Improving starting time in operating rooms of a tertiary hospital in Rwanda: a quality improvement project

Abstract

Background Delay in the first surgery start time at operating room (OR) could inevitably decrease utilization, lose very expensive OR resources, reduce satisfaction of patients and staff and potentially affect quality of patient care. Objectives This study utilized the Strategic Problem Solving (SPS) quality improvement approach to increase the percentage of first surgeries started on time at a tertiary hospital in Rwanda. Methods A pre-and post-intervention study was conducted between March 2016 and March 2017. The intervention included developing a policy on staff arrival time, training sessions on the policy and regular supervision of OR managers to ensure staff were arriving on time. Results Chi square tests were performed to analyze the pre-and post-intervention results. The percentage of first surgeries started on time significantly increased from 3% pre-intervention to 25% postintervention (P<0.001), average duration of delay decreased by 55 minutes (P<0.001) and the percentages of nurses, anesthetists and surgeon arrived on time also significantly increased (P<0.001). Conclusion The SPS approach can be useful in addressing the starting time of first surgery at OR. Support from the senior management team and buy-in from staff are essential. This project cannot eliminate confounding factors and the results cannot be generalizable to other settings. Longer term evaluation on sustainability is needed.

Root causes of first-case start time delays for elective surgical procedures: a prospective multicenter observational cohort study in Ethiopia

“…Efficient time management and prioritization are necessary to strike a balance between these tasks and make sure that the first case of the day gets to the operating room on time. On the other hand, if morning rounds or other activities extend beyond the first case’s scheduled start time, the surgeon’s entrance into the operating room may be delayed, which may result in later first case start times [ 7 , 33 ].…”

“…Anesthetists require sufficient time before surgery in order to prepare the anesthetic workstation, go over patient data, and review preoperative evaluations. If they are late, it could interfere with workflow and teamwork, delaying the initial case [ 7 , 34 , 37 ]. Similarly, surgeons and support staff need sufficient time to review patient charts, gather necessary equipment, and conduct final assessments before the start of surgery.…”

“…Thus, there was a 10.5-fold increase in the chance of a delayed first-case start time if the surgeon entered the operating room at or after 2:30 a.m. Comparably, a study conducted in South Africa and India demonstrated that surgeon-related factors, including late surgeon arrival time, were the first reasons for the first-case start time delay [ 4 , 43 ]. Anesthetists and surgeons’ tardiness was found to be the primary cause of late surgery start times in a baseline assessment of an interventional study from Rwanda that aimed to increase the percentage of first surgeries starting on time from 3–25% [ 7 ]. This could be explained by the fact that surgeons are essential to the preoperative stages of the procedure; they organize surgical sites, update patient assessments, and collaborate with anesthesia providers, nurses, and support staff to ensure that everyone is ready for the scheduled surgery.…”

“…On the other hand, delays in the start time of the first case cause delays in subsequent cases, decreasing efficiency throughout the day [ 6 ]. The OR is a significant source of cost for hospitals because of the large volume of clinical activity, the need for numerous types of expensive equipment, and the quantity of qualified professionals needed for each case [ 7 ]. As a result, being inefficient in the OR can have serious financial consequences, as OR rooms are staffed yet underutilized [ 8 ].…”

Faktor Yang Menyebabkan Keterlambatan Mulai Operasi Pertama Pasien Elektif: Literatur Review

“…Penelitian yang dilakukan oleh Ciechanowicz et al di Pusat Kesehatan Inggris menetapkan bahwa 22% kasus bedah elektif pasien pertama tidak dimulai pada waktu yang dijadwalkan, dengan sebagian besar kasus bedah elektif dimulai lebih dari 15 menit setelah waktu yang dijadwalkan (Ciechanowicz et al, 2017). Sebuah studi oleh Yamuragiye mengenai penundaan waktu mulai di ruang operasi di rumah sakit pendidikan universitas Kigali menetapkan bahwa hanya 3% dari operasi yang dimulai tepat waktu sementara 97% ditunda (Yamuragiye A, 2017). Penelitian lain yang dilakukan di rumah sakit perawatan tersier mengidentifikasi hanya 33% operasi pertama pasien elektif dimulai tepat waktu, dan 67% kasus dimulai terlambat (Kumar M et al, 2016).…”