title: Preventing Delays in First-Case Starts on the Neurosurgery Service: A Resident-Led Initiative at an Academic Institution.
abstract: OBJECTIVE
  On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time.
  
  
  METHODS
  In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases.
  
  
  RESULTS
  In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays.
  
  
  CONCLUSIONS
  Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California. Electronic address: HanSJ@neurosurg.ucsf.edu.
authors.forename: Seunggu J
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: John D
authors.initials: JD
authors.lastname: Rolston
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Matthew Z
authors.initials: MZ
authors.lastname: Sun
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; Division of Hospital Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Lau
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
mesh_terms: D000046:Academic Medical Centers; D001071:Appointments and Schedules; D004282:Documentation; D004503:Education, Medical, Graduate; D004526:Efficiency; D006801:Humans; D007396:Internship and Residency; D009493:Neurosurgery / Q000193:education*; D009873:Operating Rooms / Q000592:standards* / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012495:San Francisco
keywords: Practice-Based Learning and Improvement; Professionalism; Systems-Based Practice; financial incentive; first case; on-time start; operating room efficiency; quality improvement; resident education