title: Measuring and Improving First Case On-Time Starts and Analysis of Factors Predicting Delay in Neurosurgical Operating Rooms.
abstract: BACKGROUND
  We undertook an operating room (OR) process improvement project to increase first case on-time starts (FCOTS) in the neurosurgical ORs at a tertiary care academic medical center. We engaged the neurosurgical perioperative team which included neurosurgeons, neuroanesthesiologists, and nurses in a shared goal of improving FCOTS.
  
  
  METHODS
  Our project involved hiring a new service manager and a focused shared effort on improving FCOTS. After project completion, we conducted a retrospective analysis of FCOTS in 6 neurosurgical ORs. If patients were not in the OR within 5 minutes of scheduled start time, it was considered a late start. Factors predicting delayed start were also identified. During the same period, first cases performed outside the neurosurgical ORs served as a control group.
  
  
  RESULTS
  A total of 2328 elective neurosurgical cases were evaluated. The baseline FCOTS from November 2009 to March 2010 was 33%. The first performance shift occurred during March 2010 to January 2011 when FCOTS increased to 44%. In the second performance shift between January 2011 and November 2011 during the implementation phase of this quality improvement project, FCOTS rose to 68% and has continued to increase. Multivariate logistic regression analysis identified the following as significant predictors of delayed start: female sex (odds ratio [OR]=0.771; 95% confidence interval [CI], 0.599-0.943), certified registered nurse anesthetists on the case (OR=0.750; 95% CI, 0.576-0.924), cases done on Friday (OR=0.551; 95% CI, 0.312-0.791), and American Society of Anesthesiologists status IV (OR=0.530; 95% CI, 0.157-0.903).
  
  
  CONCLUSIONS
  The quality improvement project, which was implemented in 2 phases, successfully increased the FCOTS rate in our neurosurgical ORs from 33% to 68%.
authors.affiliation: Vanderbilt University Medical Center, The Vanderbilt Clinic, Nashville, TN.
authors.forename: Letha
authors.initials: L
authors.lastname: Mathews
authors.forename: Koffi M
authors.initials: KM
authors.lastname: Kla
authors.forename: Khensani N
authors.initials: KN
authors.lastname: Marolen
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
mesh_terms: D000046:Academic Medical Centers; D001071:Appointments and Schedules; D006801:Humans; D019635:Neurosurgical Procedures; D009873:Operating Rooms / Q000592:standards* / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014481:United States