title: Effective strategies in improving operating room case delays and cancellations at an academic medical center.
abstract: BACKGROUND
  Traditionally, the operating room (OR) in an academic medical center has faced numerous challenges to effective clinical productivity, including additional missions of teaching and research. Level 1 trauma poses more challenges related to the need for additional specialized personnel in anesthesia, surgery, and nursing. The present investigation explores lessons learned in efficiency, teamwork, and data evaluation at a level 1 academic teaching facility.
  
  
  METHODS
  The months of July 2012, July 2013, and July 2014 were selected for this study. Multiple strategies were implemented through the Operating Room Committee during this time in an effort to reduce the number of OR delays and cancellations.
  
  
  RESULTS
  Case cancellations decreased significantly over the three-year period, while delays remained relatively stable. In July 2012, 15.0% of cases were cancelled and 10.2% were delayed. Cancellations decreased to 6.3% in 2013 and to 5.9% in 2014. The total number of cases completed per month increased each year throughout the study, from 577 in 2012 to 649 in 2013 to 842 in 2014.
  
  
  CONCLUSIONS
  These results are remarkable in comparison to the greater-than 20% cancellation rate recorded in 2005 when the current OR leadership team first assessed OR efficiency. An increase in the number of cases completed per month likely can be attributed to a reduction in the number of case cancellations. Increased efficiency allows for more operations to be performed, leading to increased profitability and an increased ability of hospitals to continue caring for patients. We advocate the implementation of a comprehensive multidisciplinary strategy for sustained improvement in OR efficiency and utilization.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
authors.forename: Joseph L
authors.initials: JL
authors.lastname: McDowell
authors.forename: James H
authors.initials: JH
authors.lastname: Diaz
authors.forename: Jay A
authors.initials: JA
authors.lastname: Buras
authors.forename: Amy E
authors.initials: AE
authors.lastname: Young
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D001071:Appointments and Schedules; D017598:Efficiency, Organizational; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D009873:Operating Rooms / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D058996:Quality Improvement; D014193:Trauma Centers; D014600:Utilization Review; D014850:Waiting Lists