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The Willingness To Change Operating Workflow

Improve operating room turn around time and eliminate hidden waste

Most hospitals define turnaround time as previous patient ‘wheels out’ to the next patient ‘wheels in’ – where ‘wheels out’ and ‘wheels in’ are the exact times that a patient bed rolls out of or into an operating room (OR). This is a key metric in determining OR efficiency, as long turnarounds reduce available operating time and longer-than-planned turnarounds cause OR delays. Because this is so important, most hospitals know what their OR turnaround times are and if they are increasing or decreasing. What many hospitals rarely have visibility into, however, is why their turnaround times are moving. This is because most hospitals only record their ‘wheels out’ and ‘wheels in’ times. While this provides them their total turnaround time, it fails to provide visibility into how each step in the process is performing. We believe that breaking turnaround time into three areas – namely: clean time, preparation time, and delay time – allows for a complete picture into why turnaround times are changing, and most importantly: where they are changing.

Clean time

Also called turnover time is the amount of time it takes to clean the room from the previous surgery. Hospitals generally manage this area very well, as leadership often thinks this is the key to reducing their turnaround times. Although these times are rarely regularly recorded in a hospital, this area, somewhat surprisingly, has the smallest opportunity area for improving turnaround time since it often has the most policies, procedures, and guidelines surrounding it – not to mention hospitals are subject to certain constraints regarding critical cleaning chemical instructions.

Preparation time

Refers to the amount of time it takes to bring in and arrange the bedding, instrumentation, equipment, and all the other supplies required for the next surgery. This time is more variable as it is more unique to the type of case being conducted. For example, vascular and orthopedic cases have much more complicated equipment requirements than general surgery cases (hernias, for example) and, therefore, take much longer to prepare. In the current environment of updated preference sheets and tray optimizations, it has become a very routine task to set up a room for any type of surgery.

Delay time

Delay time is what most hospitals generally refer to as any delay between the scheduled start time of a surgery and when the patient wheels in to the OR. What hospitals lack understanding on, though, are the three hidden delay buckets, namely:

• Delays between wheels out and clean begin,
• Delays between clean end to prep begin, and;
• Delays between prep end and scheduled start

Opening your eyes to these three hidden sources of waste may be critical as they may have as large of an impact on turnaround time as the usually-documented turnaround time delay (scheduled start time to actual start time). If you, cumulatively, lost five minutes from wheels out to the scheduled case start (or approximately 100 seconds for each of the three aforementioned hidden segments of potential delay) for each turnover and did 160 turnovers per week (~200 surgeries per week) at your hospital, you would lose 800 minutes a week, which is nearly 700 hours of delay per year. Recapturing even half of that time (2.5 minutes) would equate to ~250 additional surgeries per year. This could be ~$750K per year depending on your contribution margin per surgery.

Now that it has been pointed out, the hidden elements of waste in your turnarounds and how minimal improvements here can make a large improvement in your OR, you can address how to capture these metrics, determine causes of delays during these times, and identify solutions to these problems. These items will be addressed in a future post.