Improving Operating Room Efficiency Through Reducing First Start Delays in an Academic Center

ABSTRACT Background: Delays in operating room (OR) first-case start times can cause additional costs for hospitals, healthcare team frustration and delay in patient care. Here, a novel process improvement strategy to improving first-case start times is presented. Methods: First case in room start times were recorded for ORs at an academic medical center. Three interventions—automatic preoperative orders, dot phrases to permit re-creation of unavailable consent forms, and improved H&P linking to the surgical encounter—were implemented to target documentation-related delays. Monthly percentages of first-case on-time starts (FCOTS) and time saved were compared with the “preintervention” time period, and total cost savings were estimated. Results: During the first 3-months after implementation of the interventions, the percentage of FCOTS improved from an average of 36.7%–52.7%. Total time savings across all ORs over the same time period was found to be 55.63 hours, which is estimated to have saved a total of $121,834.52 over the 3-month interventional period. Conclusions: By implementing multiple quality improvement interventions, delays to first start in room OR cases can be meaningfully reduced. Quality improvement protocols targeted toward root causes of OR delays can be a significant driver to reduce healthcare costs.