How to Address Start Time Delays in Operating Rooms

Charles Trentham

If you are a hospital administrator or operating room director experiencing growing concerns over first case start delays, you are in the right place. Since 2004, CCI Anesthesia has been able to help facilities overcome these inefficiencies through a variety of proven strategies. Here, we will discuss some of the most common causes of first case start delays and explain how to address them.

Understanding Data Related to Start Times

To be better prepared to close gaps and support your facility’s performance goals, it is important to understand the data measurements related to first case start times. Frequently, anesthesiologists are measured by the percent of first case on time start (FCOTS) times and by first case start delay (FCSD) times. FCSD times are factors that contribute to OR inefficiencies which can ultimately impact patient satisfaction scores. Reducing FCSD minutes increases patient satisfaction, reduces money lost in the practice and creates more time available in the OR to take more cases. 

Common Causes of First Case Start Delays

Your first case starts should be carefully observed to best diagnose the reasons for delays. We find that the most common causes of first case start delays are due to:

  • The patient arriving late from home
  • A delayed transfer of the patient from another department
  • Slow registration of the patient in the admissions department
  • The anesthesia provider or surgeon arrives late to check the patient
  • A failure of equipment needed for the case
  • An inadequate number of beds available
  • An insufficient number of nursing staff, anesthesia staff and OR facilities for an unplanned emergency surgery

Your facility could be experiencing one or a combination of these issues. Even though some of these issues fall outside the responsibilities of your anesthesia department, CCI Anesthesia always goes the extra mile to help our facilities meet their performance goals.

How to Improve First Case Start Delay Times

Before developing a comprehensive plan to improve FCSD times, the team should agree on the definition of an “on time first case start.” Is this defined as when the patient is fully anesthetized or when the surgeon makes the first incision? There are several other ways to define an on time first case start and whenever this is agreed upon, a plan to improve these times can be developed.

We have been able to help improve FCSD times by implementing the following strategies:

  • Create a clear policy for anesthesiologist and surgeon arrival times.
  • In billing models that require 4:1 anesthesiologist supervision of CRNAs, develop a detailed and realistic staggered start schedule for each OR.
  • Achieve a vested interest in meeting goals by incentivizing FCSD improvement to leadership.
  • Implement changes focused on increasing care coordination between the OR, inpatient units and ICU units. This will be accomplished, namely, by standardizing patient OR admission, using a pre-operative checklist and reducing the uncertainty for post-operative ICU availability.

Always Think Outside the Box

In situations where these strategies alone are not enough to significantly improve FCSD times, you may need to consider a change to your anesthesia staffing model. For example, if your current anesthesia staffing model requires staggered starts for the first cases of the day for your anesthesiologist to be present at inductions, you might consider a larger supervision ratio. Changes to your staffing model can lead to significant time savings and make a tremendous impact on your budget.

If you are interested in learning more about how CCI Anesthesia can improve your hospital or surgery center’s on time starts, give us a call at 800.494.3948. After years of improving efficiencies and patient satisfaction scores in the operating room through our practice management services, we are confident we can help you meet your facility’s goals, too.

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