Anyone working in the perioperative arena is familiar with the importance of first case on-time starts, i.e. starting the first cases scheduled for the day in each operating room on time. When these cases run late, it has a cascading effect on cases scheduled afterward, leading to overruns and inefficient use of costly operating room resources including staff.

Tackling first case on-time starts can lead to a quick win that’s easier to achieve and offers a bigger payoff than trying to tackle other frequently-mentioned issues such as reducing turnover time between cases . This is largely due to the fact that surgical team members tend to have similar perspectives and incentives when it comes to starting the day on time, but different perspectives and interests related to turning rooms over between cases. Surgeons tend to view room turnover as unproductive/idle time because their work on a case typically ends when the patient has been stitched back up, while nurses and other team members, who actually perform room turnover, see it as active/work time. In contrast, all team members benefit from starting the day on time because it contributes to a more predictable and productive work day for everyone.

Podcast: First Case On-Time Starts

Even so, many hospitals struggle to achieve a high rate of on-time first starts. This is often due to lacking a culture of accountability, which leads to a sense of futility among relevant stakeholders. However, a culture of accountability can be fostered by implementing several key initiatives:

Near-term reminders: Automatically send notifications regarding first-start procedures and start times to relevant surgical team members the night beforehand.

Immediate follow-up: When cases run late, send requests to all surgical team members for verification/correction regarding the reason(s) for the delay within a few hours. This creates a sense that the organization cares about on-time starts and is monitoring performance in real time.

Full stakeholder input: Include all surgical team members involved in a case in each request for feedback regarding the reason(s) for delays. This creates a sense of inclusiveness and promotes accuracy in recorded delay reasons. Instead of relying on one data entry point, organizations can use feedback from multiple stakeholders’ perspectives to abstract a more complete understanding of delay reasons and work to address them going forward.

Organizational support: All of the steps above should be part of an organization-wide effort to optimize timely starts. In addition, the feedback given by surgical team members must lead to organizational action to address common delay reasons and give surgical teams the best possible chance of succeeding in their efforts to start on time.

Within a few weeks of implementing such efforts, hospitals can improve first case on-time starts rates dramatically—in some cases from below 40% to above 70%. While all of these steps can be accomplished manually, such manual workflows are prone to human error and lack long-term stability.  Hospital IQ’s solutions enable organizations to implement these highly beneficial initiatives using an operations planning and management platform that automates the workflow and makes the process more stable, reliable and sustainable over time.



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