First Case On-Time Starts Barriers and Strategies to Success and Sustainability

Abstract

<h3>Background Information</h3> The Operating room (OR) is a costly environment and it should be managed efficiently. Starting the first case on time is crucial for maintaining an operating room's schedule. However, for a myriad of reasons, first cases can be delayed, causing subsequent cases to be delayed, affecting OR efficiency and satisfaction of patients/families and the perioperative team. In response, the Main OR First Case On-Time Starts (FCOTS) team was formed under the Perioperative Joint Operating Council (JOC) to focus a shared effort on correcting the delays. The number one reason the first cases started late was surgeons' late arrival and other surgeon related issues. <h3>Objectives of Project</h3> Identify the root causes of first cases delays, including strategies to correct delays to improve OR efficiency and improve the satisfaction of patients/families and the perioperative team. <h3>Process of Implementation</h3> There is a substantial opportunity to enhance OR efficiency by improving FCOTS. The Perioperative JOC has engaged a multidisciplinary FCOTS team to apply the Lean process improvement methodology to achieve improvements. The steps of this project included (1) creation of A3 document and project charter, (2) creation of action register and "just-do-it" items, (3) continuous measurement, analysis, and evaluation, (4) communication/reporting and dissemination of data; and (5) Celebration of success. The FCOTS team reports monthly to the Perioperative JOC. <h3>Statement of Successful Practice</h3> Data has shown that in 2018, 50%-60% of cases started on time; while between January 2019 to August 2019, 70% - 77% of cases started on time. These results demonstrate that the application of Lean process improvement methodology, the presence of more credible data, enhanced communication processes, and most of all, the commitment of highly collaborative multidisciplinary teams can significantly improve FCOTS, leading to a more efficient OR and higher satisfaction of patients/families and perioperative team. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The goal to improve FCOTS to positively impact OR efficiency and patient/family satisfaction is a shared responsibility of the Department of Anesthesia, Surgery, and Perioperative Services. The success of the project has made Perianesthesia team become more invested, motivated, and committed to improve FCOTS and sustain improvements utilizing process improvement tools.