coffee and donuts…. time for a break

Oh what fun…       This is just one of many factors affecting turnover time  (TOT).

For the sake of  smaller graphs and clarity, I’m showing only the times till anesthesia induces the patient to show the comparison of surgery cut times.  The time from anesthesia induction till surgical incision will stay the same, so will not add to the overall decrease.

LEGEND:    nurse -> lighter purple       anesthesiologist -> green

Here we have a common scenario in which the nurse who is setting up the room also has to wheel the patient from the pre-op holding area to the OR room.  This is not including the situation in which the same nurse who sets up the room is also the nurse who does the pre-OR check-in in the pre-op holding area (the cut time would be delayed even longer).

In the first graph, with the nurse doing all the work, the start time for the anesthesiologist would be 9:17 am (last green bar).  And–as you can see–the anesthesiologist has a 13.75 minute (6m + 7.5m) slack period between the time he sees the patient in pre-op holding till the time he has to start setting up his anesthesia equipment.  That’s plenty of time for a cup of coffee and donut (bathroom break, too).

Now we have a different policy in which the nurse who is setting up the room is different from the nurse who brings the patient from pre-op holding to the OR room.  In this scenario, the anesthesia start time is 9:10 am (last green bar)–which is 7 minutes earlier, which means the surgical cut time is 7 minutes earlier, which means turnover time is 7 minutes shorter.  The anesthesiologist does not get coffee, nor a donut, nor a bathroom break.

The additional risk from this is that you’ll have a sleepy, hypoglycemic anesthesiologist who is anxious because he needs to use the restroom.  It could affect the induction.


About Brian D Gregory MD, MBA

Board Certified Anesthesiologist for 30 years. TOC design and implement for 30 years. MBA from U of Georgia '90: Finance, Data Management, Risk Management. Practiced in multiple US states and Saudi Arabia at KFSH&RC and KFMC Taught residents in two locations. Worked with CRNAs for 20 years.
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2 Responses to coffee and donuts…. time for a break

  1. I agree, Ed. It’s all about context. You should only save a little time when it makes a big difference in the larger scheme of things. If you check out some of the other blogs, you’ll see that 15 minutes of TOT can make the difference between hiring an extra anesthesiologist for the year, or for keeping a surgeon coming to work in your hospital. And, if you save 15 minutes in the right place, you can dramatically reduce injury to patients because you have the time to double check instruments, or take the safer route during an induction. At other times, an hour or two doesn’t matter. With the right model and software, you can see whether the 15 minutes matters…and keep people from wasting their time and endangering patients by hurrying too much.

  2. says:

    Turn around time, unless you have enough demand seems like its sub-optimizing.
    So as soon as the operation is done, we work as fast as we can, breakdown the sterile field toss the instruments in to whatever set you can, or just dump them into a basin, Oh and leave the instruments closed and locked, throw the sets into a case cart and jam the Bio bag, dirty linen and send it to Central Processing, The wipe down everything like crazy, put everything away rush in the next case. So we trimmed 10 minutes off the time…. And we did 6 cases that day that’s 60 minutes. Then we leave today at 4:30 instead of 5:30. That hour saved us $5000… Wrong..
    That’s the way we thought it in manufacturing 10 years ago before Lean/Sigma.
    Without standardized work, 5’s, mapping the whole value stream that hour cost you big time. I guarantee you that.
    Lets start in my department Central Processing a year ago, the cart comes down to me, At times the carts is so heavy that it takes two people to pull off of the dumbwaiter. When we open the cart, (taped shut because over loaded) the container lids are mixed. Sometimes the ortho lids that stay with the set are thrown on the bottom shelf under the bio bag. The canisters of liquids are randomly placed on any shelf. Twice a week the fall out when we open the door. Scopes are in the containers but tucked out of site, when we pull out the red bio bag some loose instruments fall on the floor, the linen are the same way. After stripping the cart we pop open the sets to make a decision if we hand wash, sonic clean, or send though the auto washer. The is no way to determine what instruments were used (I’m told less then 10% get used) so we are responsible to check every instrument. Every hand held instrument is closed and clamped so every instrument is opened and put on a stringer.
    In assembly because not all the instruments make there way back to the set after the Operation, it’s a matter of search and rescue. Every time the there is a missing instrument, the flow stops…
    The ironic part is, because of this waste it takes us longer to process the sets. So our cycle time is longer then it should be, while this is going on in assembly we are pulling cases for the next day, yup assembling them short without all the instruments because in assembly their looking for the missing items. So, this creates a expedite list, we have two employees on the third shift working on sorting through everything to pull everything to meet the expedite list first. Then at 6am the OR managers then come down to help with the search and rescue.
    This was just one stream, there is so much more.. got to go…

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