Improving First Case Starts for a Neurosurgery OR

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction. Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%. Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide for neurosurgical procedures was created for placement required equipment and bed. Testing was from September 2-23, 2021, and the visual guide was presented to staff on October 12, 2021. Measures: On-time to the OR is 7:45 a.m. or earlier. The delay minutes and reasons were tracked. The worksheet was a yes/no form confirming if the room had the case cart, equipment, and bed made each morning. Results: August 2021 delay minutes totaled 279, September total was 259, with an improvement of 7.2%. October total was 189 minutes, with an improvement of 32.3%. Overall, surgeon-related delays led the cause for not achieving first case on-time starts; OR-related delays decreased. Conclusion: Identifying the causes of late on-time starts is key to changing practice and to improving metrics. Deeper dives can help streamline and standardize care for the patients. Staff and leadership buy-in is needed for success