Patient and personnel factors affect operating room start times

Abstract

Objectives: Perioperative efficiency has been studied, though little is known about patient and personnel factors associated with a timely operating room (OR) start. We hypothesize that patient, personnel factors, and induction order decisions are associated with anesthesia induction time.Methods: An institutional database was used to identify the anesthesia induction time of adults undergoing first start, elective operations from January 2014 to May 2017 at an academic quaternary care center. Data included patient demographics, the gender of the surgeon and anesthesiologist as well as their seniority (years since initial board certification), Certified Registered Nurse Anesthetist (CRNA) versus anesthesia resident staffing, and use of neuraxial anesthesia. Times were measured as minutes from scheduled start to induction. Univariate and multivariate analyses were performed to identify factors associated with induction time. Results:We identified 15,823 cases. Predictors of later induction included add-on cases (1,224 cases were add-on's, 7.73%), ASA≥ 3, neuraxial anesthesia, and CRNA staffing. Surgeon seniority but not gender affected induction time. In 11,093 (70.1%) of cases, the anesthesiologist was scheduled for multiple first starts with a choice of which patient to induce first. Surgeon gender was predictive of induction order, with the cases of male surgeons were induced somewhat first more frequently than female surgeons' (47.0% vs 44.1%; p=0.02). Cases staffed by anesthesiology residents were more likely to be induced first compared to those staffed by CRNAs (52.1% vs 41.5%, p<0.01). Conclusions:Patient and personnel factors affect the order of case induction, but induction time is most dependent on patient factors. Hospitals should focus on improving preparedness and limiting bias to create a more equitable and efficient perioperative process.

Efficiency in the operating room: optimizing patient throughput

“…They also noted that add-on cases were also more likely to be delayed. In contrast, higher level surgical resident, female anesthesiologist, surgeon experience, and anesthesiologist experience were all independently associated with a decreased incidence of delayed starts 21…”

“…Starting the operative day on time is important for many reasons. In addition to maintaining OR efficiency, delays can lead to increased costs, decreased utilization, and decreased patient and staff satisfaction 19–23. Although entering the operating room with a patient on time seems simple, the process requires the coordination of personnel and processes throughout the entire perioperative enterprise.…”

“…In addition to maintaining OR efficiency, delays can lead to increased costs, decreased utilization, and decreased patient and staff satisfaction. [19][20][21][22][23] Although entering the operating room with a patient on time seems simple, the process requires the coordination of personnel and processes throughout the entire perioperative enterprise. Often, the failure of any one part of the throughput process has a domino effect and causes delays.…”

“…In contrast, higher level surgical resident, female anesthesiologist, surgeon experience, and anesthesiologist experience were all independently associated with a decreased incidence of delayed starts. 21 A number of strategies to improve first case on-time starts have been studied. 26 The first step is evaluation and identification of the issues that lead to delays.…”

Der pünktliche morgendliche OP-Beginn

“…▪ Geplante anästhesiologische Freigabe: 08:00 Uhr. Status des Patienten beeinflusst[22],[23]. Eine präzise Vorhersage wäre jedoch für eine optimale Steuerung der Prozesse von großem Nutzen und könnte somit nicht nur Verzögerungsinzidenzen reduzieren, sondern auch unerwünschte Wartezeiten für Operateure und das OP-Team zumindest reduzieren[24].…”