John Di Capua, MD, is deputy CEO and chief medical officer of North American Partners in Anesthesia Corp.; vice president of anesthesia services of North Shore-Long Island Jewish Health System; and chairman and the Peter Walker Professor of Anesthesiology in the department of anesthesiology of Hofstra University-North Shore LIJ School of Medicine. Dr. Di Capua previously discussed "Hospital OR Turnover Challenges and Solutions."
Q: What measures can be taken in order to improve surgical preparation and patient draping time?
Dr. John Di Capua: In order to be proactive in minimizing surgical prep and patient draping time, there really should be a parallel process in place between the anesthesia team and nursing. Once the patient is in the room, the anesthesia team should begin treating the patient, while nursing is getting their equipment ready for the case.
In a lot of hospitals, this tends to be done serially, where the patient is not allowed into the room until all of the equipment has been opened, which equates to time lost. The typical anesthesia prep time once in the OR is around 10-20 minutes. The anesthesiologist has to put in an IV, possibly put in an arterial line, start the sedation process, put on monitors — all of which takes time. If there is a parallel process implemented that allows anesthesia prep time to coincide with the time when nurses open their equipment, you can shave 15-20 minutes off of your turnover time, and that's assuming you count turnover time as wheels out to surgery start time.
A lot of hospitals and ambulatory surgery centers measure turnover time as "wheels out to wheels in" but that's only half of the turnover time. Typically, what surgeons use to measure turnover time is the time they leave the OR from the end of one case to the time they actually start the next operation, which includes the anesthesia prep time.
Q: How effective is parallel processing on reducing turnover time?
JD: Probably the first thing you can do at any hospital that wants to reduce turnover time is implement a parallel process system. Parallel process can reduce turnover time by up to 50 percent. Other ideas include creating a tracking board system in the OR so the people who clean the room know exactly what stage of a surgery you're in. By doing this, the crew does not need to be called to clean the room. They're already waiting outside the door when the patient leaves. You can page surgeons when you're getting close to the end of the prior case so they know when their room is ready for their next case. You can develop a case cart system so packs come up properly designed for the next case.
All-in-all, for not a very high-tech/equipment case, your best practices can probably get turnover time in a main OR inpatient case to about 15-20 minutes, against the usual 30-40 minutes.
Q: What factors impact creating and implementing a parallel process in a hospital?
JD: It requires a little bit of additional resources commitment for nursing because if they're going to be opening and counting their equipment, they can't be focused on the patient. You typically need an ancillary assistant to help the patient while the anesthesiologist is getting ready. It's certainly worth the investment to allow the RN and the surgical tech to be doing what they have to be doing on the equipment side. The resource is not a high-tech resource but it does require just a little investment to allow parallel process.
Learn more about North American Partners in Anesthesia.
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