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Updated: Feb 10, 2026

Safety Precautions and Operating Procedures in an ABSL-4 Laboratory: 4. Medical Imaging Procedures
Published on: October 3, 2016
Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical
Charles Coffey1, Edward S Cho2, Eric Wei3
1Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
Background:
Delays in first cases contribute to multiple operating room (OR) inefficiencies and decreases in OR productivity.
Methods:
Lean process improvement methods were used to redesign the existing workflow for elective first cases of the day in a large, urban, public hospital. First case start times were prospectively recorded from May 2, 2016 through December 29, 2017.
Results:
Data from 415 operating days were examined, 86 days prior to, 35 days during, and 294 days after implementation of interventions in the pre-operative holding area. During this time, of 23,891 operations performed, 14,981 were elective procedures, 5963 (39.8%) of which were first cases of the day. The mean rate of elective first case on-time starts per week went from 23.5% before and during to 73.0% after implementation of lean interventions (p < 0.0000001).
Conclusions:
Implementation of lean interventions in the pre-operative holding area was associated with significantly improved rates of elective first case on-time starts.
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