Applying a Process Improvement Approach to Optimize Operating Room Turnover in Urology.

Objective: To apply a process improvement approach to optimizing operating room (OR) turnover time at an ambulatory surgery center.

Methods: Turnover was defined as the time a patient leaves the OR to the time the room is ready to receive the next patient. This process was observed multiple times to define the steps and operators involved. Each step was timed and meticulously studied to identify opportunities for improvement. New times for each step were obtained. The projected impact on the system capacity and potential financial implications were calculated using $1 per second as the "rent" of an OR.

Results: The OR turnover baseline time ranged from 31:45 to 42:49 minutes:seconds. Four opportunities for improvement were identified and proposed: 1) calling housekeeping earlier so they can be ready to enter the OR as the patient is being rolled out, 2) mopping the floor starting from the side of the OR where the back table is located to allow back table preparation to proceed without delay, 3) performing as much set up in the attached annex room as possible, and 4) rolling the next patient in as the scrub technician is scrubbing in and completing last minute organization. The theoretical financial benefits resulting from the implementation of these process improvements were calculated to be $1559 per turnover, with an annual saving of $2,025,000 per individual OR.

Conclusion: By applying process improvement techniques, the authors uncovered a multitude of opportunities to improve the OR turnover process, which, if optimized, could generate significant financial benefit.