Process improvements boost operating room efficiency Published May 6, 2010 By Steve Pivnick 81st Medical Group Public Affairs KEESLER AIR FORCE BASE, Miss. -- Improved communication has led to a substantial improvement in operating room turnover, according to Capt. Scott Thallemer, 81st Surgical Operations Squadron. He noted the process improvement, utilizing Team STEPPS and concepts gleaned from the John Nance book "Why Hospitals Should Fly," enabled the OR to reduce turnover time by 35 percent. STEPPS stands for "strategies and tools to enhance performance and patient safety." "We were prompted by the (Air Force Medical Operations Agency) OR optimization project to reduce the time one patient is 'wheels out' of the OR until the next patient is 'wheels in,'" the captain explained. He noted that in a civilian hospital every minute of OR time equates to about $80 per minute "so every minute counts." Captain Thallemer, a perioperative nurse and the flight informatics officer, commented that prior to the process improvement, the average time was 50-55 minutes. "Now it's down to 33-36 minutes, depending on the (surgery) service a patient is undergoing." Preparing an OR for the next patient includes cleaning the room, setting up the required equipment and instruments, based on the type of case, such as a total knee replacement or hernia repair, and ensuring the proper medications are present. "The biggest effect that resulted was we built a team that included more than just the OR staff," he said. "We broadened the scope by including members of the ambulatory care unit, anesthesia department and others. Then we discussed issues, using what we learned in Team STEPPS training. The young Airmen were encouraged to speak up. For example, one Airman observed he had to go from the OR to the other end of the hospital to dispose of soiled material and then get back to the OR to prepare the room for the next patient." He added, "When we measured the steps that were taken to perform surgery, we counted 247. Once we scrubbed them and removed the redundancy, we reduced them to just 38. We also found we were doing about nine interviews per patient -- asking the same questions -- which we reduced to six." Using Team STEPPS concepts, the captain said the OR staff uses several communication venues throughout the day. "We have a morning briefing 'huddle' then huddle again in the OR when the team introduces themselves, verifies the site (right patient, right side, right procedure), and the doctor confirms he or she has the correct equipment which lets everyone know they're doing the right procedure. After the surgery, we have a debriefing to discuss what went right or might have been done better. "We questioned why things were done the way they were," he continued. "Often the reply was, 'That's the way we've always done it,' or, 'It's the rule.' We discovered that in many cases that wasn't true." Among other process improvements are the use of radio frequency identification to track equipment and instruments and a Web-based schedule board developed by the 81st Medical Support Squadron medical information management flight. "The schedule board tells everyone what's going on with a patient, from arrival in the OR to departure. Everyone can mark on the board and can follow the patient. A color-coded version of the board (without personal information) is also located in the waiting room so family members can track their loved ones. Ambulatory surgery has reduced the number of phone calls about patients they receive from family members. In addition, visitors now remain in the waiting area rather than going into 2B or elsewhere trying to obtain information about patients. The board allows us to provide information to both staff and families." Lt. Col. Nneka Williams, operating room support element chief, stressed, "Communications is the major factor in OR improvements and the staff does "whatever it takes to take care of the patient."