Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center

Charles Coffey Jr; Edward S Cho; Eric Wei; Allison Luu; Maria Ho; Rodolfo Amaya; Marie Pecson; Florence V Dalton; Deborah Kahaku; Brad Spellberg; Stephen F Sener

doi:10.1016/j.amjsurg.2018.05.002

Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center

Am J Surg. 2018 Aug;216(2):194-201. doi: 10.1016/j.amjsurg.2018.05.002. Epub 2018 May 24.

Authors

Affiliations

¹ Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
² Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
³ Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
⁴ Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Anesthesiology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
⁵ Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
⁶ Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA; Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA. Electronic address: stephen.sener@med.usc.edu.

PMID: 29803501
DOI: 10.1016/j.amjsurg.2018.05.002

Abstract

Background: Delays in first cases contribute to multiple operating room (OR) inefficiencies and decreases in OR productivity.

Methods: Lean process improvement methods were used to redesign the existing workflow for elective first cases of the day in a large, urban, public hospital. First case start times were prospectively recorded from May 2, 2016 through December 29, 2017.

Results: Data from 415 operating days were examined, 86 days prior to, 35 days during, and 294 days after implementation of interventions in the pre-operative holding area. During this time, of 23,891 operations performed, 14,981 were elective procedures, 5963 (39.8%) of which were first cases of the day. The mean rate of elective first case on-time starts per week went from 23.5% before and during to 73.0% after implementation of lean interventions (p < 0.0000001).

Conclusions: Implementation of lean interventions in the pre-operative holding area was associated with significantly improved rates of elective first case on-time starts.

Keywords: Efficiency; Lean; Operating room; Start time.

MeSH terms

Delivery of Health Care / standards*
Efficiency, Organizational*
Elective Surgical Procedures / statistics & numerical data*
Follow-Up Studies
Hospitals, Urban*
Humans
Operating Rooms / standards*
Process Assessment, Health Care
Quality Improvement*
Retrospective Studies
Time Factors
Workflow