Improving operating room first start efficiency – value of both checklist and a pre‐operative facilitator
- 30 July 2013
- journal article
- Published by Wiley in Acta Anaesthesiologica Scandinavica
- Vol. 57 (9), 1118-1123
- https://doi.org/10.1111/aas.12166
Abstract
There are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process. An orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18-month period. Initially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (-49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as 'other reasons' (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion. While we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet - pre-operative checklist in addition to a dedicated pre-operative facilitator; allowed us to make a substantial improvement in our first start on time starts.Keywords
This publication has 16 references indexed in Scilit:
- Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of AnestheticsAnesthesiology, 2012
- Characterizing the Structure of Operating Room Staffing Using Social Network AnalysisNursing Research, 2011
- Team training can improve operating room performanceSurgery, 2011
- Delayed operating room availability significantly impacts the total hospital costs of an urgent surgical procedureSurgery, 2011
- Typical Savings from Each Minute Reduction in Tardy First Case of the Day StartsAnesthesia & Analgesia, 2009
- Both Bias and Lack of Knowledge Influence Organizational Focus on First Case of the Day StartsAnesthesia & Analgesia, 2009
- Zeitverzögerungen beim morgendlichen OP-BeginnDer Anaesthesist, 2008
- Why we are wasting time in the operating theatre?The International Journal of Health Planning and Management, 2008
- Optimization of surgery sequencing and scheduling decisions under uncertaintyHealth Care Management Science, 2006
- Late operating room starts: experience with an education trialCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1996