The critical path system. The road toward an efficient OR

Since January 1990, surgeons have been able to make their incision within 15 minutes of the scheduled time. Total joint procedures, craniotomies, open heart surgery, and thoracic surgeries have had incision times within 15 minutes of the critical path timetable. Daily analysis of activity is done by reviewing the time study. The monthly delay report is becoming a quality assurance monitor for the hospital. Reports are sent to nurse managers, the director of surgical services, and the vice president of nursing. Daily review of the time study points out trends that can be addressed before they become a major problem. For example, in one month a surgical group had three delays. An informal meeting was held with the SDS nurse manager and the surgeon. The SDS manager and I met with the business manager of the group and the problem was resolved. In another example, a surgeon established a trend of consistently being late for cases. After a brief hallway chat, the problem was identified and an agreement reached that his time would be moved to 8 AM induction time. The last example concerns equipment failures. In one month, we had 20 delays due to equipment failures. By the next month, we had reduced equipment failures to 10, and by the end of the following month, we had three delays due to equipment failure. This was achieved through accurate documentation of the failures and frequent follow-up calls until the equipment was repaired. Surgeons and anesthesiologists still complain about delays, but not as often. Using the critical path concept has improved our efficiency and our image. This is only one facet of achieving timeliness in the OR. The teamwork between the OR nursing staff, surgical nursing staff, anesthesia staff, and the surgeons makes this program successful. Daily maintenance of the path with timely follow-up keeps the path working.