Rewarding On Time Start Times in Operating Rooms Improves Efficiency

Abstract

Background The average cost of running an operating room (OR) is approximately $37.00 a minute. Therefore, every effort should be made to start in a timely manner. There are several factors at play that can cause OR delays. Attaining consistent start times is a multidisciplinary task, which requires good communication and rewards for efficiency. Methods At our institution, a “star system” was implemented to improve compliance with timely start times. All OR staff (scrub tech, OR nurse, anesthesiologist, and physician) get 1 star for every on time start. Once a person attains 10 stars, they are awarded a $20 gift card to a local bakery/coffee shop. Results There was a significant difference in the 3 months pre- and post-implementation of the star system in regard to starting on time (54% vs. 71%, P-value .047), and there were significantly less late starts within 6-10 minutes (14% vs. 4%, P-value = <.01). There was no statistically significant difference in late starts >11 minutes or when comparing days of the week. The most common reasons for delay are as follows: surgeon running late (23%), anesthesiologist tardiness (11%), patient is late (9%), preoperative orders, or test not completed (7%). Conclusion The significant increase in the number of cases that start on time after implementation of the star system leads us to believe that late start times are multifactorial, and that incentives are a positive way to encourage the OR team to start on time.

Strategie per la corretta previsione dei tempi operatori allo scopo di aumentare l'efficienza in sala operatoria: uno studio osservazionale retrospettivo

“…È risultato esserci una differenza significativa nei tre mesi precedenti e successivi all'implementazione del progetto, con i ritardi scesi dal 71% al 54%. Ne è risul-tato che l'efficienza migliora se il personale è motivato e premiato, infatti gli incentivi sono risultati essere un ottimo metodo per incoraggiare tutto il personale di sala operatoria a iniziare in tempo gli interventi [19] . Lo studio retrospettivo ha limitato la disponibilità dei dati e la possibilità di ottenere informazioni dettagliate, inoltre l'assenza del processo di randomizzazione rende reale il problema del selection bias.…”

Efficiency in the operating room: optimizing patient throughput

“…This intervention improved ontime starts from 54% in the preintervention period to 71% postintervention. 31 Instituting a systems-based approach and adding protocols have also been shown to be effective in decreasing delays to the first case starts. Han et al 32 were able to decrease delays in first case starts simply by implementing protocols that stated that surgical residents must mark and consent the first patients of the day at least 30 minutes before the scheduled start time.…”

“…Similarly, Jreije and colleagues rewarded OR team members (scrub technician, OR nurse, anesthesiologist, and surgeon) with a gift card after achieving 10 on-time starts. This intervention improved on-time starts from 54% in the preintervention period to 71% postintervention 31…”

First Case On-Time Starts: The Sound and the Fury

“…The authors showed a significant increase in the number of first cases that started on time, and they noted a higher level of enthusiasm at the beginning of each clinical day. 1 However, we believe that the current study can be improved upon immediately from an operational and financial perspective.…”

“…Perhaps the waning enthusiasm for the current project could be directed into a different initiative, one that encouraged the interests of the seeming non-adopter. Richard M. Dobson, DO 1 , and Mitchell H. Tsai, MD, MMM, FASA, FAACD 2…”