M. O. Meneveau1, J. H. Mehaffey1, F. E. Turrentine1, A. M. Shilling2, A. T. Schroen1 1University of Virginia Health System,Surgery,Charlottesville, VIRGINIA, USA 2University of Virginia Health System,Anesthesiology,Charlottesville, VIRGINIA, USA
Introduction: Operating room (OR) delays are multifactorial and represent a large healthcare burden. Both perioperative and intraoperative factors associated with lost efficiency have been studied, though little has been reported about factors associated with on-time versus late OR start times. We hypothesize that certain factors are associated with timeliness of first OR start that can be optimized to improve efficiency.
Methods: An institutional OR database was used to identify induction and procedure start time of adults undergoing weekday, first-start, elective operations from January 2014 to May 2017 at a single academic quaternary care center. Data points included patient demographics (age, American Society of Anesthesiologist (ASA) class); surgeon and anesthesiologist gender and experience (years post board certification); post-graduate year (PGY) of surgery resident; Nurse Anesthetist (CRNA) versus anesthesia resident; and use of regional anesthesia. Times were measured as minutes from scheduled OR start time. Univariate and multivariate analyses were performed to identify factors associated with mean induction and procedure start time.
Results: Of all 15825 cases identified, the mean time to induction was 18.3 [SD 23.5] minutes, and mean time from induction to procedure start was 41.1 [SD 19.3] minutes. In 11093 cases, the anesthesiologist was scheduled for more than one first-start with a choice of which to induce first. Among these, mean time to induction was 6.3 [SD 11.3] and 28.6 [SD 25.2] minutes for the first and second case induced, respectively, while the time from induction to procedure start was 41.3 [SD 19.1] and 40.8 [SD 19.4] minutes respectively. Of these, 41.5% of cases staffed by CRNAs were induced first, compared to 58.5% staffed by anesthesia residents (p<0.01). Clinically relevant predictors of mean induction time included add-on cases, ASA≥3, spinal/epidural placement, and CRNA staffing (Table). Longer induction to procedure-start times were associated with higher ASA class, while shorter times were associated with CRNA staffing and female attending surgeons (Table). More experienced surgery residents were not associated with earlier procedure start.
Conclusion: Although a number of factors affect time to induction, including whether anesthesia faculty are covering more than one OR, the time from induction to procedure start is comparatively stable at 41 minutes. Future studies should focus on improving efficiency in surgeon and nursing activities leading to procedure start. Modifiable factors influencing induction time may include review of anesthetic plans the night before between CRNAs and faculty as is required for residents likely contributing to earlier induction.
