Time never stops. It ticks away in seconds, minutes, and hours each day, marching on without thought to our schedules, how busy we are, or how many things we have on our to-do lists. And in the operating room, it is an unseen, driving force; an undercurrent pushing us forward case, after case, after case. How well we use it will ultimately determine the entire surgical experience for our patients, for our surgeons, and for ourselves.

Time is a Metric.

Time is a tool used to determine our productivity. Efficiency is the goal, and delays are to be avoided. Oftentimes, it seems that it’s the delays that are always the focus. When we’re clipping along on time, with on-time starts and quick turnovers, no one complains about our efficiency. Although someone somewhere has a chart that they are happy to show off that illustrates that efficiency – usually in color, by service, and down to the minute of OR time used.

Don’t roll back on time, though, and you’ll hear it from everyone. And complaints come from every direction. Our patients are upset, and rightly so, that they must wait. They’re scared or nervous, hungry, possibly hurting, and now they’re waiting even longer for their procedure. Surgeons and staff know that delays mean longer days and later nights trying to get cases finished. And management knows that longer workdays lead to decreased employee satisfaction, and longer wait times lead to decreased patient satisfaction.

Time is money.

This is no secret. Surgery is expensive. For many reasons, of course. How much time a patient spends in an OR is a billable expense. Hospital budgets are built around total cases per year, and the amount of time that each case needs determines how many cases each room can do. I realize I’ve over-simplified it, but you get the idea. There is a cost associated with time spent in the operating room.

Time can also be dangerous.

The amount of time a patient spends under general anesthesia shouldn’t be any longer than necessary. They shouldn’t lay on a table exposed for extended amounts of time, either. When our patient is asleep, any time spent waiting is time that can increase their risk of infection, increase their need for more anesthesia, or increase their risk of side effects from their anesthesia. Considering that the safety of our patient is our highest priority, and that we want the best possible surgical outcome, avoiding delays must be a priority in every operating room.

It’s a struggle to stay on time.

The struggle is definitely real. As O.R. staff, we fight to stay on time, usually from the moment we clock in. Maybe our room was left a mess from the case the night before or our case wasn’t pulled correctly. Sometimes, when opening for our case, we have a contaminated tray or a missing instrument. Or, we don’t have the right equipment available, and we’re running around trying to find everything that we need. It’s a daily struggle, just on our end, to make sure that we are always ready to roll on time.

But what about the multitude of other issues beyond our control? The surgeon is late. Our patient is late, or they decided to eat breakfast. Maybe they are an inpatient, coming to the O.R., but the unit didn’t get them ready in time. Or we’re waiting on blood work that was ordered at the last minute, and we can’t roll back until we have those results. I could keep going…

Obviously, we can’t control the events that happen outside of the O.R., but those delays can quickly bring us to a screeching halt, stuck waiting, sometimes for hours on end. Or we’re left scrambling with a last minute schedule change so that the room can keep going. Patient A is delayed, but Patient B is ready. Break down the set-up for Patient A and quickly get set up for Patient B, and pray you don’t mix up anything in the process.

Safety comes first.

When cases get moved from room to room, trying to keep up with which patient you’re supposed to be setting up for can be so confusing. I realize that rearranging the schedule is necessary at times to avoid additional delays, but communicating those changes is vital. We don’t want to waste our time setting up for the wrong case (we’re busy enough already), but more than that, we want to avoid errors and protect our patients.

Our fast-paced environment means that we’re constantly on the go, adapting to changes, and finding solutions to problems that come our way. It also means that we’re under pressure. And we’re stressed. The constant go – go – go, turnover faster, move more quickly mentality adds an additional layer of stress to what is already a naturally stressful environment. This can lead to frazzled, exhausted, worn out staff, who are more likely to make a mistake.

So we’re faced with a dilemma.

How do we streamline our services and achieve our desired efficiency, without cutting corners, exhausting staff, and/or risking errors?

I would argue that it’s all in our priorities. Yes, time is important. We don’t want to be wasteful with our resources. Measuring how well we use our time shows us where we can improve. But if we simply view time through the lens of measurable data, we fall into the metric trap. And the attainment of benchmarks becomes our master. We forget that people are behind that data, and it’s the people (patients and staff) who lose when the priority is “do more, and do it faster.”

Instead, we should look to correcting and improving processes. Address the issues in the O.R. and other departments that directly cause delays. Reduce the redundant paperwork that our nurses are saddled with, so that they have more time available to get their rooms turned over. Hold staff accountable when they show up late, don’t clean up their rooms, or take long breaks. But also reward staff for their hard work. Provide additional training so that everyone knows how to do things the right way. Teach the process, teach the rationale, and hold people accountable. Efficiency will naturally flow out of a process that is taught and done correctly.

What’s our ultimate goal?

Keeping time in perspective in the O.R. means that we want to be time/people oriented. Meaning, we want to be efficient, but not because it looks good on a spreadsheet. Our goal with using our time well is to improve the experience for our patients. We want to provide them with a safe environment. We want their surgeries to run smoothly, we want to avoid error, and we never want to be tempted to cut corners – because our goal, ultimately, is not the measurement of time, but patient safety.

Sometimes, delays are just inevitable. Every variable can’t be controlled. But as much as it depends on us, we need to take a hard look at the processes within our O.R.s that need to be changed or improved, and make the change!

And when we improve the environment for our patients, we ultimately improve the environment for ourselves as well.

Keep up the good work,

Melanie

PS – Considering the CNOR? You can read my experience of the review class I took here, or you can check out the website for Zander Periopertive Education here.