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5 Ways to Maximize OR Efficiency for Orthopedics Cases

Here are five ways to maximize operating room efficiency with quick turnover times and optimal scheduling from Kelly Doyle, CEO of Rothman Orthopaedic Specialty Hospital in Philadelphia.

1. Huddle to discuss surgical cases beforehand. The clinical team comes together every day to discuss upcoming cases so everyone understands what to expect. The huddles include the director of nursing, director of operating rooms, operating room charge nurse and other representatives from each department.

"They go over the next day's schedule so everyone is on the same page about how things will play out," says Ms. Doyle. "They make sure we have everything we need for the next day's surgery and go over the game plan. It's very effective."

This is particularly helpful for orthopedics-driven cases since each case requires a different set of materials and implants.

"We are implanting things quite often and miscommunication can really slow things down or cause an issue," says Ms. Doyle. "We really have to make sure we don't miss a beat. There are some things that are out of our control — such as a patient running late — but we want to make sure we do everything in our power not to cause a delay."

2. Appoint a navigator.
Assign a navigator who is responsible for controlling traffic in the operating space. The navigator is dedicated to making sure everything runs smoothly and efficiently from the first case to the last.

"You need one person to look at the overall picture of what happens in the operating rooms," says Ms. Doyle. "The schedule moves fast and you have teams of people dedicated to each room, but you also need extra support looking at the whole picture. That extra support should come from nursing and anesthesia departments."

Rothman Orthopaedic Specialty Hospital assigned one person to take charge of anesthesia and another on the surgical end to communicate throughout the day so patients move through the surgical process as expected. If there is a bump in the road — such as a patient taking longer than normal in anesthesia — the navigator can make everyone else aware of this issue and control traffic accordingly.

3. Assign a point person to maximize communication.
Beyond the navigator, assign a point person who is in charge of communicating between all different departments in the facility. In some facilities this is the charge nurse, who runs the board or another staff member in the halls to inform others about the patients' progress.

"This person has their finger on the pulse of what is going on," says Ms. Doyle. "If the incision is being closed, this person gets the turnover team ready to clean the room. This person retrieves the case card with instrumentation to begin the next case and helps with set up. It's important to have constant communication between the departments."

Communication is especially important for OR efficiency and allowing surgeons to optimize their time at your facility. If everything runs smoothly, surgeons will be more satisfied with their experience.

4. Ensure everyone knows expectations.
All staff members should understand expectations at the facility and be familiar with the surgical game plan each day. They must also understand the protocol for when something goes wrong so the issue can be fixed.

"If the patient is half our late, that could throw a monkey wrench into our day," says Ms. Doyle. "We might have to cancel a surgery because the patient shows up sick or has had a new cardiac episode. Another situation might be the anesthesiologist has a hard time placing the spinal and our schedule is slowed. Everyone has to communicate and know what the plan is for these situations."

5. Develop a close relationship with physician office schedulers.
It's important for your schedulers to have a good relationship with the schedulers at the surgeons' offices so cases can be scheduled promptly and appropriately. Rothman Orthopaedic Specialty Hospital works closely with the schedulers for physicians at Rothman Institute to bring cases into the facility.

"We know the schedulers by name and we can call them directly if there is a misunderstanding," says Ms. Doyle. "We have a good relationship at all levels with Rothman and every single person who comes in contact with the patient from pre-op to surgery has an important role to make sure there aren't any bumps in the road."

When there are special order items that surgeons need, the schedulers and staff members at Rothman Orthopaedic Specialty Hospital work together on those arrangements. Any questions between the groups can be discussed or clarified between the nurses, physician assistants or surgeons.

"That's the beauty of our organization; the relationship between Rothman Institute, surgeons, nurses and schedulers," says Ms. Doyle. "We have an advantage because our relationship is so strong."

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