Improving first case start times using Lean in an academic medical center.
BACKGROUND
Lean is a process improvement strategy that can improve efficiency of the perioperative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects.


METHODS
A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases 7 months before and after implementation were analyzed.


RESULTS
A total of 4,492 first-start cases were included; 2,181 were pre-Lean and 2,311 were post-Lean. The post-Lean group had significantly higher on-time starts than the pre-Lean group (69.0% vs 57.0%, P < .01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to preoperative assessment (14.9% vs 9.9%, P < .01) and more likely due to patient-related (16.5% vs 22.3%, P < .01) or chaplain (1.8% vs 4.0%, P < .01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (P < .01).


CONCLUSIONS
Modifying preoperative tasks using Lean methods can improve operating room efficiency and increase on-time starts.
Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Romina
R
Deldar
Department of Surgery, Michigan State University College of Human Medicine, East Lansing, MI, USA.
Tahereh
T
Soleimani
Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Carol
C
Harmon
Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Larry H
LH
Stevens
Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Rajiv
R
Sood
Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Sunil S
SS
Tholpady
Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: dr.michael.chu@gmail.com.
Michael W
MW
Chu
D000046:Academic Medical Centers; D017598:Efficiency, Organizational; D006801:Humans; D019990:Perioperative Care; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D013997:Time Factors; D014887:Weather
Efficiency; Lean; On-time starts; Surgery