Improving on-time surgical starts: the impact of implementing pre-OR timeouts and performance pay

Martin, Luke; Langell, John T.

doi:10.1016/j.jss.2017.05.092

Cited by 19 publications

(22 citation statements)

References 10 publications

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“…First, our average baseline on-time start rate was around 62%, already much better than in many other studies where baseline on-time start rates were anywhere from 6% to 49%. 1 , 3 , 5 Although a subsequent improvement to 77% from 62% seems modest, it is noteworthy that patient-related causes led to 20% delays in our assessment. We did not do any patient-focused interventions, and innovative measures aimed at these issues may drive improvement further.…”

Section: Discussionmentioning

confidence: 74%

“…1 , 9 Other studies used significant financial incentives such as annual bonuses of up to $2,000 for surgeons for more than 90% on-time starts or an at-risk salary model for anesthesiologists. 5 , 6 These interventions require a significant financial investment. The literature on improving on-time starts in the pediatric OR is limited, and there may be additional challenges in this population due to a high level of anxiety and a possible need for more discussion from surgeons and anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

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

Pashankar¹,

Zhao

Bathrick

et al. 2020

Pediatric Quality &Amp; Safety

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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.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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

Pashankar¹,

Zhao

Bathrick

et al. 2020

Pediatric Quality &Amp; Safety

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“…We conducted a pretest-posttest audit of electronic secondary data to describe changes in the numbers of procedural delays and DOS cancellations following implementation of an intervention to improve participation in the WHO SSC. DOS cancellations and delays, regardless of the underlying cause(s), negatively impact on use and consequently on costs 13 . Retrospective audits of an electronic database of surgical information maintained by the hospital occurred over two 12-month periods.…”

Section: Methodsmentioning

confidence: 99%

The impact of improved surgical safety checklist participation on OR efficiencies: A pretest-posttest analysis

Gillespie¹,

Harbeck²,

Mn³

et al. 2019

Journal of Perioperative Nursing

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BMG conceived of the study, assisted in participant recruitment and drafted the manuscript. BMG and EH performed the quantitative analysis. AM and EH contributed to study conception and assisted in interpretation. TG, JL and TKW assisted in recruitment, participated in the study and assisted in interpretation. All authors participated in the design and coordination of the study and read and approved the final manuscript. The impact of improved surgical safety checklist participation on OR efficiencies: A pretest-post test analysis Does improved use of a surgical safety checklist influence OR efficiency?

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“…There have been several approaches adopted to increase OR efficiency, including ensuring on-time surgical starts, improving intraoperative time, reducing OR turnover time between procedures, decreasing idle time, implementing preoperative checklists and timeouts, postoperative debriefs, and providing incentives to increase efficiency. [6][7][8][9][10] The 2 main strategies that have received significant attention in the health care field are Lean and Six Sigma, which are quality improvement processes that were initially adopted in the manufacturing industry. The Lean strategy was developed in 1988 by Taiichi Ohno at Toyota and focuses on eliminating waste that does not contribute to the overall manufacturing process.…”

Section: Introductionmentioning

confidence: 99%

A Successful Organized Effort to Improve Operating Room First-Case Starts in a Tertiary Academic Medical Center

Chua

Lewis

Huang

et al. 2020

The American Surgeon

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Background Operating room (OR) inefficiency drives up cost, decreases revenue, and leads to surgeon, staff, and patient dissatisfaction. Given a low mean first-case start rate in our tertiary academic medical center, we developed a process to improve first-case start rates in an effort to increase OR efficiency. Methods A working group of the OR Executive Committee was constituted to develop and implement a multistep operational plan. This plan was predicated on a sensible staggered start framework, coordination of stakeholder responsibilities, a visual preoperative Stop/Go checklist tool, real-time measurement, and feedback. Results Within 11 days of implementation, 95% of first-start OR cases were tracked to start on time. Throughout the observation period (May 2015-July 2016), the goal of a daily mean 80% on-time start rate was either met or exceeded. Conclusions Implementation of an organized collaborative effort led to dramatic improvements in first OR case on-time rates. Such improvement in OR utilization may lead to an increase in staff and patient satisfaction and cost reduction.

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Improving on-time surgical starts: the impact of implementing pre-OR timeouts and performance pay

Cited by 19 publications

References 10 publications

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

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

The impact of improved surgical safety checklist participation on OR efficiencies: A pretest-posttest analysis

A Successful Organized Effort to Improve Operating Room First-Case Starts in a Tertiary Academic Medical Center

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