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…

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With fewer new ambulatory surgery centers (ASCs) forming each year and more merging back into hospitals, it has become popular to describe the industry as “mature.” It’s not yet time for an obituary, however. Improved technology, bolstered by healthcare reform, is driving a transition to outpatient treatment, and, when it…

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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…

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Surgical team familiarity contributes to reductions in operative time, and performance improves as team experience accumulates, a new study finds. Previous studies of teamwork and its influence on surgical outcomes have been limited by the challenge of objectively quantifying teamwork. Survey-based methodologies are subject to responder bias, and the tools…

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Putting a hold on the OR can lead to revenue losses no manager wants to see. At Lehigh Valley Health Network (LVHN) in Allentown, Pennsylvania, OR holds were averaging 1,100 minutes per month. Jodi Koch, BSN, RN, director of perioperative services, and Kathleen Duckworth, RN, CPAN, their colleagues got holds…

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Improvements in first case on-time starts and turnover time at Lancaster General Hospital in Lancaster, Pennsylvania, attest to the success of using Lean strategies. Within an 8-month period, first-case on-time starts (FCOTS) jumped from 35% to 72%, and the monthly average overall turnover time (TOT) for a 7-month period was…

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Efficient throughput—difficult to achieve, yet essential to long-term financial success—is a Holy Grail for OR nurse leaders, who spend much time and energy seeking it. Given all the demands of their role, how can leaders best use their time to gain the most benefit from throughput initiatives? One method is…

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Less than a year after adopting a “college structure” model akin to that of specialty teams, the UF & Shands Academic Health Center in Gainesville, Florida, is close to achieving a goal of 100% on-time starts. “We track first-case start times, and a report goes out every morning, so we’ll…

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Duke University Hospital has had a Pre-Operative Screening Unit (POSU) in place for the past 16 years to optimize patients prior to surgery, but until recently, there were no hard data on surgical cancellation rates. Now, a retrospective analysis has revealed that fewer cancellations occur when patients are seen in…

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Changes in staff responsibilities and greater collaboration have contributed to dramatically improved first-case on-time starts at the University of Louisville Hospital, Louisville, Kentucky—from about 35% to 86% in a little over a year. Turnover time has been reduced, too, with slow but steady progress suggesting that revamping existing structures can…

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