Visual cues help to improve the turnover process.

Visual cues help to improve the turnover process Third of 3 articles on applying Lean management to turnover time. C reating a " visual workplace " is a principle in Lean management. Visual cues have been one solution for improving turnover time at Thomas Jefferson University Hospital in Philadelphia. In a visual workplace, the goal is to make waste, problems, and abnormal conditions readily apparent so they can be addressed. Eight ORs that perform primarily general and gynecologic surgery were selected for the Lean project. The health system has a total of 58 ORs. The goal was to improve turnover time from an average of 47 minutes to 30 minutes and to reduce variation, notes Monica Young, DNP, MBA, RN, CNOR, senior clinical director of perioperative services. Turnover time is defined as wheels out (patient leaves the OR) to wheels in (next patient enters the same OR). The project team included a certified Lean Master, Lean facilitators, nursing staff, a nursing assistant (NA), and managers. The Lean leaders interviewed the staff, performed time studies and observations, and analyzed turnover time data. Among solutions the team selected were to adjust nursing assistants' hours and to use visual cues to aid turnover time, including a tablet computer for the OR charge nurse so she can monitor the status of cases from any location. One issue the team identified was the need for a more structured role for nursing assistants. The assistants had competing duties, such as delivering specimens and transporting patients, which often took them off the unit. Plus, their break time coincided with the busiest time of the day for turnovers. A suggestion was to make the nursing assistants members of a team so they would feel more valued, says the charge nurse, Debra Righter, BSN, RN. The solution was to assign 1 nursing assistant to every 2 ORs instead of having all 4 responsible for 8 ORs. " That gives more structure to who is assigned to each room and makes the nursing assistant feel more a part of the team for the day, " she says. An iPad helps charge nurse Debra Righter, BSN, RN, monitor the status of cases in 3 OR locations.