[Time delay in beginning first OR positions in the morning]

Delayed starts of operation room (OR) processes in the morning lead to suboptimal use of expensive OR personnel and resources. Therefore, the anaesthesiologist has to take care that anaesthesia preparation and induction are finished in time and the patients are ready for the surgical intervention according to the OR time schedule. However, if the anaesthesiologist starts too early, preincision waiting periods occur. The literature provides little data regarding the complex interaction of anaesthesia process times and delayed operation starts in the morning. In this prospective study 710 first operation positions in the morning were analyzed with respect to the incidence of and reasons for delayed finishing of anaesthesia induction and investigated the interaction of early and late finishing of anaesthesia induction. In 27.5% of anaesthesia inductions the preset time schedule was not reached and the average delay was 19.3+/-17.2 min. The main anaesthesia-dependent reasons for delays were complex anaesthesia inductions with difficult line placement. Also organizational difficulties such as changes in the OR case schedule and delayed patient transport were of major importance. The results of a simulation model showed that in 100% of the cases finishing anaesthesia induction in time would only be feasible if anaesthesia processes started much earlier. However, this would lead to a sharp increase in preincision waiting time with the patient being under anaesthesia but surgeons not ready to start, therefore having only a minor effect on surgical waiting time. Subsequently, on-time anaesthesia induction in all cases is not a reasonable target in OR management.