Turnover Time

Argo · May 9, 2011

How many open heart rooms do you have? 20-25 is a respectable turnover time for these cases. Depending on who our Anesthesia is it would be impossible to come in an ill prepared room with out quick guys. Our quick ones have all lines in and we are cutting within 15 minutes. Our surgery room times are around 2.5 hours for cabg x 4 or valve replacements. All I would suggest to get your following cases prepared and waiting in the hall with all instruments, supplies and drugs ready to roll in the room.

We have had as fast as 15 minutes turnover in to same room. 3-4 minutes going into a separate room. Our surgeons don't really care too much about the turnover but I don't want to be there all day, the faster we get in the room, the faster we go home.

canesdukegirl, BSN, RN · May 9, 2011

I used to work in a private hospital in Western NC and the turnover times were 8-15 minutes. We were able to do this because EVERYONE helped turn the rooms over. Nurses, techs, nurse manager, team leader, anesthesia techs, and every free nurse that was available. The anesthesia care provider drew up meds for the next case and kept them in a separate locked drawer. It was incredibly efficient.

I agree with you that it isn't the greatest thing to have a pt see the chaos that reigns at the beginning of the case. The room should SURELY be cleaned and at least set up before the pt starts to roll in.

I have found that to help facilitate turn over times, I will begin to clear the backtable for my tech when closure begins. I take everything (they hand it to me, rather) except the instrument basket and dressings. I will have looked up my next pt's hx and begin to fill out path forms. I clip all of my paperwork together for the next pt and put it underneath my computer keyboard so I won't confuse it with my current pt's paperwork. I take all of the non-essential equipment out of the room after its use and ask the assistant assigned to my room that day to bring needed equipment for the next case and place it in the hall next to my room.

I think that 20-25 minutes is a good turnover time. What are some of the things you are doing to facilitate faster turnover times? What do you see that are your major challenges in accomplishing this?

Argo · May 10, 2011

Sorry but im not breaking down a heart room before the patient is out of the room. I have seen how quickly a patients heart stops when they tamponade. Its not even ideal to break it down until they are clear in ICU but when we have the same surgeon and Anesthesia for the next case we do it. Outs a different surgeon we go into one of our other rooms and wait until the patient is officially cleared before we break down. Granted you only bring back one in a hundred but when you need them opened back up, you reallly need them opened quickly.

$fracturenurse$ · May 11, 2011

Yeah, I agree with Argo on this one, not breaking down a heart room back table early. That's OK for an umbilical hernia or something, but I wouldn't do that on a heart or vascular. Turnover times drive me crazy. I hate being pushed, that's how mistakes happen. Good luck.

drums326 · May 11, 2011

That's pretty wild about having the patient come in the room with all that commotion. Our anesthesia providers like it completely quiet with as little movement possible from when the patient arrives to when they are induced. The rational they use is to prevent laryngospasm and losing their airway. Luckily I work in a facility that rarely voices concern about turnovers. Does anesthesia usually sedate your patients prior to bringing them to the OR? Ours usually have some versed on board and they usually don't remember coming back to the OR.

canesdukegirl, BSN, RN · May 11, 2011

On a different note (and forgive me, OP for hijacking your thread for a bit), it really ticks me off when the staff in the room are not considerate of the patient when they first roll into the room. It should be QUIET. The staff (docs and residents are actually the WORST) should not be having loud conversations about what went on during rounds that morning, or making small talk about XYZ. I am not suggesting that there should be NO conversation in the room, but I am stating that there should be some consideration that the pt is more than likely terrified, and the staff in the room should do everything in their power to facilitate a calm environment for the pt during induction. I continue to be amazed at the number of circulating nurses that don't assist with intubation, or positioning. Where is the focus on the PATIENT?!?!?

When I am scrubbed, I have to slow down when I am setting up my instrument baskets if the pt is rolling in the room. I know they are already terrified. I don't want their last memory before induction to be the sound of metal instruments rattling around. On the same note, during emergence, I CRINGE when the scrubbed person is hastily throwing instruments in the baskets, making loud noises by putting the baskets into the containers and then slamming them into the case carts. That IS NOT what the pt should be listening to upon emergence.

OP, thank you for letting me hijack and vent about noise pollution in the OR...it is one of my pet peeves. I realize that Versed has a retro-amnesic effect, but if I can somehow make a more pleasant (hence QUIET) environment for an already scared pt, then I am going to do it. I have even been known to turn off the overhead fluorescent lights and only have the OR lights on and turned to the side of the room in order to make emergence a less frightening experience for pediatric pts, or pts that are "nervous nellies".

If any of you have had general anesthesia, I know that you can relate to my rant. Emerging for general anesthesia from a pt's point of view is very scary. Things seem brighter, louder, and COLD. Couple all of those things with the pain associated with the procedure, and you have one miserable patient. We as OR nurses can do a great deal to make the pt more comfortable. Warm blankets, quiet, and dimmed lights make for a better experience.

OK-done with my rant!