1. Goss, Linda K. MSN, ARNP-BC, CIC, COHN-S

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OR processes must follow a predetermined routine so that healthcare providers can quickly and safely care for one patient while preparing for another. The processes may appear to work seamlessly, but there's always potential for improvement. Try the tips in this article for reviewing current processes and identifying areas for improvement.


Typical activities associated with surgery follow an algorithmic process and include the surgeon closing the case, the anesthesia provider completing the anesthesia process, the circulating nurse completing the documentation, and the patient leaving the room.1


Each OR team member has a role in the process. Understanding the importance of each person's role and its effect on the overall OR schedule is imperative to improving turnover time.


The OR nurse has an opportunity to control many aspects of the surgical process and can provide -valuable input to those in management who can implement change. Review of the following may provide insight into areas for improvement:


* Supplies can be managed efficiently via automated inventory systems with predetermined par levels that help contain costs and assure appropriate supplies for case selection.2 Periodically review preference cards to standardize like procedures as much as possible. Reviewing this aspect as a quality measure can help identify gaps in the process.


* Work flow can be affected by many factors, including space constraints, equipment placement, assigned tasks, and interruptions. Changing the OR layout can maximize space without compromising the overall process. A simple count of the circulating nurse's tasks and where they occur may provide opportunity for adjustment and free valuable time.3


* Patient flow from the preoperative area to the OR and to the postanesthesia care unit can affect overall turnover time. Ideally, tasks that are traditionally sequential activities should be performed in parallel to each other.4,5 Reviewing the process with the -facilities engineer or architect may provide new insight into managing competing processes. New construction usually isn't an option, but areas may be reorganized or relocated to minimize delays and decrease overall wait times.


* Cleaning begins intraoperatively and continues postprocedure. Breaking down equipment and counting as you go lets staff vacate the OR entirely once the case is closed. Segregating waste early on in the case eases the transition for disposing of the waste. Minimizing contamination and unnecessary supply use will also help in the overall process. Environ-mental staff should be prepared to immediately clean and remove trash and ready the OR for the next case.



Products are now available that may help expedite the cleaning process. OR turnover systems use the bundle approach adopted by nursing to group together items needed to completely clean and ready a room for the next patient. The bundles contain drapes for equipment, patient drapes, trash bags, linen bags, impervious bed linens, disposable mop heads, and other custom products.


By revisiting current processes and identifying areas for improvement, you can lead the process to improve throughput and OR turnover times.




1. Surgery Management Improvement Group. Rapid operating room turnover. [Context Link]


2. Sandberg WS, Daily B, Egan M, et al. Deliberate perioperative systems design improves operating room throughput. Anesthesiology. 2005;103(2):406-418. [Context Link]


3. Cendan JC, Good M. Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for -additional caseload. Arch Surg. 2006;141(1):65-69. [Context Link]


4. Park KW, Dickerson C. Can efficient supply management in the -operating room save millions? Curr Opin Anesthesiol. 2009;22(2):242-248. [Context Link]


5. Friedman DM, Sokal SM, Chang Y, Berger DL. Increasing operating room efficiency through parallel processing. Ann Surg. 2006;243(1):10-14. [Context Link]