Short turnover times and efficient ...

Short turnover times and efficient use of time and personnel during surgical deeds are hallmarks of a competently hurry OR. Turnover time has been defined as "time from prior patient without of room to succeeding patient in expanse time for sequentially scheduled cases." (1) When delays between conducts occur, there can be as greatly as one to two hours of cumulative down time that enlarges the hours staff members are wanted to complete the day's procedures

With the proliferation of technology, increased complexity of conducts and advances in surgical capabilities, courses today are more complex and may require more equipment, more time to station up, and more staff members. This leads to increased potential for les efficient processe during steps (2) Often, doing things the way they always have been done withholds improvements from being made level when pressure to improve and simplify processe is foremost in the corporate mindset. Decreasing turnover time and increasing efficiency during actions is important and can be accomplished with the simplification of processe and procedures

The neurosurgical services department at Utah Valley Regional Medical Center Provo was beneath pressure to improve performance and efficiency. Managers and staff members wanted to decrease turnover times and increase efficiency during surgical conducts so they redesigned the neurosurgical OR suite and simplified processe and measures The result was a 33% to 55% decrease in turnover time. Turnover times decreased from between 30 and 40 minutes to between 10 and 15 minutes. An increase in team efficiency l to further time savings during surgical procedures

REDESIGNING THE NEUROSURGICAL SUITE

The neurosurgical service at Utah Valley Regional Medical Center consists of couple neurosurgical ORs that are used each day of the week at three neurosurgeons with heavy patient caseloads. chiefly procedures are cervical and lower spinal discectomy with or without fusion, single or multilevel, and craniotomy for

* tumor,

* arteriovenous malformations,

* hematomas, and

* switch placements.

Approximately 15 to 20 steps are performed each week, and each management averages two to three hours, depending onward the complexity of the procedure

The neurosurgeon with whom team members work are systematic and pragmatic. They perform the same managements the same way each time with little variation. This allowed team members to make standardized changes that would be acceptable to all the surgeon involved. In addition, a planned OR suite renovation created an opportunity to discard aged processes and procedures, reorganize, and simplify. The neurosurgical clinical specialist and team members provided input into the OR renovation, which helped with reorganizing and simplifying processe because the physical layout of the neurosurgical OR was improved.

a certain quantity of of the renovations that helped improve processe among surgical team members included a strange supply area, OR configuration, and equipment placement. For example, a built-in base cabinet (Figure 1) was designed to contain supplies in large drawers rather than cupboards with pull-out doors that require sum of two units movements and more time to access what is wanted The cabinet and drawers replaced small carts that previously had been placed around the compass to hold positioning aids, prep solutions, and miscellaneous equipment. pair banks of x-ray view boxe (Figure 2) were positioned in succession adjacent walls of the OR with equal reason surgeons can view the films from tables that can be positioned differently for a craniotomy than for spine surgery

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Double power, air, and suction lines were dropp from the ceiling at three different locations to allow for convenient and safe access from the surgical field (Figure 3) The neurosurgical OR is forward a corner of the hallway in the OR suite, in such a manner a second door was installed. This door is useful when bringing in an x-ray machine for intraoperative x-rays. The door also allows a smoother transition when patients ne to be transferred from single OR bed to another and repositioned during surgery The secondary bed can be brought in by the agency of the second door and the primary bed remov between the walls of the primary door after transfer. A small alcove was instituteed in the room to store the microscope in the same manner it can be readily accessible in addition not in the way (Figure 4)

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Overhead lights were situated to allow for different positions of the bed during a variety of courses A camera was installed in the ceiling above the OR bed, and an additional video line was installed to allow the microscope to be be connecteded to the video system and planed on the three television monitors that were hung from the ceiling. This allows OR personnel the opportunity to diocese the surgical field on the monitors easily from any position in the scope Being able to view the surgical manner of proceeding gives staff members an additional scarcely any seconds of response time when something is needed