The Annals of Thoracic Surgery reports on a study from NYU Langone Medical Center which applied the concepts of Lean process improvement to OR Turnover. A multi-disciplinary team was converted into a turnover time (TOT) “Performance Improvement Team (PIT Crew)”. This team created numerous value stream maps for the perioperative period from the preop area to PACU holding. Each process was identified as “valued” or “non-valued” and the non-valued steps were eliminated. The valued steps were further reviewed and streamlined by removing unnecessary or duplicate movements.
In addition, steps were evaluated to determine which could be performed in parallel with other teams. Although there were only 86 procedures in the “control” historical group prior to implementing changes and 42 patients evaluated under the new process, results were significant. Median turnover time was reduced from 37 to 14 minutes. The study goes on to report that the cost of the PIT Crew was $1,298 per day, offset by estimated savings of $19,500 per day.
EHC NOTE: Although this study was only applied to the cases of two surgeons the results are impressive enough to take note of and investigate further. Certainly, a reduction of 62% in median TOT should be enough to move the needle on surgeon satisfaction and in some cases allow for additional case volume. The article also contains a detailed table which looks at the original process steps and those deemed non-valued for a number of stakeholders – such as anesthesia, nurse circulators, housekeeping, and patient transport. This table is a good resource for OR managers or Operating Room committees interested in identifying opportunities for TOT reductions and implementing parallel processes.