turnover times in a small or

[tiny1]

I work in a small hospital with two or suites. We have three scrubs and three RNs. We admit our patients in the holding unit, which we staff as well as surgery, we do the surgeries and do our own recovery as well. We clean and set up our own rooms as well as pull for the cases and set the cases up. Our turnover times are around thirty minutes with some being as fast as twenty minutes. At the begining of the day, the scrubs pull for the cases and set up the first two cases of the day, we then go to the holding unit and do whatever is needed to finish getting patients ready for surgery. When surgery starts, we scrub the cases with one RN circulating. At the end of the case, one scrub will remove the instruments and clean them while the other stays behind with the patient to clean and apply the dressings. While we are waiting for anesthesia to finish, I am empting the trash replacing the trash bags and picking up the floor. As soon as the patient is moved to the gurnie, I clean the bed and apply new sheets. the floor is mopped and we are setting up the next case on a wet floor. All of this and still, we cannot always meet the twenty minutes that management wants.We are breaking rules by removing the instruments before the patient leaves the or and setting up a case with a wet floor.What are we doing wrong? I am so sick of the doctors complaining about the turn over times.

[canesdukegirl, BSN, RN]

You are doing everything right. I don't know how you could possibly improve this. Are you flashing instruments that are needed for the next case? If so, that in itself is at least 10 minutes, and that doesn't even count the time that you must soak and wash the instruments, clean out the lumens and rinse everything before it goes into the autoclave. Are suture and gloves already picked for the following cases? Do you have to move/find equipment? If my assumptions are correct, there is no way possible that you can do better. These surgeons need a reality check already!

[Argo]

Tell them to grab a mop and help. I have told them this and you'd be surprised cause a few have started helping turn over rooms when we are busy.

[mercys]

This Or needs a extra person to help out. Not a nurse or tech even.A person to turn over inst,help clean,move patients,etc. Most small ORs in my area have a inst tech that cleans inst ,and helps with everything else. Your hospital seems to be squeezing every drop out of you.

[ScrubCap]

Are the two cases that start off the day for different surgeons? If not, then when you are closing on your first case, the second OR team could be bringing patient #2 into the other OR so that when the surgeon closes and talks to the family of patient #1, he's ready to go right to work on the next case (given that he had seen them in preop prior - or he could see them in the OR just prior to induction). I am assuming that you have at least two anesthetists present during the day to complete cases?

The only other thing I would suggest is to pull all your cases for the next day before you leave - one less thing you have to worry about in the morning. What's the third RN and tech doing? I would think that you could hire a dedicated RN for PACU - this RN could help the outpatient/holding RN with admissions and preparing them for surgery until she gets her first patient in PACU. Other than those minor suggestions, it sounds like you have a good system.

[wartthree]

How much are you opening? I worked at one hospital that had their packs made so all they opened were gloves and suture. Everything else was in the pack. I know it costs quite a bit to do pack conversions, but may shave a few minutes off. Plus that hospital even took it a step further and had 'trained' the surgeons to all use the same type of suture..saving time and not keeping suture on hand that was seldom used.

[mercys]

She is right. At our hospital we have minor packs,major packs. total joint packs. We just open gloves suture and any extras pertaining to that case. The saveings on time will make the difference eventually. Oh and we also have neuro packs and laproscopic packs. We are a 7 room OR with cysto,do a lot of totals,and general cases.The outpatient next door has 4 room and have their own style of packs. They can turn over in minutes. They keep the days cases in case cart in room. Tech takes insts to inst room grabs a cleaning cloth,wipes table and bed and is ready to open. They do not mop unless there is spillage. I have adapted this for my ENT service,and can turn over by myself while nurse gets pt.