Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center - 19/07/18

Doi : 10.1016/j.amjsurg.2018.05.002

Charles Coffey ^a,^b, Edward S. Cho ^c, Eric Wei ^a,^d, Allison Luu ^a,^b, Maria Ho ^a,^d, Rodolfo Amaya ^a,^e, Marie Pecson ^a, Florence V. Dalton ^a, Deborah Kahaku ^a, Brad Spellberg ^a,^d, Stephen F. Sener ^a,^f,^⁎
^a Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
^b Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
^c Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
^d Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
^e Department of Anesthesiology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
^f Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA

^∗Corresponding author. LAC + USC Medical Center, 1100 North State Street, Clinic Tower, 6A231A, Los Angeles, CA, 90033, USA.LAC + USC Medical Center1100 North State StreetClinic Tower6A231ALos AngelesCA90033USA

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.

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Highlights

•	Lean process improvement methods were used to increase the rate of OR elective first time starts.
•	Over 415 operating days, 23,891 operations were performed.
•	Elective first case on-time starts went from 23.5% before to 73.0% post-Lean implementation.

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Keywords : Operating room, Lean, Efficiency, Start time

Plan

Introduction

Methods

Lean process improvement methods

Data collection and statistical methods

Results

Discussion

Conclusions

Conflicts of interest

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Vol 216 - N° 2

P. 194-201 - août 2018 Retour au numéro

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Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center - 19/07/18

Abstract

Background

Methods

Results

Conclusions

Highlights

Plan

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