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Is anyone else being pushed for 30 minute turnover times in between cases?

Posted

Specializes in Operating Room. Has 18 years experience.

My hospital in San Diego, CA is pushing for NO more than 30 minutes in between cases. The time begins when you leave the OR with your patient and you must be back in the OR with your next patient within 30 minutes. So you have to take the patient to recovery, set up your room for the next case, preop the next patient all within 30 minutes. I don't understand this push for time since mistakes happen when you are rushed.

Are other hospitals doing this 30 minute turnover push and if so why?

RobtheORNurse

Specializes in Surgery. Has 30+ years experience.

A hospital I worked for pushed for as fast of a turnover as possible and many times it was far less than 30 minutes. I don't support that but yes, it is everywhere. To administrators, time is money and an empty OR is not making money. They do not see the patient or staff safety aspects unfortunately.

They want ours as fast as possible. For some of our docs, 30 minutes is too long.

JoeTheRN

Has 5 years experience.

I would love to have a 30 minute window! Our goal is 15 minutes, but we average somewhere around 18. We have a couple of ortho docs who do hand procedures and the turnover in those rooms is less than 10 and we can easily do 15 cases in an 8 hour shift. The same with our cataract cases too, it seems kind of like an assembly line to me sometimes. As said before me, it's all about the money. Shorter turnover means a doc can fit more cases into a day and more cases = $$$$$ That is always the bottom line now days...

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 15 years experience.

We schedule a turnover time of 20 minutes. Don't always make it, but that's the goal.

My hospital's goal is 36 minute turnover time. We rarely make it, but it's usually more an anesthesia hold-up than OR staff. I also think rushing leads to mistakes and dislike it.

kguill975, MSN, APRN, NP

Specializes in APRN, ACNP-BC, CNOR, RNFA. Has 1 years experience.

On cataracts and hand cases maybe, but on big joints, they're still getting blood off of the ceiling at the 30 min. mark. The only place I've ever seen it really enforced was in surgery centers. In big trauma centers, it's a lot harder.

GadgetRN71, ASN, RN

Specializes in Operating Room. Has 14 years experience.

In one Or I worked for, 30 minutes was on the late end of things and was only really acceptable for total joints. They preferred 15-20 minutes. I shoot for 30 minutes tops now and hopefully a little less than that.

I did work in a big OR where turnovers were an HOUR in some cases. That was because we weren't allowed to help clean the room. In my current facility, I will help clean if it means the room moves faster.

Where I work they push about. 20 min turnover time. Everyone pitches in (for the most part). I'm a new surg tech and even on the total joints, we are expected to be ready very quickly. It makes learning pretty challenging. We are usually still setting up and doing a count when the pt is in the room!

ShariDCST

Specializes in CST in general surgery, LDRs, & podiatry.

I worked in many different sizes and types of facilities, from 3 OR county hospitals, to major metro teaching hospitals to a private 2 OR surgery center, and about everything in between. (I wasn't a "job hopper" ~ I worked as a "temp" or Traveling Tech for several years, in addition to some stints as a regular full or part timer.)

A 30 minute turn over at any of them would have been a luxury. But, it depends on where you are, what kind of cases you do, and what sort of turnover help you have.

One nice mid-range facility I temped at had a button on the wall inside each OR. When your case was over, and your patient ready to be moved, you rang the bell the same number of times as your room number. Turn over/housekeeping staff was waiting at your door to come in and move your patient, clean the room and set it up for the next case. Frequently any equipment you would need for your next case was waiting outside your door too, and brought in when the room was clean.

They had quite a training program to learn what was what, where to put it, and how it all got handled! Nursing went with the patient out to PACU, and then to PreOp to take charge of the next patient, or if there were 2 RNs (usually) 1 came back to help get the room opened and going for the next case.

Surgical Techs took care of getting instrumentation down to the dirty room, take a potty break as needed, pick up the next case cart and bring it in to open. (That is if someone hadn't beaten you to it, and was already opening the room by the time you got back to it!)

The RN not bringing the patient was helping to open the room and do counts, while the other RN brought the patient. It worked beautifully, nobody stressed, and we were always well under 30 minutes at the same time. When my time was up covering for a couple of maternity leaves, I really hated to leave! Everyone was friendly, and we all helped out each other.

Another place, there were a couple of docs always up our behinds for "FASTER FASTER!" turnovers. One had a habit of standing in the doorway and looking at the clock and patting his foot while watching us do all the work (grinning, of course.) Of course he was also frequently in the way. I broke him of it when I started handing him the mop, or a full trash bag to take out and down the hall. When he figured out that I was always going to put him to work if he continued to stand there, he began making himself scarce between cases! We also never had over 20 minute turn over times.

There are lots of other stories, but it all boils down to who's in charge and whether or not they have your back or are only interested in kissing someone elses's ass while protecting their own at your expense. Employee and patient safety should always be #1 on the Hit Parade!

Unfortunately, the almighty $ is what rules the game these days. Your only protection is to have each others' backs, and help out whenever and wherever you can. And the #1 rule in Healthcare is "Document document document!" If 30 minute turnovers are impossible to do safely, then make sure they know why! Find out where the process is failing you, and have brainstorming sessions on how to fix it. Try out what makes sense, and can be done safely, and if it works, incorporate it into your routine. (The "you" being collective here ~ not individual.) If not, throw it out and try something else. For instance: If you have to run all over hell and gone for supplies everytime the room gets turned over, figure out how to make turnover packs, or have a cabinet arranged to have all those supplies in one place. Linens, disposable trash/linen bags, suction cannisters and tubing and anesthesia circuits, and whatever else you use to change out the room. There's all kinds of ways to consolidate work. You have to figure out what works best for you. Good luck!

Edited by dianah
misspelling, add comment

Libitina

Specializes in Obs & gynae theatres.

In the UK we have separate anaesthetic rooms. We send for our next patient as we get towards the end of the procedure. We then turn the room round in the time the patient is being anaesthetised. Our lists do not allow anaesthetic or recovery time. Then they wonder why we either run over or end up cancelling patients. :no:

ShariDCST

Specializes in CST in general surgery, LDRs, & podiatry.

Curious - Who is "dianah" and why is she editing my page? The bottom of my page says "Last edit by dianah on Mar 1 : Reason: misspelling, add comment". I put that there myself when I corrected something - but my name isn't "dianah"....

Our main OR where I work has a hard time keeping it under 40-45 minutes, but our ASC is usually pretty good at keeping it at 20 or so. I'm still amazed when management and doctors still complain that that's not fast enough! Obviously, the ones doing the griping are the ones who don't have to do the cleaning and setting up or dealing with brand-new set up/anesthesia techs fresh out of college with liberal arts degrees and minimal training from the company we contract!

kat von b

Specializes in OR-ortho, neuro, trauma. Has 4 years experience.

We have a 30 minute turnover where I work too. Some days it works and other days it doesn't. I always feel rushed, bring back our unused supplies, grab stuff for the next case, go see the patient, and open the room. With these ortho cases that's a lot to get done in a short amount of time. Heaven forbid I have to pee. If we miss our 30 minute mark we get a call from charge asking why, well it's either bc it took so damn long to clean or the anesthesia resident and/or attending is chatting away, or we are missing something (happens more than it should). We have all voiced our concerns but I doubt it will ever change. I work at a huge level one teaching facility.

Aussie RN here, I work in a religious hospital and thus gets tax breaks as it is not a for profit organization. However the managers push us for a quick changeover.

we average 5-10 minutes change over time for joints.

wow, 30 minutes would be a luxury! I work in a physician owned 8 OR hospital. Our goal is a 10 minute turnover. We average 12 minutes. However, we often "flip" rooms with 1 surgeon....while the RNFA is closing one case, the next patient is being put to sleep, prepped, draped next door. The surgeon literally has time to talk to the family, scrub & get going on the next one. That provides what we call "negative turn over". One patient is out of the room AFTER the next case got into the room. The key to this actually working is a well built team. From the surgeons office to the housekeepers....we all watch out for each other & do what we can to help. We are fortunate that we usually have a couple extra bodies floating around to interview patient, open cases, help prep, etc.

ceman

Specializes in operating room. Has 4 years experience.

let me say this u r lucky having a 30 minutes .

in the hospital i used to work its been only 15 minutes , i know its too hard but i guess team work may solve this thing ...

Example :

while the circulating nurse is transferring the pt to RR & giving endorsement , the third nurse or the assistant could set up the room , the scrub nurse set up all instruments & supplies that well used in the surgical procedure & the nurse anesthetist well prepare for anesthesia ..