1. AORN Perioperative Efficiency Tool Kit 2016
                         

2. Instructions for using the Perioperative Patient Throughput and Turnover worksheet
The attached PowerPoint® document is a process mapping tool where the swim lanes define each team member’s lane for mapping tasks performed over the defined time period. The time increments at the top help define the amount of time each task requires and sequences tasks performed by multiple team members. The times may be longer or shorter depending on the complexity of the procedure and the physical layout of the facility.
The swim lanes do not reflect a race but rather help synchronize each team member as the patient moves through the process. The first three slides provide an example to trigger discussion about the turnover process among team members. The blank slides can be edited to describe the roles at your facility and the tasks for your process flow. See instruction document on web site for more detail on how to use the worksheet.

3. Apply dressing and remove drapes
Participate in debrief/confirm time to return to OR for next case
Apply dressing and remove drapes
Greet next patient in Preop area and mark surgical site
Write postop orders and dictate postop note
Participate in debrief/confirm time to return to OR for next case
Assist with patient transfer and transport
Apply dressing and remove drapes
Extubate patient
Assist with transfer of patient to bed
Transport patient to PACU
Give hand-over report to PACU Nurse
Participate in debrief/confirm time to return to OR for next case
Arrange Patient #2 transport
Keep assigned team members in the OR informed of any changes to the schedule
Participate in debrief/
designate time to return to OR with next patient based on facility standard
Notify front desk when ready to send for Patient #2/call for turnover help/alert PACU that closure started/give approximate time of arrival to PACU
Assist in patient transfer to patient bed
Give hand-over report to PACU nurse
Finalize patient documentation
Assist with transfer to PACU
Review Patient #2 chart
Secure dressing
Participate in debrief
After count, begin instrument gathering/ organize instruments for processing by placing back in original containers to decrease the risk of loss and improve turnaround time for set assembly and sterilization
Break down sterile field and put dirty instruments in trays according to policy/hand off any instruments that need to be sterilized for subsequent cases
Assist with collection of trash and dirty linens
Assist Surgeon with dressing/remove drapes
Bring bed and transfer device into room
Assist with collection of trash and dirty linens
Move equipment to periphery/begin wipe down of equipment (foot pedals, cords, outer surfaces)
Transport Patient #2 to Preop area if necessary/collect room cleaning supplies
Participate in debrief
Assist with patient transfer to bed
Assist with termination of anesthesia
Assist with transport to PACU
Complete Patient #2 case cart
Return unused, clean supplies
Assist with patient transfer to bed
Return equipment that is no longer needed
Initiate DVT prophylaxis and prewarming protocols
Complete preop preparation of Patient #2
Start IV and give medication as ordered
Receive patient and hand-off information from RN circulator/receive hand-off information from anesthesia provider
Place case cart and equipment for Patient #2 by room
Assist Scrub Tech in breaking down sterile field
Clean nurses desk and computer keyboard
Verify case cart and equipment for next patient
Assist with patient transfer to bed
Remove unused medication

4. Mark surgical site for Patient #2 Communicate with Patient #1 family
Out of room/return to OR at designated time discussed during debrief for Patient #1.
PACU with Patient #1/write postop orders
Out of room
Return to OR
Start invasive line, blocks etc/verify and document preoperative antibiotic/ communicate special needs to RN Circulator and Anesthesia Tech
Transport Patient #2 to OR at designated time
Greet Patient #2 in Preop area
Notify team if more time is required
Greet Patient #2/verify identity, site marked, and procedure with patient/review preop assessment and receive hand-off report from Preop Nurse/perform additional assessment if needed and provide patient teaching/check blood product availability/erase whiteboard from previous patient/write Patient #2 information on whiteboard
Coordinate, assess and assist with progress of turnover/ review preference card/ensure equipment and supply readiness/ spread sterile supplies and begin opening
Greet patient upon entering room and introduce other staff members in the room to the patient
Final check for necessary equipment and supplies
Complete initial count and document on whiteboard
Breaks down sterile field/wipe down back tables, Mayo stands, and ring stands/places them in designated position to identify that they are clean/ transport case cart to decontamination area
Validate Patient #2 case cart and bring into room/spread sterile supplies and begin opening
Scrub, don gown and gloves
Prepare sterile field
Count with RN Circulator
Wipe down lights, OR bed/mop floor/ remove trash and equipment
Make bed
Pick up Patient #3
Remove dirty equipment from anesthesia machine and cart/wipe off anesthesia cart and all cables with approved disinfectant
Put new breathing circuit on anesthesia machine/ prepare any needed supplies or equipment for Patient #2
Assist Anesthesiologist with patient transport from Preop to OR
Provide hand-over report to Anesthesia Provider and RN Circulator
Begin preop of Patient #3/review and complete preop checklist/ contact MD or PA to resolve missing items or conflicts in orders/manage patient anxiety
Coordinate sterilization of instruments for
Patient #3 or later patients in the day
Begin review of Patient #3 case cart, instruments, and supplies/pick suture and gloves for case cart
Assemble positioning equipment for Patient #2
Bring new medication tray into room/set up prep tray/prepare medications
Greet patient if RN Circulator is still involved in count
Assist with opening sterile supplies/ dispense medications to field

5. Assist Scrub Tech with items needed to complete sterile setup
Scrub and don surgical gown and gloves/wait appropriate time for skin prep to dry
Perform briefing and surgical time out
In room at designated time
Assist and direct positioning/clip skin if needed
Drape patient
Make incision
Scrub and don surgical gown and gloves
Perform briefing and surgical time out
In room\assist with transfer of patient to OR bed
Assist with positioning
Drape patient
Assists with transfer of patient to OR bed/apply monitoring equipment
Induction and intubation
Assist with positioning and applying warming blanket/ assess patient alignment when positioning complete
Perform briefing and surgical time out
Line placement
Assist with transfer of patient to OR bed/continue prewarming of patient/assist with applying monitoring equipment
If Anesthesia Tech is not available, assist with intubation
Assist with positioning and perform final assessment of patient alignment
While skin prep is drying, perform briefing and time out
Assist with draping and positioning back table/connect ESU, suction, and other equipment
Insert Foley if required
Perform skin prep
Document time of incision
Apply SCD
Gown and glove surgeon and assistant
While skin prep is drying, perform briefing and time out
Complete sterile field set up
Assist with draping patient
Hand scalpel to surgeon
Move stretcher/bed out of room to designated location
Assist with transfer of patient to OR bed
Assist surgical team as needed with supplies and equipment
Assist with positioning
Assist with prep if necessary
Continually monitor the room and be available to assist with running for items
Assist with transfer of patient to OR bed/assist with applying monitoring equipment
Assist with induction and intubation/ assist with line placement
Cover for other technicians if they are busy in another room/ restock extra anesthesia carts and exchange with depleted carts/ restock depleted carts throughout the day to have them available for exchange
Assist with positioning
Deliver HLD or IUS items to room
Continue to sterilize other instruments needed for subsequent cases/communicate with OR Aide for delivery of supplies not anticipated for procedure
Preop assessment of subsequent patients
Assist Scrub Tech with items needed to complete sterile setup
Continually monitor room and be available to assist with running for items
Prepare case cart supplies and equipment for Patient #3
Provide breaks and lunches as assigned