Improving Surgical On-Time Starts and Room Turnover Times

Captured time can mean extra cases in a day without the usual added cost in labor for both anesthesia and the facility. In addition, and as importantly, it can improve patient and surgeon satisfaction at the same time.

There are a myriad of multi-disciplinary factors that can lead to delays in on-time surgical starts and room turnover times. Everyone within the surgical services team can play a role. Issues involving anesthesia, surgeons, nursing (Pre-op, Intra-op and PACU) admissions, transport and even center policy and budget can lead to delays. So, resolving these issues and improving on-time surgical starts and room turnover times must involve a multidisciplinary approach, with leadership buy in from all these areas. Improvements will no doubt require addressing some difficult issues and an overall culture change in many areas, and it will take a commitment from leadership in every area to make significant improvements.

This brings us to the first step, the formation of a multidisciplinary team, with leaders and teammates from all areas involved. Start by clearly defining the goals, and how they will be measured. Agree on the definition of an “on-time start” and “room turnover time”? These terms alone can mean different things to different people or groups. For instance, a surgeon or anesthesia provider who is chronically late in the morning may not see an issue with a delayed start time as long as the first case is done at the scheduled time; not realizing that a delay in the first patient leaving the pre-op area can impact the time available to prepare the next patient, triggering delays in the schedule thereafter.

Improvement Process Steps

1. Form a multidisciplinary team with leaders and teammates from all areas (surgery, anesthesia, administration, nursing, transport and admissions).
2. Define “on-time surgical start time” and “room turnover time” and assign a process for collecting that data.
3. Begin with baseline data collection.
4. Communicate in detail with the entire operative team the opportunity and necessity for improvement.
5. As a team, map the process starting with the time the first patient is called to the OR (or in the outpatient setting, when the patient is told to arrive at the center) and ending when the second case begins. Do so with an eye for barriers that impede the smooth flow of patients.

Barriers can include:

1. Patient arrival time, arrival time policy
2. Late staff (surgeons, anesthesia, nursing or admissions)
3. Inadequate staff (anesthesia, nursing or admissions)
4. Inadequate pre-operative patient beds
5. Inadequate post-operative patient beds
6. Equipment issues (inadequate supply or failure)
7. Other facility specific issues
8. Random events

6. Identifying the opportunities for improvement
7. Formulate improvement process steps
8. Implement process improvement plan and continue to measure results
9. Celebrate successes along the way

Identifying the opportunities for improvement and formulating the improvement process steps necessary is usually not difficult. However, implementing those steps or cultural changes can be where the challenge lays. It takes a commitment from leadership in all areas to own their part in the process, accept the responsibility for their team’s role and embrace and support the necessary changes. Communication is key. Among leaders within the various groups, and between those leaders and all teammates. Defining the problem with the whole team and getting buy in is key to success. Hold individuals accountable but take a non-disciplinary approach which recognizes and rewards the successes.