Standardization of operative start times for non-emergent cardiac surgical procedures

Objective: Late surgical start times have been associated with a multitude of adverse consequences such as increased cost, delay in treatment, increase in medical errors, and patient complications. From October 1, 2018 to September 30, 2019, 47% (67/ 144) of non-emergent cardiac cases in our institution had a late start by our institutional standard. Our objective was to decrease the percentage of late start non-emergent cardiac cases from 47% to 37% by October 2020. Methods: All non-emergent cardiac surgical procedures as first start cases in a single institution were included in our study. Preintervention cardiac surgical cases were reviewed from October 1, 2018 to February 28, 2020 to determine key drivers contributing to late start times. A multidisciplinary team was formed and utilized A3 process and problem-solving strategies to address our objective. A multipronged intervention approach was used to address key drivers contributing to late start times. Results: All interventions were implemented in March 2020. Postintervention data was collected from March 1, 2020 to February 28, 2021, on all non-emergent cardiac surgical procedures. The percentage of non-emergent cardiac cases starting after 8:00 a.m. decreased to 27% (17/62). The decrease in late start cases translated into saving an average of 45min of operating room (OR) time (average cost savings of -$5,000/case). Additionally, staff reported improved job satisfaction. Conclusions: Delayed surgical case start times can have negative effects on patients, employees, and lead to increase costs of medical care. Our research has shown adherence to on-time surgical start can improve OR efficiency, decrease cost, and improve employee satisfaction.

Automated summary

This study aimed to decrease the percentage of late start non-emergent cardiac cases through a multi-pronged intervention approach. The interventions resulted in a decrease in the percentage of cases starting after 8:00 a.m., saving operating room time and cost, and improving employee satisfaction.