Email Discussion GroupTurnover Times

Topic Under Discussion: Turnover Times We are a multi-tasking (Cath, PCI, EPS, implants, peripheral, pediatrics, etc.) cath lab dept. of 6, growing into 8 labs this year. One of our issues that we are tackling right now are turn-over times. We average about 25-30 cases daily. How are cath lab turnover times measured in departments with 5 or more labs? Do they rely on computerized or written measurement? How are the times identified/initiated? (Patient In room to Out of room, Case Start to Case End, MD called to MD arrival, etc.) What are the ideal turnover times for depts. of that size? What kind of staff are utilized to ensure rapid turnover (additional nurses, techs, environmental services, etc.)? Is there a national benchmark or other similar studies conducted by other CCLs for turn-over times for multi-tasking labs (EPS, implants, peripheral, pediatrics, etc.)? Thank you for your help. Norman Jacinto, BSN, RN, Interim System Administrator Research & Database Nurse Coordinator Memorial Regional Hospital, Cardiac and Vascular Institute Hollywood, Florida NJacinto@mhs.net Group Members’ Responses to …Turnover Times 30 Minutes Between Patients Goal Here is what we do: We have one lab (cath, PCI, pacemaker implants, etc...) and are hopefully going to 2 this year. Our documentation/database system is able to capture times. We are able to track table time (pt. on the table to off table), time to MD arrival after being paged, and time between cases. Housekeeping is available to us by pager for trash removal and mopping the floor between cases. Adequate nursing is an important factor for us (assuring that we have a nurse to be present for the next case coming in the room). Our longest turnaround time is when we switch from cath set-up/equipment/supplies to pacemaker set-up/equipment/supplies. We try to group procedures when possible. I have not seen national benchmarks/standards for these times but our goals have been: Natalie Beiler, NBeiler@rhcc.com Swift teamwork Our cardiac cath lab has 3 procedure rooms. One room is solely for EPS, PPM and AICD implants. We have 2 rooms for cardiac caths and PCIs. Every day, we usually do 18“20 cases in an 8 hour shift. Turnover time in our cath lab relies on teamwork with RNs and techs and environmental aides. We have our own housekeeper who cleans the room after every procedure while the team gets the new patient in and the MD is waiting in the room. Usually, we have an average of 8“10 minutes turnover time from patient out to time pts gets in the room, and we can get the pt ready in 10 minutes from pts time in to MDs giving the local. George Robert Victoriano III, BSN, RN, Mc Allen Medical Center, Mc Allen, Texas Grvictoriano@hotmail.com Strategies from Multi-Tasking Lab Hello! We are also a multi-tasking cath lab (caths, PCIs, peripherals [carotids, dialysis shunts, renals, SMAs, subclavians, extremities], EPS/ablations, PPIs/ICDs, tilt studies, TEEs, no peds). We average 18-25 cases a day, and have 4 labs and a 10-bed recovery room. We utilize the computer for measurements; the monitor person makes any necessary corrections! We average a 10-15min turnover time (end to art. stick). Recovery preps and recovers; picks up the patient (IP), along with anyone free to assist with transport. Start time starts with the monitor person starting the report, MD called and arrived are documented along with arterial/venous access. We have the GE Marquette system. The team consists of 1 RN and 2 techs (RCIS, EMTs, and RT(R)s are under the position in this lab). When there are 2 RNs on a team, we all rotate scrub, circ, monitor, with the RN on the monitor assisting with the meds if the tech is circulating. The scrub person gives report in recovery and comes back to turn over lab along with the other two.We rotate by scrub-monitor-circulate, then back to scrub.If we have 4 team members, then the scrub is free the next case and then comes back to monitor. This person helps in transport along with assigned duties. Hope this helps. Chris Reoch RCIS St. Mary’s Hospital, Richmond, Virginia reochris2000@comcast.net Important to Document Various Times Our turn around time starts at the end of the case (when the MD steps away from the table) until the beginning of the next case (when the MD scrubs in). We rely on the time documented in the hemodynamic system, which makes it easier to run queries. We also document the time the patient arrives and leaves, the time the patient is ready, the time the MD is paged, and the time they arrive. We function with 4 cardiovascular specialists in the procedure room (which could include, RTRs, RNs, RTs, or paramedics) to aid in rapid turn around time. We utilize patient service assistants to help transport patients as well. Sheila DeBastiani, RT(R), Supervisor/Educator WakeMed Invasive Cardiology sdebastiani@wakemed.org MD Given 20 Min Post Page This has been an issue for years with most cath labs. A significant factor pertains to how fast an attending physician wants to handle his caseload. One of the most efficient systems is the cath lab system in The Belk Heart Center, Presbyterian Hospital, Charlotte, NC. Most days, their support staff completes invasive procedures on 2.6 patients per hour. In addition, the cardiologists and the support staff have an excellent working relationship. If an attending is not present within 20 minutes after being paged to do his patient, the patient is removed from the table and the next one placed in the room. Also, the physicians and staff have a monthly meeting. During this meeting, everyone is given a chance to vent any issue that could hamper the quality of patient care. If any negative feelings surface with anyone, the situation is openly discussed. The personnel focus on finding solutions to any problem that arises. Chuck Williams RPA, RT(R)(CV)(CI), RCIS Emory University Hospital Atlanta, Georgia cowrpa@yahoo.com Accurately Appraise Turnaround Times I do not believe cath lab turnaround times should be any different no matter how many labs you have. I have an analysis from Goodroe Healthcare Solutions addressing how to accurately appraise turnaround. The analysis defines turnaround as time elapsed from procedure finished to next patient ready for procedure start. Within this measurement, the following will be monitored: prepping patient for transfer, lab cleaned and set up, next patient in the lab. This refined measurement should have an elapsed time of 30-45 minutes. In the past, a typical measurement may only include the cleaning and set up. When using this for your study, elapsed time should run between 10-20 minutes. The study shows that labs with turnaround times of 40 minutes rank in the 50th percentile, while improving your average time to 30 minutes should bring you in at the 25th. As for the staff that is utilized for turnaround, we use everyone and anyone with a free hand. When working together on all issues, we found the department to be much more efficient. Scott Fylling, Manager of Cardiac Cath/Special Procedures Scott.Fylling@bhsnet.org

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