Medical Center's Lean program reduces OR turnover time

In a matter of two months, Crestwood Medical Center, Huntsville, Ala., reduced its operating room (OR) turnover time from 14 minutes to nine. Knocking five minutes off its turnover time may not seem like a big deal, but considering the amount of surgeries conducted at Crestwood&'s 19 ORs — 1,100 per month — any ounce of efficiency goes a long way.

"Saving five minutes between cases may not seem like a lot, but when you multiply it by the number of procedures done per year, it adds up,"says Linda Homan, RN, BSN, CIC, senior manager of clinical and professional service at Ecolab. "Crestwood performs over 12,000 procedures a year, so that adds up to over 1,000 hours a year. Time is money in the OR, as the more time you save, the more procedures you may be able to do in a day or a week's time. Even if you don't add more procedures to your schedule, the time saved on room turnover can be used to get other things done to drive operational efficiency and quality."

The center created a multidisciplinary team including OR and environmental services (ES) staff, hospital leadership, a corporate clinical expert, a corporate Lean Six Sigma Black Belt team and two subject matter experts from a partner company to initiate a Lean throughput project.

The team started by collecting pre-implementation data on room turnover times, high-touch object cleaning, storage and use of environmental hygiene equipment and linens, compatibility of disinfectant materials, disinfectant contact time and cleaning roles and responsibilities. After that, four areas of improvement were identified:

• High-touch objects not consistently cleaned
• Environmental hygiene equipment and linens not conveniently located
• Difficult to know when a room was clean
• Bleach disinfectant required a 10-minute contact time and damaged equipment

The team's solutions to these issues included developing disposable room turnover kits and designating point-of-use cleaning carts and tools. The medical center also switched to a sporicidal hydrogen peroxide/peroxyacetic acid disinfectant with a five-minute contact time and began using fluorescent markers to monitor environmental hygiene. ES staff were trained on the new tools and best practices, such as leaving a turnover pack on the OR table in empty rooms for a quick and simple visual cue that the room is cleaned and ready for its next surgery.

OR staff collected post-implementation data from late July 2014 to late January 2015. Two months post-implementation, Crestwood Medical Center improved its between-case cleaning of high-touch objects from 28 to 95 percent. Its terminal cleaning of high-touch objects improved from 28 to 70 percent. Six months post-implementation, both categories continued to see improvement, with between-case cleaning increasing to 97 percent and terminal cleaning jumping to 86 percent.

The collaborative study team revealed its findings and best practices at the OR Manager Conference held last week in Nashville, Tenn.