How to Improve Operating Room Efficiency

Operating rooms (OR) have a yearly profit and loss (P&L) guideline that they must follow to stay within the hospital's overall budget. A nurse manager is responsible for reducing nonoperative time (NOT) and room turnover time (TOT), which is counted against the budget. Unfortunately, a significant amount of time is spent on patients besides an anesthesia induction and the surgical procedure. Changes in staffing and technology may result in higher efficiency ratings and less NOT.

Instructions

• 1

  Meet with the operating room department heads; anesthesia, chief of surgery, nursing, housekeeping and sterile processing. Gain the endorsement and support from each manager to run a more efficient operating room. Create a document for each department head with expectations and suggestions of how to reach the mutual goal for turnover in the OR. Encourage each manager to express their ideas and suggestions to make changes to reduce the TOT and NOT.

• 2

  Conduct meetings with the mid- and lower-level staff in the operating room to share the new ideas and equipment that will be used to decrease turnover time. Encourage the doctors, nurses, surgical techs, anesthesia techs, sterile processing techs and surgical housekeeping staff to express their concerns and share ideas. Gain a commitment from each staff member to do their best to decrease TOT and NOT. Lead the team to work together as a unit.

• 3

  Create a new document to record TOT, NOT, patient in the room time (PRT) and how quickly the turnover team arrives after the patient leaves the room after surgery. Designate a dedicated nurse monitor who will walk room-to-room and document results. Chart the time each team takes to turnover a room. Document each success or failure for further review by the nurse manager.

• 4

  Respect the challenges each department faces to meet the expectations for a faster turnover.

  Follow up with the department managers after one week to discuss areas that need improvement. Refrain from encouraging staff to work faster and harder, there are far better ways to reach the new goals. Use new technology, modify the design of the OR, increase support staff, and experiment with modifying work flow. Highlight the successes and the on-going teamwork of each department to improve the NOT and TOT. Discuss how the NOT and TOT could be better by using different strategies. Coordinate the complete scheme of manager-agreed processes, such as extra people and new technology. Evaluate the reduced NOT and TOT in cases that last two hours or less with a constant vigil over staff and new equipment or technology.

• 5

  An operating room for OB/Gyn will have a different NOT than open heart surgery,

  Assess any success of the overall goals. Share results during the weekly staff meetings, so they may continue to participate, and have a sense of ownership in the goals to lower the TOT and NOT. Tailor the long-term goals based on the special needs of an ever-changing operating room. Evaluate a day of eye surgeries with different expectations for turnovers than delivering newborns or open heart surgery. Allow for variants, change of staff and time of day, when calculating the NOT. Realize that a small tray of eye instruments will take less time in the autoclave than two large trays for a Cesarean section (C-section).

• 6

  Set a reasonable goal for each successive month. Create a chart that is visible in the lunch room where staff can see the results. Encourage the on-going team effort, by making announcements of the teams who surpass set standards. Over time, staff members will incorporate all the changes as standard practice.