Late operating room starts: Experience with an education trial

Abstract

Purpose: This study was undertaken to determine if late starts of first cases in the Operating theatres at the SMBD-Jewish General Hospital remained a problem after identification of the causes of late starts and remedial actions being taken. Methods: Hospital approval was obtained. A retrospective chart audit analyzed a two week period (10 days with 90 elective surgical cases) in October 1993. The time of entry by the first patient into each Operating Room (OR) was transcribed from the nursing records from each OR. A late start was defined as patient entry into the OR after 0745 hr. This audit revealed 77.8% of patients scheduled for surgery at 0745 entered the OR late with a cumulative time lost of 1101 min. The reasons for this inefficiency were identified by a follow-up assessment in April 1995 as a result of this audit. Corrective measures included presentation of inpatients for the first case, reorganization of transport personnel schedules to facilitate arrival of patients to the OR, alteration of patient verification procedures prior to entry to the OR, and education of nursing, anaesthesia, and surgical personnel of the scope of the problem of late OR starts. All attending surgeons were notified either by letter or by discussion at departmental rounds. These measures were in effect by July 1995. A second audit, using the same methodology as the first, evaluated a two week period (10 days with 87 elective surgical cases) in October 1995. Results: The second audit showed 65.5% of patients (average of 9 operating rooms daily) scheduled for surgery at 0745 entered the OR late with 601 min lost. The average delay for late starting cases decreased from 15.73 ± 4.56 to 10.54 ± 3.92 min (P < 0.05). Conclusion: Late OR starts are common and only modest improvements can be achieved without cooperation from anaesthetists and surgeons to arrive on time.