Successful interventions to reduce first-case tardiness in Dutch university medical centers: results of a nationwide operating room benchmark study

Am J Surg. 2014 Jun;207(6):949-59. doi: 10.1016/j.amjsurg.2013.09.025. Epub 2014 Jan 4.


Background: First-case tardiness is still a common source of frustration. In this study, a nationwide operating room (OR) Benchmark database was used to assess the effectiveness of interventions implemented to reduce tardiness and calculate its economic impact.

Methods: Data from 8 University Medical Centers over 7 years were included: 190,295 elective inpatient first cases. Data were analyzed with SPSS statistics and multidisciplinary focus-group study meetings. Analysis of variance with contrast analysis measured the influence of interventions.

Results: Seven thousand ninety-four hours were lost annually to first-case tardiness, which has a considerable economic impact. Four University Medical Centers implemented interventions and effectuated a significant reduction in tardiness, eg providing feedbacks directly when ORs started too late, new agreements between OR and intensive care unit departments concerning "intensive care unit bed release" policy, and a shift in responsibilities regarding transport of patients to the OR.

Conclusions: Nationwide benchmarking can be applied to identify and measure the effectiveness of interventions to reduce first-case tardiness in a university hospital OR environment. The implemented interventions in 4 centers were successful in significantly reducing first-case tardiness.

Keywords: Benchmarking; Economic impact; First-case tardiness; Operating room; Performance indicators; Utilization.

Publication types

  • Multicenter Study

MeSH terms

  • Academic Medical Centers / economics
  • Academic Medical Centers / organization & administration*
  • Appointments and Schedules*
  • Benchmarking*
  • Focus Groups
  • Hospital Charges
  • Humans
  • Netherlands
  • Operating Rooms / statistics & numerical data*
  • Organizational Policy
  • Time Factors