On-call requirements in perioperative services can be a barrier to recruiting younger RNs and in retaining older nurses. Covering the daily surgical schedule with fatigued staff who have worked during the night can be a safety issue or a staffing issue if the call team is too tired to work…

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Fourth in a series on ten elements of safer surgery.   It’s axiomatic that sterile processing is critical to safe and effective surgical care. The sterile processing department (SPD) is like an “engine room” for the OR, where the staff produce the sterile instruments and other equipment needed for surgical…

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Last month, we wrote about the long history of unnecessary preoperative testing for healthy patients. This month, we’re happy to report that some leading medical societies are publicly calling for physicians and patients to rethink certain kinds of testing. The recommendations are part of the Choosing Wisely campaign, an effort…

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Marty Makary, MD, MPH, now a prominent cancer surgeon at Johns Hopkins, says he once took a year off from medical school because the culture didn’t feel right to him—“it wasn’t telling patients the truth.” He had witnessed wide variations in quality and the medical community’s lack of response. He…

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Checklists are a common safety strategy in the OR. Why not have a checklist for the sterile processing department (SPD)? A “cockpit checklist” has helped reduce defects in instrument sets at Virginia Mason Medical Center in Seattle, Washington, by serving as the final quality assurance audit before a set enters…

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Lean management and automation have come together to create a sterile processing department (SPD) that can efficiently process the 700 to 1,000 instrument sets a day needed to support a caseload that is primarily orthopedic. The SPD at New England Baptist Hospital in Boston is one of the few in…

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A heavy call schedule at one community hospital was driving the perioperative staff away and raising concerns about patient safety because of staff fatigue. With a staff turnover rate of 40% in 2007, the perioperative management team knew changes were needed. Since then, a new staffing model has almost eliminated…

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Team members simply introducing themselves to one another at the start of a case made a difference in the rate of infectious events in a pilot study. The rate was 1.9% when the introductions were documented and 21.1% when they were not. (The infectious event rate included surgical site infections,…

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Preparing patients for surgery at Cullman Regional Medical Center in Cullman, Alabama, used to take about 200 phone calls a day. Here’s a typical scenario: The OR is ready for the next patient. The OR calls the same-day surgery unit and asks if the patient is ready. Same-day surgery says…

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OR Business Performance is a new series intended to help OR managers and directors improve the success of their business.   Imagine that you were recently hired as director of perioperative services at a 450-bed hospital with 18 operating rooms. Now, 6 months into your tenure, it’s time for your…

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Many ambulatory surgery centers (ASCs) have little need for a staff radiologist because only a few procedures require on-site imaging. Yet, ASCs are subject to a rule similar to those that require hospitals to keep radiologists on staff. That will no longer be true if a proposed change takes effect…

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Shortening the time it takes for an outpatient procedure may increase volume, OR utilization, and hence revenue—but that is not the point, say the nation’s top performers in a recent survey of procedure times. Rather, the purpose is to enhance patient safety and satisfaction. For example, less time in the…

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