Improving Operating Room Efficiency Through Reducing First Start Delays in an Academic Center

Dylan Singh; Lawrence Cai; Dominique Watt; Elise Scoggins; Samuel Wald; Rahim Nazerali

doi:10.1097/JHQ.0000000000000398

Improving Operating Room Efficiency Through Reducing First Start Delays in an Academic Center

J Healthc Qual. 2023 Sep-Oct;45(5):308-313. doi: 10.1097/JHQ.0000000000000398. Epub 2023 Jul 13.

Authors

Dylan Singh^{1

2

3

4

5

6}, Lawrence Cai^{1

2

3

4

5

6}, Dominique Watt^{1

2

3

4

5

6}, Elise Scoggins^{1

2

3

4

5

6}, Samuel Wald^{1

2

3

4

5

6}, Rahim Nazerali^{1

2

3

4

5

6}

Affiliations

¹ Dylan Singh, BS, medical student at the University of Hawaii John A. Burns School of Medicine, Honolulu, HI.
² Lawrence Cai, MD, Resident Plastic Surgeon at Stanford University Hospitals, Palo Alto, CA.
³ Dominique Watt, RN, MSN, CNL, PCCN, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA.
⁴ Elise Scoggins, BS, MHA, part of the quality improvement team at Stanford University Hospitals, Palo Alto, CA.
⁵ Samuel Wald, MD, MBA, FS, Clinical Professor, Anesthesiology, Perioperative and Pain Medicine, Stanford University Hospitals, Palo Alto, CA.
⁶ Rahim Nazerali, MD, MHS, FACS, Clinical Associate Professor, in the department of Plastic Surgery at Stanford University, Palo Alto, CA.

PMID: 37596242
DOI: 10.1097/JHQ.0000000000000398

Abstract

Background: Delays in operating room (OR) first-case start times can cause additional costs for hospitals, healthcare team frustration and delay in patient care. Here, a novel process improvement strategy to improving first-case start times is presented.

Methods: First case in room start times were recorded for ORs at an academic medical center. Three interventions-automatic preoperative orders, dot phrases to permit re-creation of unavailable consent forms, and improved H&P linking to the surgical encounter-were implemented to target documentation-related delays. Monthly percentages of first-case on-time starts (FCOTS) and time saved were compared with the "preintervention" time period, and total cost savings were estimated.

Results: During the first 3-months after implementation of the interventions, the percentage of FCOTS improved from an average of 36.7%-52.7%. Total time savings across all ORs over the same time period was found to be 55.63 hours, which is estimated to have saved a total of $121,834.52 over the 3-month interventional period.

Conclusions: By implementing multiple quality improvement interventions, delays to first start in room OR cases can be meaningfully reduced. Quality improvement protocols targeted toward root causes of OR delays can be a significant driver to reduce healthcare costs.

MeSH terms

Academic Medical Centers*
Efficiency, Organizational
Hospitals
Humans
Operating Rooms*
Patient Care Team
Time Factors