Parallel processing to reduce turnover time in the operating room: A quality improvement case report

Introduction: At a Veterans Affairs Medical Center, turnover times exceeded national benchmarks. A quality improvement project sought to decrease turnover times to the national benchmarks - from 43.2 to 35 min and 28.5 to 20 min - over a four-month period. Methods: Gemba walks identified that patient transport to the operating room (OR) began after setup was complete. The first plan-do-study-act (PDSA) cycle employed parallel processing by transporting the patient to a nearby staging area during OR setup. PDSA 2 introduced a daily leadership huddle to optimize turnovers staged. Outcome measures were average biweekly turnover times and process measures were the time between OR readiness and patient arrival and the percentage of turnovers staged. Measures were analyzed using statistical process control (SPC) charts. Results: Through the PDSAs, the time between OR readiness and patient arrival was reduced by 5.8 min and the percentage of turnovers staged was increased from 71.9% to 93.4%. The average turnover time decreased by 7.86% for turnovers with a 20-minute goal and by 1.33% for turnovers with a 35-minute goal from pre- to post-intervention. SPC charts demonstrated special cause variation in the 20-minute goal turnovers only, but it was not sustained throughout the intervention period. A major limitation was the inability to stage every day due to staffing constraints. Conclusion: This single-institution case report describes a quality improvement initiative to reduce OR turnover times. Although turnovers times did not meet the national benchmarks, the lessons learned from the project have inspired future interventions.