Rewarding On Time Start Times in Operating Rooms Improves Efficiency

The average cost of running an operating room (OR) is approximately $37.00 a minute. Therefore, every effort should be made to start in a timely manner. There are several factors at play that can cause OR delays. Attaining consistent start times is a multidisciplinary task, which requires good communication and rewards for efficiency.

At our institution, a "star system" was implemented to improve compliance with timely start times. All OR staff (scrub tech, OR nurse, anesthesiologist, and physician) get 1 star for every on time start. Once a person attains 10 stars, they are awarded a $20 gift card to a local bakery/coffee shop.

There was a significant difference in the 3 months pre- and post-implementation of the star system in regard to starting on time (54% vs. 71%, P-value .047), and there were significantly less late starts within 6-10 minutes (14% vs. 4%, P-value = <.01). There was no statistically significant difference in late starts >11 minutes or when comparing days of the week. The most common reasons for delay are as follows: surgeon running late (23%), anesthesiologist tardiness (11%), patient is late (9%), preoperative orders, or test not completed (7%).

The significant increase in the number of cases that start on time after implementation of the star system leads us to believe that late start times are multifactorial, and that incentives are a positive way to encourage the OR team to start on time.