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A Quality Improvement Project to Improve First Case On-time Starts in the Pediatric Operating Room
Dinesh S Pashankar1, Anna M Zhao2, Rebecca Bathrick3
1Section of Gastroenterology, Department of Pediatrics.
Insights
Improving operating room (OR) efficiency, this study enhanced first case on-time starts by 15% using quality improvement methods. This led to reduced delays and significant cost savings in a pediatric hospital.
Area of Science:
- Healthcare Management
- Quality Improvement Science
- Pediatric Surgery
Background:
- Operating room (OR) delays increase hospital costs and dissatisfaction.
- On-time starts for the first OR case can prevent subsequent delays.
- A quality improvement project was designed to improve first case on-time starts in a pediatric OR.
Purpose of the Study:
- To improve the first case on-time starts in the pediatric operating room.
- To reduce delays and associated costs in the pediatric OR.
Main Methods:
- An interdisciplinary team utilized the Six Sigma methodology (Define, Measure, Analyze, Improve, Control).
- Key drivers of delay were identified and addressed with low-cost interventions via Plan-Do-Study-Act cycles.
- Interventions included preoperative care coordination, strategic case staggering, and incentives; start times and delays were monitored weekly.
Main Results:
- First case on-time starts improved from 62% to 77% over the study period (1981 cases).
- Total minutes delayed decreased significantly from 197.9 to 133 minutes per week (P < 0.05).
- Estimated cost savings were $4,023 per week due to improved OR utilization.
Conclusions:
- A multidisciplinary, collaborative team approach enhances pediatric OR efficiency.
- Quality improvement tools are effective in improving on-time starts in the pediatric OR.
- Implementing targeted interventions can lead to significant cost savings and improved patient/provider satisfaction.
Background:
Delays in the operating room (OR) can lead to increased hospital costs as well as patient and provider dissatisfaction. Starting the first case on time in the OR can potentially prevent subsequent delays. We designed a quality improvement project to improve the first case on-time starts in the pediatric OR at a tertiary care children's hospital.
Methods:
Following the collection of baseline data, we formed an interdisciplinary team. We analyzed the causes of delay and used the Six Sigma methodology of Define, Measure, Analyze, Improve, and Control. We identified key drivers and implemented several low-cost interventions using Plan-Do-Study-Act cycles. Major interventions included preoperative care coordination, strategic staggering of OR cases, and introduction of "Wow Bucks" incentives. We monitored start times and the delay in minutes for all first cases weekly. The OR minutes saved per week were calculated and used to estimate cost savings.
Results:
We studied a total of 1981 first-start cases from May 2018 to October 2019. The first case on-time starts improved from 62% to 77% over the study period. There was a significant improvement in total minutes delayed for all the first cases from 197.9 minutes per week down to 133 minutes per week (P < 0.05). Estimated cost savings were $4,023 per week due to improved OR utilization.
Conclusions:
A multidisciplinary collaborative team approach using quality improvement tools can improve on-time starts in the pediatric OR.
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