Improving Operating Room Efficiency: First Case On-Time Start Project

J Healthc Qual. 2017 Sep/Oct;39(5):e70-e78. doi: 10.1097/JHQ.0000000000000018.


Background: Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011.

Methods: The Perioperative Services Department engaged an interdisciplinary Operating Room Committee to apply Six Sigma tools to this problem. The steps of this project included (1) problem mapping, (2) process improvements to preoperative readiness, (3) informatics support improvements, and (4) continuous measurement and feedback.

Results: By June 2013, there was a peak of 92% first case on-time starts across service lines, decreasing to 78% through 2014, still significantly above the preintervention level of 49% (p = .000). Delay minutes also significantly decreased through the study period (p = .000). Across 2013, the most common delay owners were the patient, the surgeon, the facility, and the anesthesia department.

Conclusions: Continuous and sustained improvement of first case on-time starts is attributed to tracking the FCOS metric, establishing embedded process improvement resources and creating transparency of data. This article highlights success factors and barriers to program success and sustainability.

MeSH terms

  • Academic Medical Centers / organization & administration*
  • Efficiency, Organizational / standards*
  • Humans
  • Midwestern United States
  • Operating Rooms / organization & administration*
  • Quality of Health Care / organization & administration*
  • Time Factors