team" in getting the room cleaned. The RN would help the scrub tech open the case and together they would make sure that everything was accounted for. This worked out well because when the RN was taking her patient to PACU, on the way back to the OR she would swing by holding and meet the next patient, check the consent and H&P and appropriate labwork and be done - it was the CRNA or Anesthesiolgist who was responsible for bringing the patient to the OR.

At the smaller private hospital, we only had 5 ORs, 1 cysto, and 2 endoscopy rooms. At the end of each day when the cases were completed, the staff (both RNs and scrub techs) would pull the cases for the next day - suture and gloves included. We always pulled by the preference cards, which were always up to date. So, the next day as we do our cases, we only have a 10-20 minute turnover because the RN comes back from PACU to help the scrub tech and sterile processing tech with the turnover. CRNAs are responsible for their own circuits and meds. RN helps tech open case and then helps CRNA bring patient to OR.

It seems like it is more than one process that is broken in your institution. I would look at it from the path that the patient travels and try to identify all the avenues that could be improved. For instance, do you have a pre-op clinic in place? Establishing a clinic with anesthesia to get their pre-op labs and diagnostic testing completed before arrival is a tremendous time saver. Are there delays in pre-op or in admitting/assessing the patient. How about with equipment that you need for cases - is there one for each OR or is it at least centrally located?

Keep us posted on improvements as they happen and best of luck!!!