Improving and Maintaining On-Time Start Times for Nonelective Cases in a Major Academic Medical Center

As health care expenditures continue to increase, thoughtful use of perioperative resources is important. Efforts to improve operating room (OR) efficiency often focus on increasing on-time first case starts to improve OR utilization, reduce subsequent delays, and reduce adverse events. One institution, with severely limited inpatient hospital capacity and an extensive daily add-on list of surgical cases, focused efforts to improve OR efficiency by improving on-time first case starts for unscheduled, nonemergent surgeries.

A multidisciplinary team was assembled to work together for this quality improvement (QI) initiative. The primary outcome measure was the percentage of cases starting on time. The team identified six key steps thought to contribute to on-time start performance. Data were collected for each of these process measures, and feedback was shared with stakeholders.

By measuring adherence to and giving feedback about critical steps in the preoperative process, on-time starts improved from a baseline of 65% to 85% (p = 0.041). Sustained improvement was seen even after daily measurement ceased and the QI project was completed.

Establishing a multidisciplinary team to improve timely care of unscheduled, nonelective surgical patients; identifying key elements necessary for on-time surgical case starts; and providing feedback to clinicians were associated with a sustained improvement in OR efficiency for a traditionally difficult-to-schedule patient population.