Élan Burton1, Melissa Medina1, Honeylet Antonio2. 1. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA. 2. Santa Clara County Medical Center, San Jose, California, USA.
Abstract
OBJECTIVE: Late surgical start times have been associated with a multitude of adverse consequences such as increased cost, delay in treatment, increase in medical errors, and patient complications. From October 1, 2018 to September 30, 2019, 47% (67/144) of non-emergent cardiac cases in our institution had a late start by our institutional standard. Our objective was to decrease the percentage of late start non-emergent cardiac cases from 47% to 37% by October 2020. METHODS: All non-emergent cardiac surgical procedures as first start cases in a single institution were included in our study. Preintervention cardiac surgical cases were reviewed from October 1, 2018 to February 28, 2020 to determine key drivers contributing to late start times. A multidisciplinary team was formed and utilized A3 process and problem-solving strategies to address our objective. A multipronged intervention approach was used to address key drivers contributing to late start times. RESULTS: All interventions were implemented in March 2020. Postintervention data was collected from March 1, 2020 to February 28, 2021, on all non-emergent cardiac surgical procedures. The percentage of non-emergent cardiac cases starting after 8:00 a.m. decreased to 27% (17/62). The decrease in late start cases translated into saving an average of 45min of operating room (OR) time (average cost savings of ~$5,000/case). Additionally, staff reported improved job satisfaction. CONCLUSIONS: Delayed surgical case start times can have negative effects on patients, employees, and lead to increase costs of medical care. Our research has shown adherence to on-time surgical start can improve OR efficiency, decrease cost, and improve employee satisfaction.
OBJECTIVE: Late surgical start times have been associated with a multitude of adverse consequences such as increased cost, delay in treatment, increase in medical errors, and patient complications. From October 1, 2018 to September 30, 2019, 47% (67/144) of non-emergent cardiac cases in our institution had a late start by our institutional standard. Our objective was to decrease the percentage of late start non-emergent cardiac cases from 47% to 37% by October 2020. METHODS: All non-emergent cardiac surgical procedures as first start cases in a single institution were included in our study. Preintervention cardiac surgical cases were reviewed from October 1, 2018 to February 28, 2020 to determine key drivers contributing to late start times. A multidisciplinary team was formed and utilized A3 process and problem-solving strategies to address our objective. A multipronged intervention approach was used to address key drivers contributing to late start times. RESULTS: All interventions were implemented in March 2020. Postintervention data was collected from March 1, 2020 to February 28, 2021, on all non-emergent cardiac surgical procedures. The percentage of non-emergent cardiac cases starting after 8:00 a.m. decreased to 27% (17/62). The decrease in late start cases translated into saving an average of 45min of operating room (OR) time (average cost savings of ~$5,000/case). Additionally, staff reported improved job satisfaction. CONCLUSIONS: Delayed surgical case start times can have negative effects on patients, employees, and lead to increase costs of medical care. Our research has shown adherence to on-time surgical start can improve OR efficiency, decrease cost, and improve employee satisfaction.