by Alan J Brander RN FACHE MBA BSN BSW HACP
Turnover Times are one of the most talked about areas to improve efficiency and increase revenue in the Surgery Department. As a former Surgical Director, this was one of the metrics we tracked and discussed regularly with our nurses, surgeons, and anesthesiologists.
We emphasized Turnover Time because the time between surgeries was lost revenue-generating opportunity for all parties: The Hospital, the Surgeon, and the Anesthesiologist.
But those conversations were often challenging due to two major factors: One is each party's definition of what Turnover Time is, and a lack of real time tools to measure and track improvement.
The reality is, Turnover Time is different depending on your role in the OR.
For Nurses, Turnover Time means the amount of time from one patient leaving the Operating Room to the next patient entering.
For housekeeping or a turnover crew, Turnover Time means the time it takes for them to dispose of the last case’s trash, linen and trays; and then clean the room so set-up can begin for the next case.
For Anesthesiologists, Turnover Time means from the time a patient is transported to PACU and report given, to the next patient's anesthetic induction.
For a Surgeon, Turnover Time means from the closure of one patient's surgical wound to the next patient's incision.
In the 30-suite surgery department where I worked, we measured on-time starts for the first-case of the day, and ran aggregated retrospective reports from the previous quarter out of our various software programs.
We focused on this metric first because everyone agreed this was an area we needed to be more consistent. Every surgical director understands that when the first case of the day starts late, that will cause delays to subsequent cases, causing bottlenecks and frustrating, surgeons, anesthesiologists, staff, and most importantly, our patients and their families.
The key to improving this metric was a commitment by all three parties: surgeons, nursing leadership and anesthesiology to starting on time. We set common definitions of what constitutes an on-time start and what each party should be doing to ensure we hit the defined time. Within this multidisciplinary team, we made sure there was adherence, by all specialties, for an on-time first-case start, every time!
This constant mapping, tracking, and reporting moved us from a 52% on-time start to 98% in six months. We were not alone in this accomplishment, just Google 'On-time starts for first-case of the day' and you will find hundreds of articles from hospitals and ASCs outlining various strategies and techniques to accomplish this.
The retrospective reporting from our various software programs was used to measure how we did the rest of the day, after our first-case start time. The reality of this data, while it provided averages, wasn’t helpful to drive improvement. It did not measure the key data points that each party needed based on their definition of Turnover Time.
Additionally, it was difficult to pinpoint the cause of the delay which had happened weeks or months ago, even with reporting from the EHR and Anesthesia data. The truth was the delay happened, and in the moment, we were unable to respond decisively to intervene, and the data showed us that reality.
With the first case of the day we were proactive, with all other delays we were reactive.
In fact, the only real time alert of a delay was when a surgeon was standing at my door complaining about a turnover that was slowing him down and costing him money.
While there were hundreds of studies and proscriptions for First Case On-Time start, what we needed was a tool that communicated with all interested parties and alerted us to any delay as it happened. That way we could truly manage Turnover Times throughout the day, and compare them immediately to benchmarks that we set.
With that data, we could improve Turnover Times and capture the revenue lost in an idle OR.
Working with Under the Mountain Software, we’ve created the Turnover Tracking tool I wish I had when I was a surgical director.
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Turnover Tracker is a simple to implement web application. Start tracking your turnovers and communicating operating room status with immediate notifications. Take control of your OR workflow.
Turnover Tracker is a collaboration between Under the Mountain Software, a Grand Rapids, Michigan based software company, and Alan Brander RN FACHE MBA BSN BSW HACP.
Alan is a former Director of Surgery at Spectrum Hospital. His previous software idea became TrackCore, a successful software solution for tracking implant chain of custody.
Real-time turnover tracking management had no simple technology solution before Turnover Tracker. Take 15 minutes and get started today!