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Improving operating room (OR) efficiency through first case on-time starts (FCOTS) initiatives significantly increases on-time case completions and reduces overtime costs. This study demonstrates FCOTS positively impacts last case on-time end (LCOTE) and saves substantial OR expenditures.

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Area of Science:

  • Healthcare Management
  • Surgical Operations
  • Health Economics

Background:

  • Inefficient operating room (OR) utilization leads to significant resource waste.
  • While first case on-time starts (FCOTS) are thought to reduce OR idle time, their direct impact on last case on-time end (LCOTE) and overtime costs remains under-investigated.

Purpose of the Study:

  • To evaluate the association between FCOTS and LCOTE.
  • To assess the change in FCOTS rates following an improvement initiative.
  • To quantify estimated overtime cost savings linked to FCOTS.

Main Methods:

  • Retrospective analysis of prospectively collected data from 12,073 elective cases over two 6-month periods (pre- and post-intervention).
  • Inclusion criteria: nontraumatic cases in orthopaedics, gynecology, urology, minimally invasive surgery, or colorectal surgery.
  • Statistical analyses included univariate and multivariable models to assess FCOTS impact on LCOTE, FCOTS rates, and cost savings.

Main Results:

  • The FCOTS rate increased from 76.1% to 86.6% post-intervention (p < 0.001), with cases twice as likely to start on time (aOR 2.07).
  • On-time starts were associated with a higher likelihood of LCOTE (aOR 1.76) and reduced overtime by 21.8 minutes per OR day.
  • The FCOTS initiative was linked to an estimated $87,954 in direct OR cost savings over 6 months.

Conclusions:

  • The FCOTS initiative successfully increased on-time starts, which were independently associated with improved LCOTE.
  • Achieving higher FCOTS rates resulted in significant cost savings, exceeding $80,000 in direct OR expenditures over six months.