Preventing Delays in First-Case Starts on the Neurosurgery Service: A Resident-Led Initiative at an Academic Institution

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• 作者：Seunggu J. Han ; MD^* ; ^{HanSJ@neurosurg.ucsf.edu" class="auth_mail" title="E-mail the corresponding author} ; John D. Rolston ; MD ; PhD^* ; Corinna C. Zygourakis ; MD^* ; Matthew Z. Sun ; BS^* ; Michael W. McDermott ; MD^* ; Catherine Y. Lau ; MD^* ; ^&dagger ; ; Manish K. Aghi ; MD ; PhD^*
• 关键词：quality improvement ; operating room efficiency ; first case ; on-time start ; resident education ; financial incentive
• 刊名：Journal of Surgical Education
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：73
• 期：2
• 页码：291-295
• 全文大小：476 K

文摘

On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time.

Design and Setting

In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases.

Results

In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays.

Conclusions

Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect.