Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times?

Abstract

Background: We explored whether a previously successful initiative to improve first-case on-time starts succeeded because (i) preoperative steps started earlier (but the process did not necessarily improve) or (ii) the process was brought into better control. Methods: We analysed 35 months of data comprising 28 882 first cases to calculate the difference of the time a patient entered the operating room (OR) vs the scheduled entry time. Median and inter-quartile range were used to evaluate changes in distribution parameters. A statistical process-control methodology was used to compare the differences in performance between the pre-and post-intervention phases. Results: Post-intervention first cases entered the OR on average within 4 min [95% confidence interval (CI): 4e5 min] of the scheduled start time, as opposed to within 8 min (95% CI: 8e8 min) in the pre-intervention period. The median delay decreased from 5 min (95% CI: 5e5 min) to 2 min (95% CI: 2e2 min). The inter-quartile range of the difference between the scheduled start time and the first case in room time decreased from 13 min (95% CI: 13e13 min) to 10 min (95% CI: 9e10 min). Conclusions: The reduction in inter-quartile range demonstrates that improvement in on-time starts resulted from the process being in better control. The start time of preoperative preparatory activities did not move earlier, which means that OR and preoperative staff do not need to arrive at work earlier. Improvements resulting from the process being in control were sustained.

The Contribution of Variable Control Charts to Quality Improvement in Healthcare: A Literature Review

“…The earliest study was published in 1992 41 and the latest in 2019. 38 Both of these were conducted in the USA. Between 1992 and 2006, there were long gaps between publications, but from 2006 they became more frequent.…”

Efficient perioperative time-management methods for operating theatres: a systematic review showing how to reduce overall patient waiting times for elective surgery

“…Among the 20 included studies, nine (45%) introduced perioperative management methods in common for all elective surgeries (27)(28)(29)(30)(31)(32)(33)(34)(35). There were four studies each on preoperative methods for general surgery (36-39) and for neurosurgery (40)(41)(42)(43), two articles for eye surgery (44,45) and one article for head and neck surgery (46).…”

“…Due to the inherent multidisciplinary involvement in perioperative care, many factors contributed to potential delays. The most common factors discussed were delays of the surgical and anaesthetic teams attending to work (28,30,39), delays in instruments and material processing, delivery and setup in theatre (30) and taking resident training sessions in the OT of teaching hospitals (28) were the common factors discussed. Turnover times depend on two main factors: samesurgeon turnover (same surgeon doing the next surgery) and different-surgeon turnover (new surgeon doing the next surgery) (35).…”

“…Based on the pre-operative processes considered, six studies investigated management of pre-operative assessment (27,28,34,36,43,44), seven studies discussed timely transport patients from ward to OT (28, 29,34,36,40,43,45) and three studies evaluated timeliness of the process for obtaining consent from the patient (36, 39,43). At the OT, planning for rst case start on time was discussed in 11 studies (27,28,30,31,33,34,36,(39)(40)(41)43) and eight studies focused on change over times of patients at theatre (27,34,36,37,40,42,50). Nine studies estimated scheduled surgery cancellation as a result of inadequate perioperative time management methods (27,33,34,36,42,44,50).…”

“…No missing data were noted for any study, because patient data were extracted from regular administrative records (29,33,38,39,41,43,52). The measurement of the outcome variable included in many studies that were considered in relation to perioperative times are shown in Table 3 and those time measurements associated with the waiting time was considerably unbiased (29,30,52).…”