Measuring and Improving First Case On-Time Starts and Analysis of Factors Predicting Delay in Neurosurgical Operating Rooms

Mathews, Letha; Kla, Koffi M.; Marolen, Khensani N.; Sandberg, Warren S.; Ehrenfeld, Jesse M.

doi:10.1097/ana.0000000000000131

Cited by 18 publications

(18 citation statements)

References 10 publications

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“…The project techniques were initially tested in a single OR service. 24 Next, at multiple meetings of the OR committee and perioperative services, managers provided education about the FCOTS initiative. In addition to these educational activities, the major intervention for FCOTS improvement was to institute a 'huddle' at 9:00 AM (after the majority of first cases had started) of OR operational leaders (nursing managers, lead nurse anaesthetist, charge nurse, and anaesthesiologist in charge) to conduct a mini-root-cause analysis of each case that had started late that day.…”

Section: Process-improvement Techniques Used To Increase Fcotsmentioning

confidence: 99%

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?

Tiwari

Ehrenfeld

Sandberg

2018

British Journal of Anaesthesia

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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.

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Section: Process-improvement Techniques Used To Increase Fcotsmentioning

confidence: 99%

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?

Tiwari

Ehrenfeld

Sandberg

2018

British Journal of Anaesthesia

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“…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). Nineteen of the 20 studies investigated speci c, institution-based interventions.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…Mathews (41) reported a case control study to increase rst case on-time start (FCOTS) in the neurosurgical OT in a tertiary care centre in the USA, which was conducted in 2009 to 2011. Factors predicting delayed start were also identi ed and implemented.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

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

Rathnayake¹

2021

Preprint

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Introduction: The effects on long waiting times for elective surgeries from lower operating theatre (OT) performance have been reported in many studies. The timeliness of perioperative processes and adherence to scheduled times is crucial for efficient performance in OT but the perioperative workflow includes multiple tasks assigned to different work teams. Each of these needs to be completed in a timely manner. This systematic review investigates the effects of efficient preoperative systems on the timeliness of upstream and downstream processes in surgical care pathways in order to reduce overall patient waiting times for elective surgery. Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases during December 2019 and January 2020, for articles published after 1 January 2014. All studies pertaining to perioperative time-management methods, which had an intention to reduce waiting times for elective surgery were eligible for this review. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer-related surgeries. Both randomized trials and non-randomized controlled studies were considered and the quality of studies was assessed using ROBINS-I and CASP tools. The review findings are presented as a narrative synthesis due to the heterogeneity of included studies. The PROSPERO registration is CRD42019158455. Results: The electronic search yielded 7543 records and 20 articles were eligible after deduplication and full article screening. There were two experimental studies, five quasi-experimental studies and 13 observational studies. The studies varied widely in design, scope, reported outcomes and overall quality. The first-case-start-time and patient change-over-time at OT were the main time related measures considered as affecting timeliness in many studies. Conclusion: This review suggests that a significant amount of time could be saved with efficient scheduling and planning perioperative processes, which could reduce overall patient waiting time for elective surgeries. Managing perioperative time in isolation could be an enabling factor for an overall increase in both theatre utilisation and theatre efficiency. However, only a small number of good quality studies were available and further evaluation with higher quality study designs and rigour is recommended in order for firm conclusions to be reached.

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“…In April 2017, the Division of Perioperative Services at our tertiary-care medical center launched a multifaceted FCOTS improvement initiative. Based on best practices 3,4,[10][11][12][13] and investigation of institutional preintervention workflow, the policy comprised 3 main components: defining FCOTS and stakeholder education regarding its importance; assignment of a discrete, standardized process for preoperative workflow known as "swim-lanes" (eFig. 1); and daily reporting of FCOTS rates and sources of failure to hospital leadership and surgical, anesthesiology, and nursing stakeholders.…”

Section: Description Of Interventionmentioning

confidence: 99%

“…7 Factors associated with successful FCOTS programs include specifying a discrete definition of FCOTS, 8 early identification of factors associated with delayed starts, 9 establishing a system of data collection and monitoring, 3 and short-interval feedback to stakeholders. 10 Additionally, multiple groups have found that successful FCOTS initiatives can improve surrogate measures of OR efficiency such as FCOTS rates, 6,10,11 duration of "first start" delays, 4 and perioperative staff satisfaction. 12 Disclosure Information: Nothing to disclose.…”

mentioning

confidence: 99%

Time Is Money: Can Punctuality Decrease Operating Room Cost?

Chapman

Luo

Doyle

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Inefficient operating room (OR) use wastes resources. Studies have suggested "first case on-time starts" (FCOTS) reduce OR "idle time," yet no direct association between FCOTS and markers of OR efficiency, like "last case on-time end" (LCOTE) or overtime costs, have been reported. We performed this study to evaluate factors associated with FCOTS, LCOTE, and OR overtime costs. STUDY DESIGN: In April 2017, our medical center launched an FCOTS improvement initiative. Prospectively collected data concerning cases performed in the 6-month preperiods were retrospectively analyzed. Elective, nontraumatic cases performed by orthopaedics, gynecology, urology, minimally invasive surgery, or colorectal surgery were eligible. Univariate and multivariable analyses were used to evaluate 3 outcomes of interest: the association between FCOTS and LCOTE (primary), the change in FCOTS rates after intervention implementation (secondary), and estimated overtime cost savings associated with FCOTS (secondary). RESULTS:We analyzed 12,073 cases (6,095 pre-vs 5,978 post-intervention) performed over 2,631 OR days (1,401 pre vs 1,230 post). The FCOTS rate increased after intervention (76.1% vs 86.6%, p < 0.001), with post-intervention cases twice as likely to start on time (adjusted odds ratio [aOR] 2.07; 95% CI 1.73 to 2.46, p < 0.001). Additionally, starting on time was associated with a higher likelihood of LCOTE (aOR 1.76; 95% CI 1.38 to 2.24, p < 0.001) and 21.8 fewer overtime minutes (95% CI 13.7 to 29.8, p < 0.001) per OR day. Post-intervention estimated savings of $87,954 in direct OR costs over 6 months were associated with the FCOTS initiative. CONCLUSIONS: The FCOTS initiative was associated with higher frequency of FCOTS, which was independently associated with LCOTE. This achieved an estimated 6-month cost savings of more than $80,000 in direct OR expenditures. (J Am Coll Surg 2020;230:182e189. Ó

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Measuring and Improving First Case On-Time Starts and Analysis of Factors Predicting Delay in Neurosurgical Operating Rooms

Abstract: The quality improvement project, which was implemented in 2 phases, successfully increased the FCOTS rate in our neurosurgical ORs from 33% to 68%.

Cited by 18 publications

References 10 publications

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?

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?

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

Time Is Money: Can Punctuality Decrease Operating Room Cost?

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