first two cases of the day in each room get put on the carts the night
before by the nursing staff. Additional staff then comes in later in the
morning to work on the carts for rest of the cases throughout the day.
6. Streamline flow
One area that made the biggest impact on reducing turnover times at
Riverside County Regional Medical Center (RCRMC) in Moreno
Valley, Calif., was changing a serial flow pattern to one of parallel
processing. As an example, the prior workflow included that after
one procedure was finished, the surgeon, anesthesiologist and a
nurse would converge on the next patient for the next procedure.
"We changed that to having a member of the nursing, surgical
and anesthesia teams seeing the next patient while the prior surgi-
cal procedure was ongoing," said David Ninan, DO, medical direc-
tor and chairman of the anesthesia department at RCRMC. "That
way, at the conclusion of the prior procedure, the team would only
need to verify important elements, which in turn reduced the time
needed for processing the patient."
Another idea to streamline the flow would be to have a PACU staff
member come directly to the OR to get the patient. A handoff could
be given from RN to RN while the patient is waking up.
"Eliminating the circulator from having to go to PACU would leave
one more body in the room to assist with turnover," says Jason
Bainbridge, RN, BSN, MBA, patient care manager of the surgery cen-
ter at Regina Hospital in Hastings, Minn. "It also allows the PACU staff
to interact more with OR and a PACU staff member is one more per-
son to help with transferring a patient."
7. Offer rewards
In addition to making their jobs easier, you can get a lot of buy-in from
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