Dramatic improvements in First case On Time Starts were the focus of a study published in the Journal of Healthcare Management, by Allen et. al. from Greenville Health System. They describe redesign of first cases which highlighted a change in on-time definition from “wheels in” to “incision time” with no grace period. The changes were driven by a surgeon-chaired, multi-disciplinary OR Operations Committee which solves process related issues in the OR. Their approach included classification of cases as complex (target in OR 45 minutes before scheduled incision) or simple (target in OR 30 minutes before). Process improvement efforts included identification of root causes of delays, transparent sharing of data among all perioperative stakeholders, and a focus on easily correctable issues. The process changes resulted in an improvement of 34.3% in patient in-room on-time performance and a 48.6% increase in incision on-time metrics. The authors calculated a savings in variable personnel costs of $771,000 in their 25-OR facility, generated by saving approximately 80,000 minutes.
EHC NOTE: The study highlights the power of physician driven process improvement. Surgeons and anesthesiologists led and championed the initiative, with multidisciplinary input from their OR Operations Committee. As described, the initiative included open and transparent sharing of process shortcomings for all stakeholders, surgeons included, to facilitate the impressive results. In the current competitive operating room environment, any operational and/or financial improvements are vital to retain or gain market share and financial viability. Enhance Healthcare embraces many of the approaches described in designing perioperative improvement initiatives for facilities of all sizes.