Lean methods to improve operating room

elective first case on-time starts

BITS Pilani
Hyderabad Campus
Background

First case on-time start rate:

Percentage of patients having elective procedures and leaving the pre-
operative holding area at or before the listed start time.

Location:
Los Angeles County + University of Southern California Medical Center

Capacity:
• 25 ORs and annual surgical total volume of 14,000 procedures

• 23.5 % first-case start rate prior to lean implementation

BITS Pilani, Hyderabad Campus

Background

Problems caused due to low start rate:

• Cancellations of cases scheduled later in the day

• Long surgical queues and high hospital censuses

• Low morale amongst residents, fellows, attending physicians,

nurses, and other OR staff members

• Low patient satisfaction due to long wait times and last-minute

cancellations

Creation of a Pre-operative lean team to stage efforts to improve

first-case starts

BITS Pilani, Hyderabad Campus

Methods

1. Lean thinking and identification of goals

• Creation of a multidisciplinary pre-operative Lean Team.

• A goal was set to achieve 80% on-time starts for elective first cases

• Performed numerous observations and walk-throughs of the operating

room and pre-operative areas through the patients' eyes

• Value stream mapping, spaghetti diagrams, value and waste

identification, root cause analysis using the 5 Why's

BITS Pilani, Hyderabad Campus

• Workgroups were created to address the following:
• Patient Registration and Scheduling
• Multi-disciplinary Team Communications
• Nerve Blocks
• Last-minute Schedule and Equipment Changes
• Team Communications in the pre-operative holding area

• Pre-operative lean team implemented an improvement bundle

consisting of three key components:
• improving the patient arrival process
• improving the operative team communication
• multi-disciplinary team debriefing that reviewed and improved performance on a
daily basis

BITS Pilani, Hyderabad Campus

Methods:

• Clear map of hospital, specific parking spots for patients, new hospital signage

• Greeters met the patients at the hospital entrance and escorted them to the OR
check-in desk.

• Piloted multiple Plan-Do-Check-Act cycles on the check-in process to

incorporate staggered arrivals, expedited registration, and direct-to-bed upon
completion of check-in.

• Huddles were expected to occur at the patient's bedside 10 min prior to the
scheduled time.

• Visual “huddle ready” signs posted at the end of patient beds,

• All members of the operating team participated in the huddle

BITS Pilani, Hyderabad Campus

Process Improvement Map (Before Lean
intervention):

BITS Pilani, Hyderabad Campus

Process Improvement Map (After Lean
intervention):

BITS Pilani, Hyderabad Campus

THANK YOU

BITS Pilani, Hyderabad Campus