title: Successful interventions to reduce first-case tardiness in Dutch university medical centers: results of a nationwide operating room benchmark study.
abstract: BACKGROUND
  First-case tardiness is still a common source of frustration. In this study, a nationwide operating room (OR) Benchmark database was used to assess the effectiveness of interventions implemented to reduce tardiness and calculate its economic impact.
  
  
  METHODS
  Data from 8 University Medical Centers over 7 years were included: 190,295 elective inpatient first cases. Data were analyzed with SPSS statistics and multidisciplinary focus-group study meetings. Analysis of variance with contrast analysis measured the influence of interventions.
  
  
  RESULTS
  Seven thousand ninety-four hours were lost annually to first-case tardiness, which has a considerable economic impact. Four University Medical Centers implemented interventions and effectuated a significant reduction in tardiness, eg providing feedbacks directly when ORs started too late, new agreements between OR and intensive care unit departments concerning "intensive care unit bed release" policy, and a shift in responsibilities regarding transport of patients to the OR.
  
  
  CONCLUSIONS
  Nationwide benchmarking can be applied to identify and measure the effectiveness of interventions to reduce first-case tardiness in a university hospital OR environment. The implemented interventions in 4 centers were successful in significantly reducing first-case tardiness.
authors.affiliation: PhD Fellow Dutch OR Benchmarking Collaboration, Department of Operating Rooms, Erasmus University Medical Center Rotterdam, Room number: Hs-324, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Electronic address: lizetteberkx@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: van Veen-Berkx
authors.affiliation: Institute for Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands.
authors.forename: Sylvia G
authors.initials: SG
authors.lastname: Elkhuizen
authors.affiliation: Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
authors.affiliation: Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
authors.forename: Wolfgang F
authors.initials: WF
authors.lastname: Buhre
authors.affiliation: Department of Surgery, VU University Medical Center Amsterdam, Room number: ZH7F011, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration*; D001071:Appointments and Schedules; D019985:Benchmarking; D017144:Focus Groups; D017722:Hospital Charges; D006801:Humans; D009426:Netherlands; D009873:Operating Rooms / Q000706:statistics & numerical data*; D016134:Organizational Policy; D013997:Time Factors
keywords: Benchmarking; Economic impact; First-case tardiness; Operating room; Performance indicators; Utilization