Improving first case start times using Lean in an academic medical center

Area of Science:

• Healthcare Management
• Process Improvement
• Surgical Operations

Background:

• Lean methodology offers a framework for enhancing efficiency in healthcare processes.
• The perioperative process is complex and prone to delays, impacting resource utilization and patient care.
• Identifying root causes of late surgery starts is crucial for optimizing operating room (OR) schedules.

Purpose of the Study:

• To identify the primary reasons for delayed surgery start times.
• To implement Lean interventions aimed at mitigating these delays.
• To analyze the impact of Lean implementation on OR efficiency and on-time surgery starts.

Main Methods:

• A retrospective review of 4,492 first-start surgical cases was conducted.
• Data were collected for 2,181 cases before Lean implementation and 2,311 cases after.
• Lean interventions were implemented in May 2015, with a 7-month pre- and post-implementation analysis period.

Main Results:

• On-time surgery starts increased significantly from 57.0% pre-Lean to 69.0% post-Lean (P < .01).
• Surgeon-related factors remained the most common cause of delays, but delays due to preoperative assessment decreased (14.9% vs 9.9%, P < .01).
• Delays were more frequent on cold/snowy days and less frequent on didactic days (P < .01).

Conclusions:

• Modifying preoperative tasks through Lean methods effectively enhances operating room efficiency.
• Lean interventions lead to a significant increase in the percentage of on-time surgery starts.
• Targeted process improvements can address specific delay etiologies and improve overall surgical workflow.