A Quality Improvement Project to Improve First Case On-time Starts in Operating Room

Abstract
Background: On-time start of the operating room (OR) is a good quality indicator to measure the OR efficiency. Delay in starting the first case on time has so many repercussions not only on the hospital’s reputation, it also causes significant dissatisfactions for both patient and healthcare worker. We observed a significant delay in starting the first case on time, so we decided to undertake a quality improvement project to analyse the root causes and address them through a multidisciplinary team effort. We aimed to increase first-case on-time starts in the OR by at least 90% on-time start of the first case.

Method: A multidisciplinary task force is created. Six Sigma quality improvement tool, namely DMAIC (Define, Measure, Analysed, Improvement and Control) was used to identify and causes of delays and apply constructive interventions to address those issues to maximise the on-time start of the first case of the day. The following constructive interventions were initiated OR booking process- streamlined, Perioperative nurse Facilitator, Notification to the surgeons, OR set up, Role of the Ward nurse emphasised, Preoperative nurse, OR staff counselling and training, Insurance and other support staff training.

Results: We identified the factors for delays and categorised them into 7 main groups, namely patient related, surgeons related, anaesthetist related, nurse or other staffs related, process related (preop assessment, investigation, pending consultation, insurance, bed availability), Premedication/antibiotic related and others miscellaneous. We analysed total of 1340 first case performed during July 2021 to December 2022 (675 in pre-intervention and rest in post-intervention phase) of which 274 (60.8%) cases were start on time in the pre-intervention phase whereas in the post-intervention phase the percentage gradually improved to 90%. (606 on time out of 674 first cases). The mean delay in minutes for starting the first case on time was also higher in the pre-intervention group (28.6 minutes) which was gradually reduced to 17.5 minutes at the final phase of our analysis.

Conclusion: A multidisciplinary team approach can identify the factors for delay in starting first case on time and the delays can be significantly improved by quality improvement tool.