ABSTRACT
BACKGROUND: Prolonged operating room turnover time erodes patient and employee satisfaction and value. METHODS: Lean and value stream mapping was applied to three operating room teams at an academic health center in New York City, and a solution called Performance Improvement Team (PIT Crew) was piloted. RESULTS: Overall, 10% of operating room turnover steps were considered nonvalued and were eliminated, and 25% of previously sequential steps were performed synchronously. Seven institutional dogmas were eliminated, and three hospital policies were changed. After 35 pilot turnovers, median operating room turnover time improved from 37 minutes (range, 26 to 167 minutes) in historic matched controls to 14 minutes (range, 10 to 45 minutes, p < 0.0001) for the PIT Crew. Cost of the PIT Crew was $1,298 daily, and estimated return on investment was $19,500 per day. CONCLUSIONS: Lean and value stream mapping identifies nonvalued steps in operating room turnover and affords opportunities for efficiency. Once institutional rules and dogma are changed, culture and workflow improve and turnover time substantially improves. This process adds cost but is profitable. Scalability and sustainability are under further study, as is the "halo effect" on the culture in other non-PIT Crew operating rooms.
Subject(s)
Appointments and Schedules , Efficiency, Organizational , Operating Rooms/organization & administration , Process Assessment, Health Care , Quality Improvement , Academic Medical Centers/organization & administration , Education, Medical, Continuing , Female , Humans , Male , New York City , Operative Time , Patient Care Team/organization & administration , Pilot ProjectsABSTRACT
Surgical smoke is a hazardous byproduct of any surgery involving a laser or an electrosurgical unit. Although research and professional organizations identified surgical smoke as harmful many years ago, this byproduct continues to be a safety hazard in the OR. An interdisciplinary team at a large academic medical center sought to address the exposure of patients and perioperative team members to surgical smoke. The team used the nursing process to resolve the lack of smoke-evacuator equipment and surgical smoke staff member knowledge. To increase awareness of the hazards of surgical smoke, we gave presentations to nursing staff members and surgeons, who then completed educational modules. We conducted audits in all ORs to monitor compliance. The use of smoke evacuation supplies has more than quadrupled since education began. Additional unit-based education continues every day and is a constant reminder that safety is the responsibility of all perioperative team members.
