How often do your surgical schedules get off to a late start? How much would your efficiency improve if you knew the root cause of these delays? A team of OR personnel at New York University's Langone Medical Center found they could greatly boost on-time starts simply by holding surgeons accountable to their schedules.
The New York City hospital's On Time Start Committee examined the perioperative processes involved in more than 100 first-case-of-the-day surgeries. Not surpringly, they found late surgeons to be the major cause of first-case delays. What did come as a surprise was the significant boost in on-time start rates — from 24% to 80% — they achieved by making relatively small changes as part of a "physician accountability initiative."
The initiative, described by Maria Fezza, BSN, RN, CNOR, and Gina Bledsoe Palermo, BSN, RN, in April's AORN Journal, involved sending e-mails to first-case-of-the-day surgeons, reminding them to arrive on site at least 20 minutes before their scheduled start times. OR staff, arriving 1 hour before start times, would have already set up the rooms and prepped the patients by the time surgeons arrived. The surgeons were required to report their attendance — and answer for their late arrivals — to the chiefs of surgery and anesthesia.
Within 2 weeks of implementing the plan, report Ms. Fezza and Ms. Palermo, the incidence of first-procedure delays dropped 13%. According to a published report, the plan is now a permanent part of hospital policy.
For more ideas on how to prevent late starts and deal with tardy physicians, see this Second Opinions discussion thread.
David Bernard
