A Quality Improvement Project to Improve First Case On-time Starts in the Pediatric Operating Room

Abstract

Background: Delays in the operating room (OR) can lead to increased hospital costs as well as patient and provider dissatisfaction. Starting the first case on time in the OR can potentially prevent subsequent delays. We designed a quality improvement project to improve the first case on-time starts in the pediatric OR at a tertiary care children’s hospital. Methods: Following the collection of baseline data, we formed an interdisciplinary team. We analyzed the causes of delay and used the Six Sigma methodology of Define, Measure, Analyze, Improve, and Control. We identified key drivers and implemented several low-cost interventions using Plan-Do-Study-Act cycles. Major interventions included preoperative care coordination, strategic staggering of OR cases, and introduction of “Wow Bucks” incentives. We monitored start times and the delay in minutes for all first cases weekly. The OR minutes saved per week were calculated and used to estimate cost savings. Results: We studied a total of 1981 first-start cases from May 2018 to October 2019. The first case on-time starts improved from 62% to 77% over the study period. There was a significant improvement in total minutes delayed for all the first cases from 197.9 minutes per week down to 133 minutes per week ( P < 0.05). Estimated cost savings were $4,023 per week due to improved OR utilization. Conclusions: A multidisciplinary collaborative team approach using quality improvement tools can improve on-time starts in the pediatric OR.

Operating room efficiency in a low resource setting: a pilot study from a large tertiary referral center in Ethiopia

“…The start time was delayed in 93.4% of the cases. This may be the most important parameter as it decides the day’s surgical activity [ 18 ]. Downstream effect of the late starts can also be the cause for frequent cancellations observed in our study due to lack of OR time.…”

“…Downstream effect of the late starts can also be the cause for frequent cancellations observed in our study due to lack of OR time. Many institutions have used different strategies to improve starting time [ 18 – 20 ]. To implement these in our setting we need further data evaluating the reasons for delay of the first case.…”

Badge sign-in and report cards improve first case start times in gastrointestinal endoscopy: A prospective quality improvement study

“…In 2014, Tomer et al decreased FCS delays from 17 minutes to 10 minutes (P < 0.01) through physician education, email communication to faculty, and monthly faculty meetings [6]. Pashankar et al improved first case start times in a OR setting by setting up the room for the first case the day before, a postoperative care nurse was brought to the preoperative area to facilitate the first case, and surgeons received automated text messages [14]. Harewood et al analyzed and compared procedures prospectively to identify ways of improving effi- ciency [9].…”

Operation Note Transformation: The Application of Lean Six Sigma to Improve the Process of Documenting the Operation Note in a Private Hospital Setting

“…Six Sigma was introduced by Motorola to optimise its manufacturing processes by reducing their variability through the rigorous application of process metrics collection and statistical analysis [5]. Since the early 2000s, LSS thinking has been adapted into healthcare with the goal to improve patient safety, quality of care, efficiency, patient satisfaction, and performance [6][7][8][9][10][11][12][13][14]. LSS puts an emphasis on working with and eliciting the customers' voice [15] and has been shown to be synergistic with person-centred approaches to engagement [14].…”

“…Since the early 2000s, LSS thinking has been adapted into healthcare with the goal to improve patient safety, quality of care, efficiency, patient satisfaction, and performance [6][7][8][9][10][11][12][13][14]. LSS puts an emphasis on working with and eliciting the customers' voice [15] and has been shown to be synergistic with person-centred approaches to engagement [14]. It was therefore seen as an approach that could both improve the existing process for ON documenting and engaging our primary end-users, the surgeons who did so.…”