SURGICAL/CRITICAL CARE


Mandava. “Hospitals have dealt with the issue of burnout and turnover by continually finding and hiring new people and utilizing traveling clinicians.”


“This means that every step along the way will be slower – how rooms are cleaned and setup, where things are or where to put them away, who should be in the room, etc.,” he added. “On top of this, volumes have returned to, and are often exceeding, their pre-pandemic levels. In every meeting and survey we do with hospital executives, staffing is still the number one issue.” “Today’s periop leaders have rightly rec- ognized the best way to overcome turnover challenges is to build a process to increase agility,” said Rechin. “One example may be as simple as a process where any staff member who isn’t actively engaged with a patient helps to alleviate suite turnover challenges. On busy days, it helps to have dedicated teams to help increase turnover efficiencies…from housekeeping to room prep. Unfortunately, not every hospital or ambulatory surgical center (ASC) has the lux- ury of a dedicated team and needs to adopt an “all-hands-on-deck” approach.” Researchers from Georgetown University


School of Medicine and MedStar Georgetown University Hospital in Washington, DC, stud- ied the impact of surgical team consistency on OR TOT, where OR cases were scheduled with the same team and surgeon. They pub- lished their findings in the January 2022 issue of the Journal of Medical Systems. The Georgetown researchers conducted a retrospective analysis of 2,714 cases com- pleted on weekdays between 6:00 a.m. and 11:59 p.m. from July 2017 through March 2018. They found OR cases with the same surgeon and anesthesia team had a signifi- cant lower TOT (p < 0.0001). They also dis- covered OR cases in rooms with the same specialty had significantly less mean TOT compared to rooms switching between dif- ferent subspecialties.


Lean methodology


“Most high performing OR teams have embraced lean principles to help improve OR Suite turnover,” said Rechin. “Consider establishing a project team to evaluate current processes, step-by-step. Measure improve- ments as well as team member engagement. Strive to develop seamless communica- tion responsibilities. Make sure the SPD is involved in all process decisions to ensure it creates synergies through reprocessing.” Researchers from Switzerland applied Lean methodology, including Gemba walks, Process Mapping, Root-Cause-Analysis, and the Single Minute Exchange of Dies (SMED) system, to processes in the OR suite and those before and after the patient is in the OR. Their aim was to understand the causes


of variability and waste in TOT for gyneco- logical and general surgery cases. “Lean thinking allowed the team to re-eval- uate how the whole operating suite performs as a system, by starting from a sub-process as changeover,” the researchers stated in their findings published in the April 2022 edition of Frontiers in Medicine. They found “standardized and safer


work enabled effective parallel processing” improved patient flow and inter-professional collaboration, enabling the hospital to reduce TOT between operations by 25% on average, without no changes in infrastructure, tech- nology or resources.


One solution for measuring progress toward improved TOT is Stryker’s Dash iQ Surgical Dashboard, noted Tommy Van Galder, Vice President and General Manager of Stryker’s Communications Business Unit. He said OR teams can use the solution to monitor live OR performance and turnover to identify opportunities for improvement through a series of reporting and bench- marking tools.


OR set up and supply management


Supply management in the perioperative space is notoriously complex and challeng- ing because many items fall outside of the hospital’s enterprise resource planning (ERP) system, and therefore beyond the eyes of the supply chain team. As a result, clinicians often assume the bur-


den of inventory management and tracking. When they are challenged with finding the items they need for a case, it can prolong OR set up time. And when a surgeon finds an item is missing during a procedure, a team member may have to leave the OR and look for that item, causing further delays. Voss comments on the impact of supply chain challenges on OR efficiency, stating: “Turning over an OR is a choregraphed


affair where every minute matters, but it is just one aspect of improving OR efficiency. Streamlining supply chain activities in the new year can go a long way toward building a smooth transition from one case to another and minimizing the time that clinical staff spend searching for supplies. A strong rela- tionship between perioperative and sup- ply chain teams is crucial to building trust, improving communication, and ultimately optimizing clinical staff’s involvement in supply chain activities.”


According to Van Galder, it is not only supply tracking but also OR set up, including where supplies are stored and how easy it is to clean the room, that impact perioperative workflow efficiency. He stated: “Customers can set themselves up for suc- cess on the front end by ensuring their oper- ating rooms are ergonomically designed and


built for room turnover, such as storage for regularly needed suppliers or intentionally selecting easier to clean materials designed to support faster room turnover.” “The ability to effectively clean and dis- infect a room, as well as understanding the availability of materials, supplies and equipment needed in the room, are two of the changes we foresee on the horizon that may impact room turnover,” he added. “In response to these anticipated changes, Stryker’s Connected OR/Hospital Status support interdepartmental communications, especially with respect to patient scheduling, understanding SPD turnaround times, and supply chain management.”


Perioperative workflow automation


“Perioperative executives are seeking auto- mation,” said Mandava. “Even when they hire people, they are often new and require a lot of training. They are looking for systems that automate a lot of the workflows, data entry, and even training of staff. Many of our hospital clients are highly responsive to new features around guiding team mem- bers on next steps in their workflows and the real-time location of items throughout the hospital, amongst other benefits.” “With increased workloads and staffing shortages likely to continue throughout 2023 and beyond, it is critical for perioperative leaders to streamline non-clinical tasks for their team members so they can drive effi- cient room turnover while maintaining pos- itive patient outcomes in the OR,” said Voss. “Leveraging technology solutions that can manage aspects of OR room turnover that typically require manual processes, thereby freeing up time and space, is a key strategy for achieving these goals.”


Voss pointed to Owen & Minor’s


SurgiTrack clinical supply delivery service as a solution, which provides technology and staff to help ensure accurate inventory. She noted how SurgiTrack leverages rigorous analytics of preference cards to help surgi- cal teams standardize product preferences, improve the accuracy of case pick activ- ities, and reduce time spent on removing unused items.


“When the right technology is aligned with the right processes, backed by the right ven- dor expertise, outcomes like on-time starts and case pick accuracy can be improved, which may in turn help to help alleviate the burden on a perioperative team, and most importantly, drive high-quality patient care,” she added.


“Many technologies are available to automate caregiver workflow,” noted Van Galder. He referenced Stryker’s Connected OR platform, describing how it stores sur- geon preferences, enables communication


hpnonline.com • HEALTHCARE PURCHASING NEWS • February 2023 15


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