Benchmarking efficiency is nothing new to the perioperative team; it is talked about in huddle, in services, and staff meetings. Efficiency in the Operating Room (OR) is measured by time, including start time, end time, turnover time, incision to closure time, block time utilization and more.

OR time can be quite expensive. In California, one minute of operating room time cost an average of $36 to $37 according to a study published in JAMA Surgery. Time is the driving force behind improving efficiency in the OR but there is also an interesting balancing act between being faster and keeping the patient safe. Unsafe patient care can be influenced by validation the surgical team receives from the surgeon. For “faster turnovers” surgeons may request the team with the fastest turnover times. Improving turnover times can be done efficiently, safely, and satisfy the surgeon. It starts with effective communication and collaboration among staff.

One way to improve efficiency and turnover time is when standardization of room cleaning takes place.   Giving each member of the team a task they are accountable for, decreases repeated and forgotten tasks. Another way is to decrease the amount of people in the OR at turnover time, this can reduce chaos and disorganization that can lead to a longer turnover.

Potential pre-turnover activities to help improve OR turnover efficiency include:

  1. Ensure a debrief is included during closing time.
  2. Verbalize timelines and expectations for turnover times and next case start time. 


By including this information in the debrief, the surgeon and the team have a goal to reach, and the goal will keep the team accountable.  After the debrief, the circulating room nurse can begin to plan for the turnover by breaking down back tables that are no longer needed and communicating with the operating room assistants the needs for the next case. The circulating room nurse can make sure that all the supplies for the next case are ready and organized on the case cart so that it can be pulled into the room and opened immediately instead of having to waste time sorting. There are many things that can be done sequentially and can be standardized so that everything is done even before the patient leaves the OR.

Turnover Time represents lost revenue-generating opportunities for the surgeon as well as the hospital and anesthesiologist. Improving turnover time is a major opportunity to increase the clinicians' personal productivity and optimize hospital income. Between current time and benchmark potential can yield significant opportunities for increased business and physician satisfaction as well as keeping the patient safe.