On Wednesdays we wear pink. Deliberate Mean Girls Reference.
On Wednesdays, I write about the operating room Not so weird, considering Dispatches from the Evening Shift started as an OR blog. And then it became an operating room/nursing/post-it notes to me discussion/Tuesday Top of Mind where I discuss politics and things that are top of my mind/Cookie Thursday is a Thing/School Me Saturday blog.
Yeah, I know that the topic of my dissertation might be more of a School Me Saturday post but this is very operating room-centric. I just felt like it fit here best. And I’m doing an Alice in Wonderland theme for School Me Saturday for a few weeks.
My idea for the dissertation project that will take me nine months to do and write the damned dissertation (name of a dissertation service I’ve seen) is solidly in the OR.
Not to go too deep into the details but the OR is consumed with turnover.
This is not when people leave and new people are hired. While that is also called turnover, this is not it.
Turnover refers to the Wheels Out to Wheels In time. This is the length of time that elapses when one patient leaves the room (Wheels Out), the room is cleaned, the equipment is brought in, the next case is opened and counted, and the next patient enters the room (Wheels In).
There are industry standards. There are goal times that the hospitals strive to meet. The industry average is 26 minutes.
And I am over here doing 10-12 minute turnovers. Often in the same room, always with the same team, and always without anyone but us to clean the room/get the equipment/open and count the room.
The question is why.
Why is the evening night team so efficient?
So efficient that several doctors remarked on it. One of them went so far as to suggest they were going to schedule all of their cases after 1500.
The thing is… I don’t know.
Being a circulator is a job in a solo. We don’t know what the other circulators are doing.
This leads me to the pilot observation study that I will be doing as soon as the IRB allows.
It is my hypothesis that there are tasks that can be done to potentiate a faster turnover.
These are simple tasks.
Make sure there is no trash on the floor.
Make sure all the linen is in the linen bag.
Make sure all equipment is away from the OR table.
Make sure that all extra supplies are either put away in the room or readied to be taken out of the room.
Make sure all the suction cannisters are prepped for removal.
Be thinking ahead to the next case and the equipment that might be needed.
Be thinking ahead to the positioning requirements of the next case.
In other words, prepare to room to be left.
I only know what I do. I don’t know what other circulators do.
Hence the pilot study.
The pilot study will be in one hospital during the day shift.
The big dissertation study will be controlling as many variables as I can and observing in other venues. Such as a bigger hospital. Such as an ambulatory surgery center. Such as the night shift. Such as the weekend shift.
The thing I’ve learned about the dissertation during my program is to keep it simple.
There are many downstream effects that an efficient turnover can do. Keeping to the scheduled times. Getting people out of shift on time. Decreasing overtime costs.
The end goal is to create a checklist for pre-Wheels Out activities.
But that is NOT the dissertation goal. That’s for later.
Because creating a checklist and getting it validated can add 2 years to the dissertation time.
I don’t have time for that.
Remember. Keep it simple. This is not the best work I will ever do. This is not the most important work I will ever do.
The dissertation project is just enough. Because although there is a degree at the end, it is really about the journey.
Dispatches from the Evening Shift 