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Joos C, Bertheau S, Hauptvogel T, Auhuber T, Diemer M, Bauer M, Schuster M. [Delayed incision time of the first case : Analysis of incidences and causes and the effect of list planning instability]. Chirurg 2021; 92:137-147. [PMID: 32572499 DOI: 10.1007/s00104-020-01207-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Delays in beginning operations in the morning lead to a loss of valuable operating time and can cause frustration among the medical personnel involved. OBJECTIVE So far there are no prospective, multicentric investigations of the incidence and reasons for delayed first incision times in the morning. The effect of planning list instability of first cases on late operating room starts has not yet been evaluated. MATERIAL AND METHODS In this multicenter prospective study delays in surgical incision time in all first cases of the day were investigated in 36 German and Swiss hospitals (14 surgical specialties) over a period of 2 weeks. RESULTS A total of 3628 first of the day cases were included in the study. Looking at all subspecialties combined 50.8% of the first cases of the day were delayed by more than 5 min and in 30.2% of cases longer than 15 min. Incidences of delayed surgical incision time >5 min ranged from 40.0% (gynecology) to 66.8% (neurosurgery). The main reasons for delays in ascending order were prolonged induction of anesthesia compared to the planned time, the delayed appearance of the surgeon and prolonged preparation for surgery. The incidence of delays in incision times for planning list instability was increased by 10% and the average delay increased by 7 min. CONCLUSION Delays in surgical incision times of the first operation of the day have a high incidence in most surgical specialties; however, the reasons for delays are manifold. Plan instability of operating room lists with respect to the first cases has a negative effect on the punctuality of the incision time and should therefore be avoided.
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Affiliation(s)
- C Joos
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal und Rechbergklinik Bretten, Gutleutstr. 1-14, 76646, Bruchsal, Deutschland
| | | | | | - T Auhuber
- Berufsverband Deutscher Chirurgen, Berlin, Deutschland.,Hochschule der Deutschen Gesetzlichen Unfallversicherung, Bad Hersfeld, Deutschland.,Medizinmanagement, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Deutschland
| | - M Diemer
- Verband für OP-Management e. V., Hannover, Deutschland
| | - M Bauer
- Klinik für Anästhesiologie und operative Intensivmedizin, KRH Klinikum Nordstadt und Siloah, Hannover, Hannover, Deutschland.,Kommission OP-Management, Berufsverband Deutscher Anästhesisten, Nürnberg, Deutschland
| | - M Schuster
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal und Rechbergklinik Bretten, Gutleutstr. 1-14, 76646, Bruchsal, Deutschland. .,Kommission OP-Management, Berufsverband Deutscher Anästhesisten, Nürnberg, Deutschland.
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Case delay in the OR morning start in hospitals of different size and academic status : Results from a German multicenter study to identify incidence and causes of delayed anesthesia ready time. Anaesthesist 2020; 70:23-29. [PMID: 32960284 DOI: 10.1007/s00101-020-00842-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/28/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Delays in the start of morning operations cause a loss of expensive OR capacity as well as frustration and potential conflicts among the different professions involved. There are a lot of reasons which can lead to delayed anesthesia ready time (ART). This is the first large multicenter study to identify incidence, extent and reasons of delay in ART. METHODS First case delays in ART were studied in all regular ORs in 36 hospitals of different sizes (smaller community hospitals, larger community hospitals and university hospitals) over a period of 2 weeks. We analyzed the results comparing the 3 hospital types regarding incidence, extent and reasons for delay. RESULTS A total of 3628 first of day cases were included in the study. Incidences of delayed ART (delay >5 min) ranged from 26.5% in university hospitals to 40.8% in larger community hospitals. However, university hospitals had higher incidences than smaller community hospitals of delays greater than 15 and 30 min. The main reasons for delays were prolonged induction of anesthesia, patient in-hospital logistics and delayed patient arrival at the hospitals. The highest mean delay of delayed cases was found in university hospitals with 21.7 min ± 14.7 min (SD). CONCLUSIONS Delays in anesthesia ready time have a high prevalence in most hospitals, however the reasons for delay are manifold, making interventions to reduce delay complex.
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Dexter F, Epstein RH, Penning DH. Late first-case of the day starts do not cause greater minutes of over-utilized time at an endoscopy suite with 8-hour workdays and late running rooms. A historical cohort study. J Clin Anesth 2020; 59:18-25. [DOI: 10.1016/j.jclinane.2019.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/10/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
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Tiwari V, Ehrenfeld J, Sandberg W. Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times? Br J Anaesth 2018; 121:1148-1155. [DOI: 10.1016/j.bja.2018.05.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/17/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022] Open
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Gómez-Ríos MA, Abad-Gurumeta A, Casans-Francés R, Calvo-Vecino JM. Keys to optimizing operating room efficiency. ACTA ACUST UNITED AC 2018; 66:104-112. [PMID: 30293813 DOI: 10.1016/j.redar.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/03/2018] [Accepted: 08/09/2018] [Indexed: 11/28/2022]
Abstract
Healthcare is in constant transformation. Health systems should focus on improving efficiency to meet a growing demand for high-quality, low-cost health care. The operating room is one of the biggest sources of revenue and one of the largest areas of expense. Therefore, operating room management is a critical key to success. The aim of this article is to analyze the current principles of organization, optimization and clinical management of the operating room and its impact on the quality and safety of care.
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Affiliation(s)
- M A Gómez-Ríos
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Grupo Español de Vía Aérea Difícil (GEVAD); Grupo de Investigación Anestesiología y Tratamiento del Dolor, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España.
| | - A Abad-Gurumeta
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España
| | - R Casans-Francés
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Elena, Valdemoro, Madrid, España
| | - J M Calvo-Vecino
- Departamento de Anestesia, Complejo Asistencial Universitario de Salamanca, Universidad de Salamanca (CAUSA), Salamanca, España
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Strategies to Improve Start Time in the Operating Theatre: a Systematic Review. J Med Syst 2018; 42:160. [DOI: 10.1007/s10916-018-1015-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
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Coffey C, Cho ES, Wei E, Luu A, Ho M, Amaya R, Pecson M, Dalton FV, Kahaku D, Spellberg B, Sener SF. Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center. Am J Surg 2018; 216:194-201. [PMID: 29803501 DOI: 10.1016/j.amjsurg.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/29/2018] [Accepted: 05/04/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Delays in first cases contribute to multiple operating room (OR) inefficiencies and decreases in OR productivity. METHODS Lean process improvement methods were used to redesign the existing workflow for elective first cases of the day in a large, urban, public hospital. First case start times were prospectively recorded from May 2, 2016 through December 29, 2017. RESULTS Data from 415 operating days were examined, 86 days prior to, 35 days during, and 294 days after implementation of interventions in the pre-operative holding area. During this time, of 23,891 operations performed, 14,981 were elective procedures, 5963 (39.8%) of which were first cases of the day. The mean rate of elective first case on-time starts per week went from 23.5% before and during to 73.0% after implementation of lean interventions (p < 0.0000001). CONCLUSIONS Implementation of lean interventions in the pre-operative holding area was associated with significantly improved rates of elective first case on-time starts.
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Affiliation(s)
- Charles Coffey
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Edward S Cho
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Eric Wei
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Allison Luu
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Maria Ho
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Rodolfo Amaya
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Anesthesiology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Marie Pecson
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Florence V Dalton
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Deborah Kahaku
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Brad Spellberg
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Stephen F Sener
- Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
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Decreasing the Hours That Anesthesiologists and Nurse Anesthetists Work Late by Making Decisions to Reduce the Hours of Over-Utilized Operating Room Time. Anesth Analg 2016; 122:831-842. [DOI: 10.1213/ane.0000000000001136] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Villarreal MC, Rostad BS, Wright R, Applegate KE. Improving Procedure Start Times and Decreasing Delays in Interventional Radiology: A Department's Quality Improvement Initiative. Acad Radiol 2015; 22:1579-86. [PMID: 26423205 DOI: 10.1016/j.acra.2015.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES To identify and reduce reasons for delays in procedure start times, particularly the first cases of the day, within the interventional radiology (IR) divisions of the Department of Radiology using principles of continuous quality improvement. MATERIALS AND METHODS An interdisciplinary team representative of the IR and preprocedure/postprocedure care area (PPCA) health care personnel, managers, and data analysts was formed. A standardized form was used to document both inpatient and outpatient progress through the PPCA and IR workflow in six rooms and to document reasons for delays. Data generated were used to identify key problems areas, implement improvement interventions, and monitor their effects. Project duration was 6 months. RESULTS The average number of on-time starts for the first case of the day increased from 23% to 56% (P value < .01). The average number of on-time, scheduled outpatients increased from 30% to 45% (P value < .01). Patient wait time to arrive at treatment room once they were ready for their procedure was reduced on average by 10 minutes (P value < .01). Patient care delay duration per 100 patients was reduced from 30.3 to 21.6 hours (29% reduction). Number of patient care delays per 100 patients was reduced from 46.6 to 40.1 (17% reduction). Top reasons for delay included waiting for consent (26% of delays duration) and laboratory tests (12%). CONCLUSIONS Many complex factors contribute to procedure start time delays within an IR practice. A data-driven and patient-centered, interdisciplinary team approach was effective in reducing delays in IR.
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Affiliation(s)
- Monica C Villarreal
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Drive NW, Atlanta, GA 30332.
| | - Bradley S Rostad
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Richard Wright
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Kimberly E Applegate
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
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Mulier JP, De Boeck L, Meulders M, Beliën J, Colpaert J, Sels A. Factors determining the smooth flow and the non-operative time in a one-induction room to one-operating room setting. J Eval Clin Pract 2015; 21:205-14. [PMID: 25496600 PMCID: PMC4406160 DOI: 10.1111/jep.12288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 12/12/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES What factors determine the use of an anaesthesia preparation room and shorten non-operative time? METHODS A logistic regression is applied to 18 751 surgery records from AZ Sint-Jan Brugge AV, Belgium, where each operating room has its own anaesthesia preparation room. Surgeries, in which the patient's induction has already started when the preceding patient's surgery has ended, belong to a first group where the preparation room is used as an induction room. Surgeries not fulfilling this property belong to a second group. A logistic regression model tries to predict the probability that a surgery will be classified into a specific group. Non-operative time is calculated as the time between end of the previous surgery and incision of the next surgery. A log-linear regression of this non-operative time is performed. RESULTS It was found that switches in surgeons, being a non-elective surgery as well as the previous surgery being non-elective, increase the probability of being classified into the second group. Only a few surgery types, anaesthesiologists and operating rooms can be found exclusively in one of the two groups. Analysis of variance demonstrates that the first group has significantly lower non-operative times. Switches in surgeons, anaesthesiologists and longer scheduled durations of the previous surgery increases the non-operative time. A switch in both surgeon and anaesthesiologist strengthens this negative effect. Only a few operating rooms and surgery types influence the non-operative time. CONCLUSION The use of the anaesthesia preparation room shortens the non-operative time and is determined by several human and structural factors.
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Affiliation(s)
- Jan P Mulier
- Department of Anesthesiology, Intensive Care and Reanimation, Department of Anesthesiology, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium; Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium
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Successful interventions to reduce first-case tardiness in Dutch university medical centers: Results of a nationwide operating room benchmark study. Am J Surg 2014; 207:949-59. [DOI: 10.1016/j.amjsurg.2013.09.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 09/20/2013] [Accepted: 09/29/2013] [Indexed: 11/19/2022]
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Epstein RH, Dexter F. Rescheduling of Previously Cancelled Surgical Cases Does Not Increase Variability in Operating Room Workload When Cases Are Scheduled Based on Maximizing Efficiency of Use of Operating Room Time. Anesth Analg 2013; 117:995-1002. [DOI: 10.1213/ane.0b013e3182a0d9f6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dexter F. Wilcoxon-Mann-Whitney Test Used for Data That Are Not Normally Distributed. Anesth Analg 2013; 117:537-538. [DOI: 10.1213/ane.0b013e31829ed28f] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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