Room Turnover Research Articles

Improving operating room turnover time: a systems based approach.

Operating room (OR) turnover time (TT) has a broad and significant impact on hospital administrators, providers, staff and patients. Our objective was to identify current problems in TT management and implement a consistent, reproducible process to reduce average TT and process variability. Initial observations of TT were made to document the existing process at a 511 bed, 24 OR, academic medical center. Three control groups, including one consisting of Orthopedic and Vascular Surgery, were used to limit potential confounders such as case acuity/duration and equipment needs. A redesigned process based on observed issues, focusing on a horizontally structured, systems-based approach has three major interventions: developing consistent criteria for OR readiness, utilizing parallel processing for patient and room readiness, and enhancing perioperative communication. Process redesign was implemented in Orthopedics and Vascular Surgery. Comparisons of mean and standard deviation of TT were made using an independent 2-tailed t-test. Using all surgical specialties as controls (n = 237), mean TT (hh:mm:ss) was reduced by 0:20:48 min (95 % CI, 0:10:46-0:30:50), from 0:44:23 to 0:23:25, a 46.9 % reduction. Standard deviation of TT was reduced by 0:10:32 min, from 0:16:24 to 0:05:52 and frequency of TT≥30 min was reduced from 72.5to 11.7 %. P < 0.001 for each. Using Vascular and Orthopedic surgical specialties as controls (n = 13), mean TT was reduced by 0:15:16 min (95 % CI, 0:07:18-0:23:14), from 0:38:51 to 0:23:35, a 39.4 % reduction. Standard deviation of TT reduced by 0:08:47, from 0:14:39 to 0:05:52 and frequency of TT≥30 min reduced from 69.2 to 11.7 %. P < 0.001 for each. Reductions in mean TT present major efficiency, quality improvement, and cost-reduction opportunities. An OR redesign process focusing on parallel processing and enhanced communication resulted in greater than 35 % reduction in TT. A systems-based focus should drive OR TT design.

Factors That Influence the Efficiency of an Endoscopy Unit: A Patient Flow Analysis

Introduction: With increasing demand for endoscopic procedures in the context of limited resources, it is imperative to identify factors that can be optimized to influence efficiency of the endoscopy unit. Methods: A prospective study from December 2013 to March 2014 was undertaken in the endoscopy unit at the Hotel-Dieu Hospital, Kingston, Ontario. Time elapsed for all components from patient registration to exit from the endoscopy unit was recorded. The data was collected in three components: individual endoscopy room utilization, pre-procedure room, and overall endoscopy unit room usage. Mean times were analyzed to identify if maximal time consumption was attributed to patient related, endoscopist related, equipment or process related causes. Results: Data were collected for 137 procedures in the endoscopy room, 139 procedures in the preprocedure room, and 143 procedures for overall room usage. The mean time for patient registration was 39.22 minutes ahead (95% CI: -44.76 to -33.68) of their scheduled starting time. The mean time spent in the pre-procedure room was 50.15 minutes (95% CI: 45.84 - 54.47). The mean time delay from the scheduled start time to the actual time the patient was transferred into the endoscopy room was 18.51 minutes (95% CI: 13.44 - 23.58). Whilst, the mean time delay between scheduled starting time to that of endoscopist arrival into the endoscopy suite was 27.05 minutes (95% CI: 20.93 - 33.18). Overall, the mean time spent by the patient in the endoscopy room was found to be 27.15 minutes (95% CI: 24.60 - 29.69) for an EGD, 57.95 minutes (95% CI: 50.38 - 65.53) for a colonoscopy, 71.29 minutes (95% CI: 49.36 - 93.22) for a double procedure, and 29.15 minutes (95% CI: 16.16 - 42.13) for a flexible sigmoidoscopy. The average room turnover time was found to be 7.42 minutes (95% CI: 6.85 - 8.00). Conclusion: There is limited literature on the range of efficiencies or validated methodology for evaluating the endoscopy unit. Nevertheless these findings are consistent with the recognition that individual units have unique operational characteristics and that identifying bottlenecks can lead to optimization of resources appropriately. The patient arrival to the endoscopy unit was ahead of their scheduled registration time. However their entry into the endoscopy suite was much delayed, independent of further delay contributed by endoscopist unavailability. This suggests that delays cannot be attributed to patient related causes and are either endoscopist or process related. Endoscopy efficiency to improve patient throughput is imperative for quality of care. Hence, the next phase underway entails staff interviews to further characterize the impediments and facilitate implementation of targeted quality improvement initiatives.

Patient-Specific Versus Conventional Instrumentation for Total Knee Arthroplasty: Peri-Operative and Cost Differences

The role of patient-specific instrumentation in total knee arthroplasty (TKA) is yet to be clearly defined. Current evidence evaluating peri-operative and cost differences against conventional TKA is unclear. We reviewed 356 TKAs between July 2008 and April 2013; 306 TKAs used patient-specific instrumentation while 50 had conventional instrumentation. The patient-specific instrumentation cohort averaged 20.4 min less surgical time (P < 0.01) and had a 42% decrease in operating room turnover time (P = 0.022). At our institution, the money saved through increased operating room efficiency offset the cost of the custom cutting blocks and pre-operative advanced imaging. Routine use of patient-specific TKA can be performed with less surgical time, no increase in peri-operative morbidity, and at no increased cost when compared to conventional TKA.

Sa1436 Applying Lean Process to Decreasing GI Endoscopy Procedure Room Turnover Time

Sa1436 Applying Lean Process to Decreasing GI Endoscopy Procedure Room Turnover Time

Microbial surface contamination after standard operating room cleaning practices following surgical treatment of infection.

At the authors' institution, some joint arthroplasty surgeons require the operating room to be terminally cleaned before using the room after infected cases, in theory to decrease exposure to excessive microbial contamination for the subsequent patient. The authors found no guidance in the literature to support this practice. To test this theory, the authors measured microbial surface contamination from 9 surfaces in operating rooms after standard operating room turnover following 14 infected cases vs 16 noninfected cases. A check was made for an association between organisms isolated intraoperatively from infected surgical patients immediately preceding standard cleaning and organisms isolated from common operating room surfaces. Colony counts were made at 24 and 48 hours, and organisms were identified. No significant difference was noted in colony counts between infected and noninfected cases, and no relationship was found between organisms isolated from infected cases and those from operating room surfaces. Furthermore, the largest colony count from both groups (0.08 cfu/cm(2)) was an order of magnitude less than the recently proposed 5 cfu/cm(2) threshold for surface hygiene in hospitals. This finding indicates that standard operating room turnover results in minimal surface contamination, regardless of the previous case's infection status, and that there is no need for a more extensive terminal cleaning after an infected case.

The Efficiency of a Dedicated Staff on Operating Room Turnover Time in Hand Surgery

To evaluate the effect of orthopedic and nonorthopedic operating room (OR) staff on the efficiency of turnover time in a hand surgery practice. A total of 621 sequential hand surgery cases were retrospectively reviewed. Turnover times for sequential cases were calculated and analyzed with regard to the characteristics of the OR staff being primarily orthopedic or nonorthopedic. A total of 227 turnover times were analyzed. The average turnover time with all nonorthopedic staff was 31 minutes, for having only an orthopedic surgical technician was 32minutes, for having only an orthopedic circulator was 25 minutes, and for having both an orthopedic surgical technician and a circulator was 20 minutes. Statistical significance was seen when comparing only an orthopedic surgical technician versus both an orthopedic circulator and a surgical technician and when comparing both nonorthopedic staff versus both an orthopedic circulator and a surgical technician. OR efficiency is being increasingly evaluated for its effect on hospital revenue and OR staff costs. Reducing turnover time is one aspect of a multifaceted solution in increasing efficiency. Our study showed that, for hand surgery, orthopedic-specific staff can reduce turnover time. Economic/Decision Analysis III.

Successful strategies for the reduction of operating room turnover times in a tertiary care academic medical center

BackgroundTurnover time (TOT) is one of the classic measures of operating room (OR) efficiency. There have been numerous efforts to reduce TOTs, sometimes through the employment of a process improvement framework. However, most examples of process improvement in the TOT focus primarily on operational changes to workflows and statistical significance. These examples of process improvement do not detail the complex organizational challenges associated with implementing, expanding, and sustaining change. MethodsTOT data for general and gastrointestinal surgery were collected retrospectively over a 26-mo period at a large multispecialty academic institution. We calculated mean and median TOTs. TOTs were excluded if the sequence of cases was changed or cases were canceled. Data were retrieved from the perioperative nursing data entry system. ResultsUsing performance improvement strategies, we determined how various events and organizational factors created an environment that was receptive to change. This ultimately led to a sustained decrease in the OR TOT both in the general and gastrointestinal surgery ORs that were the focus of the study (44.8 min versus 48.6 min; P < 0.0001) and other subspecialties (49.3 min versus 53.0 min; P < 0.0001), demonstrating that the effect traveled outside the study area. ConclusionsThere are obstacles, such as organizational culture and institutional inertia, that OR leaders, managers, and change agents commonly face. Awareness of the numerous variables that may support or impede a particular change effort can inform effective change implementation strategies that are “organizationally compatible.”

Deep Sedation or General Anesthesia for ERCP?

Ideal sedation for endoscopic procedures should maximize patient comfort and safety. However, during many endoscopic procedures performed under conscious (i.e., moderate) sedation, patient comfort is compromised to some extent in the interest of safety. Although conscious sedation was the mainstay for most endoscopic procedures over the initial decades of endoscopy, anesthesia services have increasingly been utilized over recent years to provide deeper levels of sedation [1]. The key driver for increased anesthesia utilization over the last decade has been the need to improve patient comfort, satisfaction, and safety while simultaneously improving the efficiency of endoscopy units. A significant facilitating factor has been the introduction and availability of new pharmaceutical agents such as propofol, which allow rapid induction of deep sedation while also enabling rapid recovery [2]. Propofol sedation for gastroscopy and colonoscopy is as safe as sedation using traditional agents, whether administered by anesthesia providers or under the direction of endoscopists [3]. Numerous studies attest to its benefits, including improved patient cooperation during the procedure, improved patient satisfaction, reduced procedural and recovery times, and, consequently, improved throughput and efficiency of endoscopy units [4]. In 2007, approximately 25 % of U.S. colonoscopies and gastroscopies were performed with anesthesiologist-assisted sedation [1]. Given the relative simplicity and brevity of many of these basic endoscopic procedures and the significant cost burden associated with the use of anesthesia, this practice remains controversial and consequently has not been universally adopted. In contrast, endoscopic retrograde cholangiopancreatography (ERCP) is a more complex endoscopic procedure that usually takes longer to perform. A recent study evaluating patients undergoing ERCP under conscious sedation found that between a third and a half of patients experienced pain and discomfort during the procedure and periprocedural period [5]. An additional study indicated that the procedural failure rate in patients undergoing ERCP with sedation was double the failure rate when general anesthesia was utilized (14 vs. 7 %). The higher failure rate with conscious sedation was entirely due to ERCPs that were terminated prematurely (8.5 %) due to inadequate sedation [6]. These data constitute powerful arguments for the use of deep propofol sedation or general anesthesia in patients undergoing ERCP and, indeed, this is the trend in many academic medical centers across the U.S. However, there is a dearth of literature evaluating the most appropriate type of sedation or anesthesia for complex endoscopic procedures such as ERCP. A recent Cochrane review identified only four randomized controlled studies comparing moderate sedation using midazolam and meperidine with propofol administered by non-anesthesiologists for ERCP. No difference in mortality, serious cardio-respiratory complications, or patient satisfaction between the two sedation techniques was noted, although patients receiving propofol sedation had a faster and better recovery profile [7]. From the viewpoint of endoscopy room efficiency, propofol sedation where safe is preferable to general anesthesia as it allows for a more rapid procedure room turnover. Anesthesia practices vary from center to center and also between anesthesiologists at the same center, with some anesthesiologists judiciously choosing between deep N. Thosani S. Banerjee (&) Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA e-mail: sbanerje@stanford.edu

"Six Sigma" as an Effective Process for Reducing Waiting Time in Surgery Patients

Background: This study investigates the outcomes of implementing Six Sigma concept to manage the total waiting time and room turnover time in the operation theater. Methods: Samples were obtained by recording the time of six major-operation activities in one medical centers located at northern Taiwan. The waiting time was divided into three groups (&lt;120 minutes="" 121-240=""&gt;240 minutes). Totally, 1,246 patients were collected as the first group (pre-study) while as another 1,266 patients after the improvement of process in the fifth month were collected as the second group (post-study). Analysis was made with descriptive statistics and to compare the differences between the pre-and post-processes. Results: The reduction of waiting time for each study group were 0.54, 4.23, 7.82 minutes respectively (p&lt;0.05); average surgery turnover time significantly decreased for each group also. The quality indicator of Six Sigma were changed from 3.35δto 3.46δ. This confirmed that the intervention of the Six Sigma concept in patient-processing management can minimize the variations in the surgical processes and stabilize the process. Conclusions: The contribution of this study lies in providing administration references for peer general hospitals, surgery departments and administrators in OR with a standard operation procedure to decrease total waiting time for surgical patients as well as to effectively shorten the waiting time for the next-in-line patient.

Operating room efficiency improvement after implementation of a postoperative team assessment

IntroductionOperating room time is highly resource intensive, and delays can be a source of lost revenue and surgeon frustration. Methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization. The purpose of this study was to determine the root cause of operating room delays in a standardized manner to help improve overall operating room efficiency. MethodsWe performed a single-center prospective observational study analyzing operating room utilization and efficiency after implementing an executive-driven standardized postoperative team debriefing system from January 2010 to December 2010. ResultsA total of 11,342 procedures were performed over the 1-y study period (elective 86%, urgent 11%, and emergent 3%), with 1.3 million min of operating room time, 865,864 min of surgeon operative time (62.5%), and 162,958 min of anesthesia time (11.8%). Overall, the average operating room delay was 18 min and varied greatly based on the surgical specialty. The longest delays were due to need for radiology (40 min); other significant delays were due to supply issues (22.7 min), surgeon issues (18 min), nursing issues (14 min), and room turnover (14 min). Over the 1-y period, there was a decrease in mean delay duration, averaging a decrease in delay of 0.147 min/mo with an overall 9% decrease in the mean delay times. With regard to overall operating room utilization, there was a 39% decrease in overall un-utilized available OR time that was due to delays, improving efficiency by 2334 min (212 min/mo). During this study interval no sentinel events occurred in the operating room. ConclusionsA standardized postoperative debrief tracking system is highly beneficial in identifying and reducing overall operative delays and improving operating room utilization.

P-008 Use of the axera neurovascular access device as a tool to promote patient comfort, faster recovery and turnover times without an arterial implant

PurposeVascular access is an area where little has changed in the past decade. Multiple devices currently available promise shorter patient recovery times with the use of sutures or plugs in...

Lean Management in Academic Surgery

Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities. In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study. There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite.

Self-Disinfecting Surfaces

Affiliations: 1. Department of Medicine, University of North Carolina Medical School, Chapel Hill, North Carolina; 2. Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina. Received October 30, 2011; accepted October 31, 2011; electronically published December 7, 2011. 2011 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2012/3301-0003$15.00. DOI: 10.1086/663648 Contamination of environmental surfaces in hospital rooms is now recognized as playing an important role in the transmission of several key healthcare-associated pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, Acinetobacter species, and norovirus. All of these pathogens have been demonstrated to persist in the environment for hours to days (and in some cases for months), to frequently contaminate the environmental surfaces in the rooms of colonized or infected patients, to transiently colonize the hands of healthcare personnel (HCP), to be transmitted to patients by HCP, and to cause outbreaks in which environmental transmission was deemed to play a role. Furthermore, hospitalization in a room in which the previous patient had been colonized or infected with MRSA, VRE, C. difficile, or Acinetobacter species has been shown to be a risk factor for colonization or infection with the same pathogen in the newly admitted patient. Pathogen transfer from an affected patient to a susceptible host occurs most commonly via the hands of HCP, but contaminated surfaces, objects, and air can be directly or indirectly involved in the transmission pathway. These transmission pathways and methods to interrupt transmission have been diagramed. Transmission can be greatly reduced by hand hygiene of HCP before and after each patient contact and by appropriate disinfection of shared medical devices between patients. However, reducing or eliminating surface contamination is crucial to preventing acquisition of healthcare pathogens by patients who are newly admitted to rooms previously occupied by colonized or infected patients and to minimizing the risk of contaminating the hands of HCP. Potential methods of decreasing contamination of environmental surfaces in hospital rooms have included routine and terminal room disinfection with chemical germicides and, more recently, the use of “no-touch” methods of terminal room decontamination with UV light or aerosolized and/or vaporized hydrogen peroxide. Unfortunately, there are major limitations associated with currently available methods of room decontamination. Multiple studies have demonstrated that less than 50% of hospital room surfaces are adequately cleaned and disinfected when chemical germicides are used, although with implementation of enhanced performance feedback, education, and other interventions, the frequency of appropriate cleaning can be increased to 71%–77%. The major limitation of UV light and hydrogen peroxide is that, because this method requires the removal of patients and HCP from the room, it can be used only for terminal disinfection. Other limitations include the high acquisition costs of room decontamination units and increasing the time of room turnover. In the past several years, another method of reducing contamination of room surfaces has emerged: self-disinfecting surfaces (Table 1). Such surfaces have also been called “selfsanitizing,” and because microbial killing requires direct contact with the surface, the term “contact killing” has also been used. One novel method to achieve contact killing is to cover room surfaces with a transition metal, such as copper or silver. Such metals influence microorganisms by affecting their growth, morphology, and biochemical activities. Toxicity is a result of the blocking of functional groups of important molecules (eg, enzymes), displacement or substitution of essential ions from cellular sites, denaturation and inactivation of enzymes, generation of reactive hydroxyl radicals, and disruption of cellular membrane integrity. Copper is an essential trace element in most living organisms and has been used for centuries as a medicinal as well as to prevent growth of barnacles and weeds on the hulls of ships. Copper surfaces have been demonstrated to be cidal to important healthcare-associated pathogens, including MRSA, Acinetobacter species, Pseudomonas aerugonosa, and influenza virus. Experimental inoculation of copper surfaces has demonstrated that dry metallic surfaces were more antimicrobial than were moist surfaces. On dry surfaces, vegetative bacteria were killed within a few minutes. How soiling,

How time flies: a prospective analysis of theatre efficiency during elective gynaecology lists

The aim of this study was to assess the time patients spend at the various stages of the surgical journey and identifying factors that lead to “bottlenecks”. A prospective, observational study of 70 patients over 23 consecutive elective gynaecology lists. Timelines of patients' surgical journey were recorded and various outcomes such as room turnover and patient turnaround intervals calculated. Of the 70 patients (23 major and 47 intermediate), 32 were managed by one anaesthetist and 38 cases by two. The mean arrival in the operating theatre—knife-to-skin interval for major cases was significantly longer than intermediate (17.9 vs. 12.05 min, p = 0.001), but there were no statistically significant differences in other time intervals between major/intermediate cases. The mean patient turnaround and room turnover times for the 70 cases were 44.2 and 60.0 min, respectively, and only 60.3% of theatre time was actually spent on surgery. Having two anaesthetists reduced the arrival in the operating theatre—knife-to-skin interval by a mean of 4 min (11.4 vs. 16.63 min, p = 0.045) but had no positive effect on other variables. Prolonged patient turnover leads to significant delay, resulting in impaired efficiency. Factors in individual cases which affected patient turnaround time include inadequate preparation of equipment and delays in preparing the patient before anaesthesia. Deploying extra personal at the appropriate time can lead to efficiency savings but adequate planning of both schedules and equipment will lead to the best outcomes.

A “swing room” model based on regional anesthesia reduces turnover time and increases case throughput

Our centre recently implemented a new ambulatory care model featuring two alternate regional anesthesia "swing" operating rooms (RA-SRs) managed by a single anesthesiologist. We hypothesized that this model would be associated with decreased turnover times and improved recovery profiles when compared with a traditional model with a single operating room using general anesthesia. We conducted a retrospective cohort study of 164 patients scheduled for hand and wrist surgery who were treated in the RA-SRs under brachial plexus blockade, and we compared the findings with a matched historical control group of patients who underwent general anesthesia in a single operating room (GA-OR). The primary endpoint was room turnover time. Secondary endpoints included home discharge time, postoperative interventions for nausea and pain, and number of cases possible per eight-hour day. Patients in the RA-SR group had faster turnover times than patients in the GA-OR group (median [interquartile range]: 15 min [8-22] vs 54 min [49-61], respectively) as well as faster home discharge times (28 min [20-46] vs 156 min [118-215], respectively) (P < 0.0001). In the RA-SR group, postoperative antiemetics were used in 3/164 patients (2%) vs 28/164 (17%) in the GA-OR group (P < 0.0001), and opioids were used in 1/164 (0.6%) vs 132/164 (80%), respectively (P < 0.0001). The median number of daily cases possible in the RA-SR group was 56% greater than in the GA-OR group (8.4 [7.5-9.4] vs 5.4 [5.1-5.8], respectively; P < 0.0001). Compared with a traditional model using general anesthesia in a single operating room, the implementation of a model using regional anesthesia with two swing operating rooms was associated with reduced room turnover times, improved recovery profiles, and a higher case throughput.

2011 ARIN Convention—Chicago, Illinois

The 30th Annual Convention of the Association for Radiologic & Imaging Nursing (ARIN) was held during March 27 to 30 in Chicago, IL, at the McCormick Place Convention Center and Hyatt Regency Hotel. The Windy City was indeed a bit chilly but beautiful and invigorating. The theme for the 2011 gathering was Adding to Out Legacy One Pearl at a Time. The success and legacy of ARIN was a theme for celebration throughout the conference, celebrating 30 years of advancing the practice of radiology nursing. Preconference workshops began on Friday with the Imaging Nurse Review Course led by Past President Kathy Scheffer and master faculty. This review course presented the revised course syllabus for the first time. Preconference workshops continued on Joint Commission Updates for Hospital Imaging Departments, a thorough presentation on What it Means to Be a Primary Stroke Center, and How to Get There, the afternoon wrapped up with a well-attended session;Understanding Budgeting in Hospital Imaging Departments. Sunday began the full conference schedule, kicking offwith an enlightening talk byDr.ArturoGonzalez telling us all about compliance and how it impacts our radiology departments.Dr.AnthonyVenbrux updated us on the importance of treating both chronic and acute deep venous thrombosis, followed by Katherine Duncan, RN, CRN, EMT educating us on What to do Until the Code Team Arrives. After an informative and interesting report on interventional radiology room turnover improvement by Jason Patton, BSN, RN, President Mag Browne-McManus cut the ARIN 30th Anniversary cake. The poster session offered many beautiful detailed posters of important projects undertaken by our peers across the country. The always popular Society of Inter-

Targeting High Touch Items Improves Patient Room Cleaning at a County Teaching Hospital

Studies have shown that microbes found in a contaminated environment, especially contamination of high touch items, can be a factor in healthcare associated infections. The current trends to decrease the number of employees but ask for rapid patient room turnover to relieve Emergency Department congestion, can lead to the misperception that a patient room clean to the naked eye is adequately clean. During an MDRO outbreak in 2009 we identified improperly disinfected touch items in patient rooms.

A Strategy for Reducing Surgical Backlogs: Lessons from a Veterans Administration Hospital

A process was developed to use a nontraditional operative day (Saturday) to increase the number of inguinal herniorrhaphies (IHs) performed. The purpose of this analysis was to compare operating times and outcomes between patients undergoing IH on Saturday versus the weekday. A retrospective review was conducted that included patients who underwent IH from October 2008 to January 2010. This cohort was divided based on the day on which surgery occurred. The outcome measures were operative times, room turnover time, and complication rates. Operative time was shorter for Saturday IHs (50.7 vs. 67.8 min, P ≤ 0.001). The greatest difference between the two groups occurred in turnover times. We considered Saturday turnover time to be zero, which was possible because of multiple support teams and additional room availability. Turnover times during the week averaged 40.5 ± 2 minutes. There was no difference in complication rates for the two groups (Saturday IHs 17.6% vs. 20.9% for weekday IHs, P = 0.75). Elective cases can be accomplished more rapidly during nontraditional operating times if there are multiple support teams and rooms available.

The Utilization of Six Sigma and Statistical Process Control Techniques in Surgical Quality Improvement

Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services.

Optimizing Operating Room Time Efficiency- Additional Obstacles to Efficient Case Flow

Introduction One of the greatest resources in the operating room is time. Its conservation can both save and make capital with improvement in OR utilization, increased throughput of patients, and a reduction in wasted time by surgeons and other costly OR personnel. Potential areas of improvement have been identified in the past, including increasing on-time surgical starts, decreasing room turnover times, ensuring accuracy of surgeon preference cards, and improving multidisciplinary communication.