Enumerating the causes and burden of first case operating room delays

The purpose of this study was to identify the frequency, causes and estimated cost of first case operating room (OR) delays.

A quarterly prospective review of the first cases in the OR was completed in 2018. The frequency and causes for delays were determined. Median delay time was calculated and opportunity cost was estimated based on idle labor and overtime for staffing of rooms beyond scheduled end times.

Of 3604 first cases performed, 55% were delayed for a median 12 min (IQR 6-24 min). The patient and surgeon were responsible for 50% of the causes. Orthopedic (20%) and General (18%) Surgery accounted for the greatest percentage of total delay. A loss of 631 h resulted in an estimated cost of $311,966 for idle labor and $78,623 for nursing overtime.

Improving accountability and reducing patient-related delays will have the greatest impact on reducing first case on-time delays.