Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF September 6, 2019 | Archived Issues

Task Force Lowers Turnover Time in Robotic Cases

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Some members of the multidisciplinary team that helped reduce turnover time in the fifth floor robotic surgery rooms are shown.

When general surgeon Daniel Shouhed, MD, first explored opportunities to improve efficiency and turnover time on the fifth floor robotic surgery rooms, he reached out to several individuals across disciplines.   

"I approached fellow surgeons, nurses, human factors researchers and performance-improvement experts," said Shouhed. "Everyone jumped at the opportunity to help understand how the system might be improved."

The multidisciplinary team reduced turnover time in fifth floor robotic surgery rooms from an average of 73 minutes to 45 minutes—thereby, freeing up staff time and allowing for surgery cases on the schedule.

"Instrumental to the success of this project was the commitment of staff to improve these processes," said Shouhed. "But first, we had to understand what caused our lengthy turnovers."

The team closely observed 20 transitions, watching the progress from start to finish. They noted each step, and the challenges individuals or teams encountered.  

"Our eyes were set on identifying inefficiencies in the system," said Tara Cohen, a human factors research scientist in the Department of Surgery who worked with Shouhed and team on the project.

The group identified several system inefficiencies, including clean-up time after each procedure, setup for the next procedure, preparation for the surgical bed mattress—a timely process of taping and its removal—and the transport of patients. 

Once the inefficiencies were addressed, the task force identified other groups of employees—including nurses, scrub techs, EVS personnel and log techs—who could describe the process behind each inefficiency and target potential solutions.

"The team worked to understand the barriers to efficient turnover time, without pointing blame at any one individual," said Cohen. "Collectively, the group reduced barriers to efficient flow without creating new roadblocks, all while bringing cost savings to the department."

Among their assessments, the team noted that nurses were responsible for both prepping rooms for surgery and transporting the next patient back to the operating room for their procedure—a dual role that was time-consuming and stressful.

Once this issue was raised, different individuals stepped up to help prepare the room, even if it wasn't their primary responsibility.

Nurses stepped in to help open instruments and assist with the count. Scrub techs volunteered to help keep the rooms as tidy as possible during the surgery to reduce the amount of cleaning required by EVS following the procedure. Moreover, anesthesiologists volunteered to wheel patients from pre-op into the operating room to reduce the time-consuming task for nursing staff.

Finally, the team developed a better method to deal with the foam-top mattresses, which are taped down before each procedure and then removed and replaced prior to the next surgery.

"Taping the mattress, then removing the tape post-surgery, was a time-consuming part of the process that fell to nurses and cleaning staff," said Cohen. "To make the process more efficient and inclusive, log techs intervened to assist with bed setup and breakdown."  

The task force hopes to take their approach beyond the 5th floor.

"We have seen tremendous success by merely opening up the dialogue and seeing where we can help people in a way that encourages openness, honesty and ongoing process improvement," said Shouhed.