J. Langell1,2, L. Martin1,2, J. Langell1,2 1University Of Utah,School of Medicine, Department Of Surgery,Salt Lake City, UT, USA 2VA Salt Lake City Health Care System,Center Of Innovation,Salt Lake City, UT, USA
Background: Operating room (OR) time is expensive. Underutilized OR time negatively impacts efficiency and is an unnecessary cost for hospitals. A major contributor to underutilization is delayed surgical starts. The purpose of this study was to evaluate the impact of a pre-OR timeout and performance pay incentive on the frequency of on time, first surgical starts.
Methods: At a single Veteran’s Affairs Medical Center, we implemented a pre-OR timeout in the form of a safety briefing checklist. The timeout occurs at the bedside in the pre-operative holding area, and attendance of the surgical attending, OR nurse circulator, and anesthesia provider is required. Initial implementation occurred in late 2008 and was quickly rolled out across all surgical divisions. Additionally, a performance pay incentive for on time starts (>90% compliance) for attending surgeons was introduced in 2009. Data were collected on all first-start cases beginning prior to implementation in 2008 and continued through 2015.
Results: Each year an average of 960 first starts occurred across 9 surgical divisions (General Surgery, ENT, Neurosurgery, Orthopedic Surgery, Plastic Surgery, Podiatry, Thoracic Surgery, Urology, and Vascular Surgery). Prior to implementation of either the timeout or pay incentive, only 15% of cases started on time, and by 2015, greater than 72% were on time (p<0.001) [Figure]. Over the study period, there was a significant improvement in on time starts (p=0.01), of delays <15 minutes (p=0.01), and of delays 16-30 minutes (p=0.04). The trends for delays of 31-60 minutes or >60 minutes were not significant (p=0.31; p=0.81). Subgroup analysis showed that the trends were significant for improving on time starts for each of the 9 divisions. Assuming a loss of 7 minutes per case for delays <15 minutes and 20 minutes per case for delays of 16-30 minutes, the total OR time saved from implementing these measures was 37,556 minutes. At an estimated cost of $20/minute, gross savings from this project were $751,120. We observed that attending surgeons were more likely to have prompt arrivals for first-start cases knowing that their attendance at the pre-OR time out was required for the case to proceed, and that consistent promptness would result in financial gain.
Conclusions: Implementation of a pre-OR timeout and performance pay for on time starts significantly improves OR utilization and reduces unnecessary costs.
