Operating Room Patients Benefit from Shorter Wait Times, More Efficient Care

LEAN thinking in the surgical department at Avera McKennan Hospital & University Health System has made for happier patients, who receive uninterrupted care with shorter wait times, as well as a happier staff, who no longer have to search for supplies or walk as many steps throughout their already busy days in the OR.

In turn, administrators are happy with a more competitive department which has increased its capacity for surgical cases - without increasing personnel or facility needs.

LEAN teams accomplished this by streamlining patient turnaround times and eliminating waste on the supply management side.

"I would equate the LEAN initiatives in the surgery department with efficiency," said Mary Sturm, Assistant Vice President of Operative and Anesthesia Services. "In a time when reimbursement is diminishing but expenses keep rising, any project that assists with managing these functions is important."

A new patient prep process was initiated in the Ambulatory Care area. Ambulatory Care was moved about 400 feet closer to the OR. By improving work flow and moving supplies to point of use, nurses' walking distance was slashed by 90 percent, from 260 feet per patient to 27.

Patients now go directly from Ambulatory Care, where they can be with their families, to surgery. Before, they waited alone in a holding room.

"It's been a huge patient satisfier," said Alice Ronk, OR nurse manager. "The holding room was just that - a holding room. And so we deleted it, taking it completely out of the play."

The time from admission in Ambulatory Care until surgery has been shortened from 45 minutes to 25 minutes - a reduction of 44 percent. Instead of asking patients to arrive two hours before their procedure, they're now asked to come 90 minutes before.

Efficient time management is important for all involved - patients, hospital staff and surgeons. "The efficiency that LEAN brings to our department allows patients and surgeons to be in our hospital - and away from home - for a shorter period of time. This is a big satisfier for all concerned," Sturm said.

To improve supply management, surgical carts are now prepared on a "just-in-time" basis rather than the day before. Previously, 45 to 50 prepared surgical carts each day created a bottleneck in the OR area.

"We would rob Peter to pay Paul," taking supplies from one cart to fulfill a need on another, Ronk said. And so surgical staff checked and rechecked carts to make sure the needed supplies were there.

Preparing carts about an hour before each scheduled procedure frees up space as well as available supplies and equipment. Special carts for emergency procedures, such as open heart surgery, are prepared in advance and left undisturbed.

Improved supply management has reduced inventory by $182,000. Staff now replenish supplies on a more regular and timely basis, eliminating the need for "crisis" ordering.

Improvements have led to a shorter room turnover time. The time between one patient leaving a surgical room and the next one arriving has been trimmed from an average of 34 minutes to around 20.
In the future, the surgery department will be able to take on up to 10 percent more cases without additional staff or space.

LEAN principles and Standard Work are not about finding the cheapest supplies, getting tasks done as fast as possible, or turning people into "robots," as staff members may fear. It's about doing things the right way every time. It's about working smarter, not harder.

"You've got to think out of the box," Ronk said. "We don't say we aren't going to try that because we've never done it that way before."

Standard Work solves the inefficiency of each staff member doing the same process their own individual way. "Buy-in is a huge word," Ronk said. Even skeptical staff members become sold when they see the tremendous benefits of LEAN. "People began to say, 'I don't ever want to go back to the way things were,'" she said.
LEAN thinking continues even after the formal implementation is complete. And so more LEAN projects are on tap in surgery. "We've just scratched the surface," Ronk said.