Firm policies and the right procedures tip the cost-benefit balance toward flip rooms
We spoke recently with surgery department leaders at an academic medical center in the Midwest. One of their biggest concerns was a challenge faced by many ORs today: “Flip rooms are just killing us.” Most surgeons prefer the efficiency and revenue potential of a flip room schedule. But for hospitals,…
Learning from Leaning: Case cart readiness improves after barriers are removed
Bristol Hospital had a supply problem. Instruments were often missing from case carts, so nurses had to scramble to find the items on the morning of a scheduled procedure. Staff wondered whether the problem was caused by shortages, but a Lean process revealed an entirely different scenario and forged a…
Multiple OR multidisciplinary team huddles promote ownership of process improvements
Huddles are hot. Experts cite them as effective patient safety tools, and many hospitals have implemented them on nursing units at the start of the shift. The perioperative services team at Vanderbilt University Medical Center in Nashville, Tennessee, broadened the huddle concept to include several disciplines and a structured format,…
Competency matrix modeled on ski trail difficulty validates staff skills at Vail center
Surgeon concerns about staff competency and high turnover of surgical technologists at Vail Valley Medical Center (VVMC), Vail, Colorado, prompted the development of a staffing skills competency matrix. VVMC is a community hospital with 4 rooms in its main OR, 4 rooms in its adjoining surgery center, and 4 rooms…
Tracking tool streamlines scheduling, enhances communication with surgeons' offices
Sacred Heart Medical Center RiverBend in Springfield, Oregon, began OR optimization efforts soon after moving to a new facility in August 2008. Because of the US economic downturn around that same time, the hospital launched several initiatives to make the most of available resources, including a Lean process to improve…
Improving instrument readiness cuts case delays, boosts surgeon satisfaction
Surgical case delays have been found to last an average of nearly 17 minutes. Not only do such delays make surgeons dissatisfied, they also reduce case volume and related revenues, and they may lead to additional time under anesthesia for patients. The root causes of instrument-based delays are seldom simple,…
Changes in nurses' pay structure solve staffing and scheduling problems
Many OR directors struggle with designing effective nurse compensation systems. The ideal system would achieve department goals while maintaining nurse satisfaction. Unfortunately, a compensation plan that links these 2 objectives is often elusive. In 2012, OR leadership at a small Pennsylvania hospital developed a compensation system that effectively aligns nursing…
Team participation and planning produce quality handoffs
After a poor handoff from the OR to the postanesthesia care unit (PACU) was identified as the culprit behind a serious adverse event, Nancy Robinson, DNP, MSN, RN, LHRM, CCM, made it her mission to avoid a recurrence. “I’m passionate about safe patient hand-offs,” says Robinson. “I didn’t want this…
First case on-time starts soar after rapid process improvement training
In 2011, fewer than half of all first cases at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, were starting on time. That meant subsequent cases were also delayed, with overtime costs exceeding $500,000 a year. “People were unhappy with that for a lot of different reasons. It was a…
Lack of surgical checklist compliance suggests need to improve implementation
Surgical checklist compliance among 4 Canadian hospitals was around 60% in a large, retrospective study of acute care operations performed in 2010 and 2011. Although Alberta Health Services in Calgary, Alberta, Canada, had mandated checklist use starting in 2009, limitations such as instructional misuse, lack of perceived benefit, and lack…
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