Implementation of 5:10:15:20 Minute Model With Improvement in First-Case On-Time Starts

The operating room (OR) is a dynamic environment requiring close communication between surgeons, anesthesiologists, and clinicians. First-case on-time starts (FCOTS) is a common metric of OR efficiency. OR delays are multifactorial and can increase hospital expenditures.

We sought to determine whether implementing explicit deadlines, in conjunction with feedback to late individuals, would improve our institution's FCOTS.

After obtaining approval from quality board at our tertiary care, Level 1 trauma institution, a "pre versus post" quality improvement project implemented a multicomponent initiative with explicit deadlines for perioperative tasks, feedback to late surgeons, and OR tracking boards. We included American Society of Anesthesiologists (ASA) classification score ≤4 patients, undergoing elective or urgent surgery.

A total of 14,609 patients were included (6,635 preimplementation and 7,974 postimplementation). Both groups were well balanced regarding most potential confounders, for example, age, sex, and ASA score. We observed a significant difference ( p < .0001) in FCOTS between the preimplementation (39.0%) and postimplementation (74.0%) phases. Using a 5-minute grace period, the monthly average FCOTS percentage increased from 54.8% preimplementation to 83.2% postimplementation ( p < .0001).

Implementation of a central OR tracking board, clinician feedback, and explicit 5:10:15:20-minute goals was associated with significant improvement of our hospital's FCOTS.