Keeping surgical procedure turnover in perspective

AORN Journal,  Oct, 2004  by William J. Duffy

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Throughout history, mankind has been challenged by problems that do not have easy answers. History is replete with issues that have vexed leaders in all fields of human endeavor for generations. No matter how we attempt to handle them, some challenges never seem to go away. In the perioperative world, one such age-old problem is the issue of turnover between surgical procedures.

TURNOVER TIMES

Procedure turnover time is a complex problem that cannot be solved with quick answers or simple solutions. I am continually amazed that some health care professionals, administrators, and consultants think that turnover time is based entirely on the time interval between one patient leaving the OR and another patient coming in. Turnover time is not this simple.

I do not think there is anything more frustrating than the constant focus on the time perioperative nurses spend trying to make sure that individual patients are prepared adequately for what may be one of the most terrifying experiences of their lives. Like many of you, I pause in wonder--and sometimes frustration--when I hear presentations that recommend eliminating the interaction between the circulating nurse and the patient as a shortcut in the patient preparation process. In many of these presentations, there is no discussion about doing quality monitoring to measure the effect these shortcuts may have on patient care.

Somewhere along the way, health care's focus shifted from the patient to the clock. I agree that time is an important factor in helping health care institutions stay competitive in a difficult environment, and I want to be clear that perioperative nurses should do their best to complete their duties as quickly and efficiently as possible. The clock on the wall, however, should not be the determining factor in this process. It should be one factor that is balanced against the time needed to adequately prepare a patient for a surgical procedure. It is our duty as the patient's advocate to constantly work to establish and maintain the balance between the need for efficiency and the needs of surgical patients.

THE PATIENT'S ADVOCATE

I believe there is a correlation between turnover and reports of wrong site surgery, retained items in patients, and surgical infections. It is well established that the circulating nurse is the patient's advocate during a surgical procedure. To be able to perform that role adequately, a circulating nurse needs to understand the needs and expectations of the patient. This understanding cannot be achieved effectively if someone else is bringing the patient into the OR, which I have heard recommended as a way to trim a few minutes from turnover time. Instead of implementing this recommendation, the circulating nurse either should be freed from cleaning up in the OR after the previous surgery or be allowed time to review the patient's chart and discuss the surgery and the patient's expectations. I know this is what I would want as a patient undergoing a surgical procedure when I am placing my life in the hands of strangers.

As a patient, I have a relationship with my surgeon, but the surgeon is only part of the team. Patients should have the opportunity to meet the other members of their health care team so they have an opportunity to educate team members about their expectations of the surgical process. How can anyone expect a circulating nurse to be the patient's advocate if this does not happen? The nurse would have to guess what the patient would want based on the nurse's experience. Statistically speaking, this probably would work the majority of the time, but even one incorrect guess could be devastating to the patient, his or her family members, and the health care professionals involved.

THE PATIENT'S PERSPECTIVE

Recently, I was on an airplane and had a long discussion with my seatmate about a surgical experience she had. She told me about how she was rushed to the OR, wondering what her future would hold. She said a lot of people asked her questions in the preoperative area, but no one really talked to her.

Inside the OR, the anesthesia care provider and the scrub person were busy, and she was alone with her thoughts. Then a nurse walked into the OR, said hello to this woman, held her hand, and, in a very polite but firm voice, told the anesthesia care provider that he should give her an opportunity to meet the patient before anything further was done. My seatmate told me that she took the opportunity to announce to the whole OR, "I would like that." The nurse then went over the patient's chart, and they talked about the surgical procedure.

What struck this woman the most about the encounter was that the nurse said, "Is there anything important you want me to know so I can be a better advocate for you?" At that point, said my seatmate, she felt like a human being again. Someone cared enough to ask about her needs and wants. I do not know who this nurse was, but she touched the life of this patient, and it took only a few minutes of her time.