318 - On-time First Case Starts in the Operating Room: A Multidisciplinary Approach
Description: Problem:Operating Room first-case starts are the number one indicator of Operating Room (OR) efficiency due to the substantial impact on revenue that delays can incur. First and foremost, patient satisfaction is greatly impacted by delayed first-case starts. A delayed first-case start typically creates a chain of delays throughout the OR day, causing longer waits for patients and their families. Also, with competition growing daily from surrounding hospitals, delayed first-case starts limit the number of elective patients able to be reached in the operating room. Patients and their families become very frustrated when they are delayed, especially when they must be rescheduled to a different day. In our pediatric population, this becomes even more of a barrier with “Nothing By Mouth” (NPO) times being involved and patients not able to receive the breastmilk and/or formula they require within a specific timeframe. Lastly, delayed first-case starts create a negative impact on staff satisfaction due to the extra staffing requirements needed when operating room days run late. Staff in holding room, Post Anesthesia Care Unit, and the OR must stay past their assigned shift to ensure patients receive the care they require. Work-life balance for our staff is disrupted when this is a common occurrence and leads to significant frustration and quicker burn-out.
Method: In November 2018, a multidisciplinary group was created with Anesthesiologists, Surgeons, and leadership/staff represented from Holding Room, PACU, and the Operating Room to focus on OR First-Case Starts. With our organizational average of on-time first case starts being significantly lower than the national average, assistance and focus was needed from every discipline involved in caring for our patients. With utilizing an Electronic Medical Record (EMR) system that was new to the organization, accurate data-gathering was immediately a challenge that had to be addressed before any projects could begin for the team. There were no specific trends to identify as many of the delay codes provided by the EMR for our circulators were not appropriate. This led to our circulators having to select “other” or leave the entry blank all together for delay reasons. Consequently, over 30% of the delays captured in the EMR were unable to be tracked due to other/blank being chosen. This led to diligent work with the organization’s EMR technical staff in providing appropriate delay codes for appropriate tracking of delays reasons. After delay codes were able to be appropriately tracked by our team, significant interventions among all groups represented were able to be implemented in improving our OR first-case starts across the OR. Specific interventions included (but were not limited to) strategic utilization of staff, utilization of tools within the EMR, surgeon buy-in through incorporating surgeon champions, and anesthesia buy-in through incorporating anesthesia champions.