Room Turnover -- How to get faster?

jeckrn, BSN, RN · Feb 7, 2016

Start the turn over while the patient is in the room. What I mean by this is have everything cleaned up that you can, have instruments no longer needed handed off the field, etc.

mhy12784 · Feb 9, 2016

Get a routine and do things the same way, everytime.

Figure out what things are "essential" and which can wait. For example if the surgeon uses his local at the end of case, you dont need it at the start of the case (can get it during the case etc)

Make small improvements to your routine overtime, thats really the best you can do

jeckrn, BSN, RN · Feb 9, 2016

Sometimes you have to push the techs to move faster. Once you get some experience you will know which ones need that little push and which ones do not. My yesterday is a good example. The tech I worked with is like watching paint dry funding the set up of the room so I had anesthesia bring the patient back will she still had a few pans of instruments not on the field. Towards the end of the case asked about taking sets off the back table for items no longer need and she would not pass any off. This was not due to her having to assist the surgeon at that time. It took her 15 minutes after the patient left the room before she took the case cart out. The next room that was doing the same case the tech was pushing his cart out right behind the patient. The reason is is that he allows nursing to help him and he gives use unneeded items.

springchick1, ADN, RN · Feb 10, 2016

Sometimes you have to push the techs to move faster. Once you get some experience you will know which ones need that little push and which ones do not. My yesterday is a good example. The tech I worked with is like watching paint dry funding the set up of the room so I had anesthesia bring the patient back will she still had a few pans of instruments not on the field. Towards the end of the case asked about taking sets off the back table for items no longer need and she would not pass any off. This was not due to her having to assist the surgeon at that time. It took her 15 minutes after the patient left the room before she took the case cart out. The next room that was doing the same case the tech was pushing his cart out right behind the patient. The reason is is that he allows nursing to help him and he gives use unneeded items.

I have this problem but it's with one of the circulators I work with. I'll tell her I'm done with the back table and she won't clean it off. I'm also having to tell her constantly to go get the next patient. She drags her feet and is never in a hurry. It drives me crazy!!!

OP, delegation is also a huge help with turnover time. If you can have someone go find missing equipment, pull up films, or help the scrub open, it is a huge time saver.

fauxpaus · Feb 14, 2016

I'd just keep in mind that while speedy turnover is important, patients are our priority. I've seen my hospital do things that were...inappropriate as far as turnover and "efficiency" that endangered patients.

Windyhill, BSN · Mar 9, 2016

It also doesnt help when there is only 2 people to show up to help clean..

offlabel · Mar 9, 2016

First and foremost, you need to have buy in from everyone in the room. It may sound corny, but people need to be enthusiastic about making it a personal challenge to make the room hum that day. That means having people that like and respect each other taking the initiative to move things along in their own area of responsibility.

It only takes one person to put the brakes on a very nice day, and that includes the surgeon.

catsmeow1972, BSN, RN · Mar 19, 2016

Today i was told that "I seem to be low energy and have no sense of urgency." I am rather put off by this. I've been in the OR for 15 years, 5 as a tech and 10ish as a nurse, so yes, i am a little hurt by this. I have never been told this before? Supposedly "doctors have complained about this and my name comes up?" That just does not seem to add up. I work in a 4 room OR. We don't have that many docs. I have ideas where this might be coming from but can't be sure. I haul butt, usually running to get stuff and like OP, I start my cleanup prior to end of case. I am also a bit OCD and tend to cruise the room during the case, keeping organized and de-trashed. I can't stand a sloppy room. Makes me itch :-). So far as the leaving the room to get stuff, there are issues with cases not being pulled correctly as well as nobody stocks the rooms on a regular basis. Me personally, i stock my cabinets before I leave for the day. I can't make other staff do the same thing.

I think some of the issue is that we have a few anesthesia docs that are push, push, push, who cares about patient safety, let's just get done so i can leave. They will push the patient back prior to me even seeing them or checking the chart. I've had to chase them down the hallway, while checking consents. i've also had to run after them to get a blanket on my nekkid patient going to PACU. If I say something, they just laugh at me. These are (it's 2 or 3 specifically) ones that will take a patient to PACU on a T-piece because they don't want to bother waiting for them to wake up enough to extubate??

I don't know what the answer is. I look around and see things that contribute to the problems (like me leaving the room to get stuff a lot). I don't want to point fingers like none of it is my fault (some days i am just plumb worn out from the running), but there are things going on here that I cannot fix and seemingly am being expected to take the hit for.

I can take criticism and in spite of many years of experience, the BSN, the CNOR, etc, I am not perfect. I am many things but "low-energy and slow" aren't two of them.

Am I getting too old for this? or am I seeing unreal expectations? I don't know, but just thinking about it gives me a bad attitude and i don't like it. I love my job, but I wonder how much longer I can take this.

Advice would be appreciated...........

SurgicalTechCST · Mar 20, 2016

Or, you have NO extra people available in the staffing that are designated to assist with room tunovers.

I have worked in a couple of places where the circulator was not the least bit helpful in cleaning up after herself, much less helping her techs with theirs. She would disappear out the door with the patient to PACU with anesthesia, and not show her face again until she showed up with the next patient, leaving every single step of room turnover on the "lowly Tech" because she thought herself too good to clean the room after the case, help set up and open the next, or even throw out her own trash, leaving it piled around the counter. She apparently was trained that way by another "entitled" circulator at another facility who taught her that.

After a few weeks of that, at one particular facility, plus complaints to the OR head nurse from not only the Techs but from other nurses who DID help their room staff and knew the meaning of the word "Teamwork," the nurse got pulled into a meeting with the Head Nurse, several of the Staff Nurses and a couple of the more senior Techs, under the guise of a discussion on room turnover times. It seemed despite mine and other Techs best efforts, when she circulated a room it was consistently over time on turnovers, and the doctors were complaining also.

There is just too much to be done to turn a room around for it all to be left to one person! She didn't seem to like being singled out, but that's too bad, because the documentation on turnover times didn't lie, and we all knew it. It took a little while, and a few reminders, but she finally got with the program, at the expense of losing her job in that department.

I travelled as a Tech for a few years too, and the best run place I was ever in had Environmental staff trained specially to work in the OR as turnover staff as well. The nurse would hit a bell button by the room door with the number of the room - four times on room #4, etc. - and the turnover crew would be waiting at the door when the patient came out, with mop and bucket, linens, trash and linen bags, cleaning spray and wiping towels, and whatever else they needed to flip the room. If the room staff needed lifting help, they would have them come in earlier and they knew how to do that also.

And during our case, they had their own turnover paperwork telling them what kind of large equipment would be required for the following cases, such as video tower, arthroscopic tower, extra suction carrier, or whatever. They spent their time between cases making sure that the equipment needed for the next case was gathered up and waiting nearby the rooms before the current case finished. And they cleaned any equipment that came out of the previous cases and put them in the storage room, or sent to the next room that needed them.

So, my only responsibility was to get my instruments back into the case cart, remove any unused sterile disposable or nondisposable supplies or instrument pans to the top of the cart, take it down the hall, past the supply room where the sterile items were placed in bins on a table outside the door, and sterile instruments on another table, and the Tech assigned to float for the day would keep stuff put away between giving breaks or relieving for lunches; then keep going on down the hall to decontam with the dirty instruments and pushed the case cart into the outer room, and left.

I picked up the next case cart in the hallway near the room where we had put them early that morning, checked quickly to see everything had been pulled the night before by night shift staff, and moved it into the now-clean room to start opening the case. If there was a few minutes available between cases, and another tech who was assigned to float and give breaks that day was handy, I would go to the restroom, grab a drink out of the break room fridge, so stocked for our use, and/or some crackers or fruit off the table, sit for 10 minutes or so, and head back to my room and scrub in to take over setting up my case!

It was as close to working the absolute perfect job as I have ever been! The room turnover staff were of course highly valued, well treated, and paid more than the regular Environmental services staff, for their extra training and responsibilities. It was a highly coveted position, and there was very little staff turnover, among them or any of the OR staff for that matter.

I was there for nine weeks to cover a couple of maternity leaves which overlapped each other. They didn't have travelers too often, but treated the ones they had as well as the rest of the staff. There were two other Techs traveling there when I was, and we all compared notes of course and agreed it was almost as close to heaven as we had ever seen! When we left, our departure did not go without notice. There was a cake in the lounge, a lunch pitch in, and a small gift from the staff for each. I have never forgotten (obviously) the wonderful way the whole place was run, and should be held up as an example to strive towards as it worked so smoothly, and functioned so well.

Outside of working in Nirvana, everyone working together and not at cross purposes is best. I would always start cleaning up my instruments as the case progressed as much as possible, and working in a teaching hospital was a special benefit as cases usually didn't go quite as fast, and there were always medical students and Surgical residents to assist the surgeon, leaving me to manage my own job. While closing was going on, the Mayo had been cleared except for closing instruments and sutures, after last count, the clean dressings were put up inside a towel with wet sponges for cleaning and dry for drying off. The towel was used to hold over the clean dressing while all the drapes were removed if they hadn't been before.

All the dirty instruments were in the basin and pans as necessary, while the trash was thrown out in the trash bin that the circulator had pushed over close to the back table. The case cart had the instruments on it before the patient was moved. The back table and Mayo stand cleared away, the remaining needle driver, forceps and suture scissors already retrieved and put with the rest of the dirty instruments. Gowns and gloves removed and discarded in the trash. The circulator pulled the bed linens and into the linen bin as soon as the patient was moved to the gurney or room bed, depending on the patient's needs.

I was gathering up any loose trash around the room if any, while anesthesia was waiting for the patient to require extubation. Anesthesia was responsible for pulling and changing their own circuits, managing their meds with assistance of Anesthesia Techs if any. Bags were pulled and changed, stuck outside the door, case cart frequently was out the door immediately behind the patient, mop and bucket was usually outside the door waiting.

Everything that needed it was sprayed and wiped down, and the floor mopped by someone while instruments went to decontam, and trash and linen bags went into the bins by someone else. The bed got made, the next case pulled into the room, any needed equipment got pulled in the room, the packs placed per location and the case opened and we're off to the races.

Once I got scrubbed back in, gowned, gloved and tied up, anything else that needed to be opened was opened, and frequently we could get the count done quickly on an average case before the circulator left to get the patient, who was sometimes still being seen by anesthesia, the surgeon and his entourage. And then we begin again...

springchick1, ADN, RN · Mar 20, 2016

Surgtech, please edit to make more paragraphs. It's way too hard to read these massive paragraphs you have. I gave up trying to read it and there may be some really going points you are trying to get across.

SurgicalTechCST · Mar 20, 2016

Done and done. Sometimes I get going, and can't quite find a stopping place! Sorry! :unsure: