A practical model for improving first-case on-time starts performance

Timely initiation of surgical procedures in hospital theatres is crucial for optimising patient care and resource utilisation. Delays in the operating theatre (OT) can lead to high hospital costs and to patient and staff dissatisfaction. However, achieving consistent first-case on-time starts (FCOTS) remains a challenge in many healthcare settings. The purpose of our study is to identify and assess strategies for improving FCOTS in a tertiary metropolitan hospital.

A six-month initiative was undertaken applying a quantitative research methodology, employing a quasi-experimental one-group design with a descriptive scope and using the continuous quality improvement (CQI) methodology, covering 12 structured steps tailored to the hospital's operational context. An independent analysis of the factors contributing to delayed FCOTS was performed, and several low-cost interventions were implemented using the Plan-Do-Check-Action (PDCA) strategic approach.

The results of the study are threefold: (1) increased the number of on-time starts, (2) increased operating room efficiency and (3) improved staff collaboration, punctuality and accountability. FCOTS across all measured indicators improved significantly, from an average of 20% to over 70%, within six weeks of implementation, and have been sustained and continue to stabilise over the 20 months since implementation. Streamlined patient flow protocols facilitated smoother transitions between preoperative and intraoperative phases, minimising idle time and enhancing resource utilisation.

This study's systematic, multidisciplinary, collaborative approach demonstrates the feasibility and effectiveness of interventions to improve FCOTS in a hospital setting.

The unique contextualised framework has assisted hospital staff in addressing FCOTS challenges through CQI practice.