you streamline? Begin this process with an open mind.
"When we started out, we didn't know what we were looking for,"
says Alicia Rock, BSN, RN, CNOR, interim assistant nurse manager at
University of Iowa Hospitals and Clinics in Iowa City. "But after
watching, the issues became obvious. We were able to narrow them
down to things that we'd be able to influence."
Spaghetti diagrams that trace each member of the turnover team's
path will help you identify wasted movements that you as the conduc-
tor of this OR orchestra can eliminate. Alternatively, you could ask all
those involved in turning over rooms — surgeons, anesthesia
providers, nurses and techs — to map out their roles in the process.
"Determine which steps are 'valued' — those that generate a positive
return on investment in terms of the resources or staffing involved, or
cannot be eliminated without having a negative impact," says Robert
Cerfolio, MD, MBA, chief of clinical thoracic surgery at NYU Langone
Health in New York City. He helped lead efforts to cut average
turnover times in the hospital from 37 minutes to 14 minutes, well
under the 20-minute goal his team set out to achieve.
Then, says Dr. Cerfolio, do whatever is necessary to eliminate
unnecessary or non-valued steps in the turnover process. For exam-
ple, circulating nurses at NYU Langone no longer walk to the supply
room to retrieve needed supplies between cases. Instead, techs gather
supplies the night before surgery and store them in case carts, which
are wheeled into the OR as needed.
2. Assign roles.
Just as having not enough staff show up to turn a
room over is a problem, so is having too many. Yes, many hands usually
make light work, but Ms. Rock noticed that too many team members
mopping the floor or spraying a surface actually slowed the team down
and resulted in duplication of efforts at University of Iowa Hospitals.
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