Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2013 Apr;110(14):237-43.
doi: 10.3238/arztebl.2013.0237. Epub 2013 Apr 5.

Delays in starting morning operating lists: an analysis of more than 20,000 cases in 22 German hospitals

Martin Schuster  1 , Marco Pezzella, Christian Taube, Enno Bialas, Matthias Diemer, Martin Bauer
Affiliations
Multicenter Study

Delays in starting morning operating lists: an analysis of more than 20,000 cases in 22 German hospitals

Martin Schuster et al. Dtsch Arztebl Int. 2013 Apr.

Abstract

Introduction: Delays in the start of the first operation of the day often lead to conflicts among the involved physicians and nurses. Data on such delays have already been published for individual hospitals, but robust comparative data from a large number of institutions have not been available till now.

Methods: The study is based on the operating room (OR) documentation of four surgical services (general surgery, trauma/orthopedic surgery, gynecology, and ear nose throat [ENT] surgery) in 22 German hospitals over a nine-month period. Three process points ("patient arrival in OR suite," "anesthesia ready," and "incision") were analyzed for the first operation of the day in each OR.

Results: 21,357 operations in the first position were analyzed. The percentage of delays differed markedly for the three process points. The incision was delayed in more than 70% of the general surgical and trauma/orthopedic cases, but less often in gynecological (61 ± 24%) and ENT cases (42 ± 29%). The frequency of delays longer than 10 minutes was between 20% and 40%. The mean delay in delayed cases ranged from 14.1 ± 5.4 to 21.6 ± 8.2 minutes depending on the type of service and process point.

Conclusion: The processes for the first operation of the day are not optimally structured in the hospitals whose cases were analyzed in this study. Delayed starts were common.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Outline of perioperative process up to time of incision
Figure 2
Figure 2
Total number of delayed first cases. Proportion of delayed cases in all first cases on the list, in the four surgical specialties studied and for three time targets: “time of arrival in the operating room,” “anesthesia ready,” and “incision time”
Figure 3
Figure 3
Delays to the first case of >10 minutes. Proportion of first cases delayed by more than 10 minutes in each of the four surgical specialties studied, for three time targets: “time of arrival in the operating room,” “anesthesia ready,” and “incision time”
Figure 4
Figure 4
Delays in “anesthesia ready” and incision despite timely arrival in the operating room: proportion of delayed cases in all first cases on the list, in the four surgical specialties studied and for the time targets: “time of arrival in the operating room,” “anesthesia ready,” and “incision time”
Figure 5
Figure 5
Time distribution before “anesthesia ready” and before incision time in trauma cases, relative to intended time. Anesthesia ready is represented in olive green, incision in blue. Frequency distribution of deviation from target time, clustered in 5 minute intervals. Negative values imply achievement of target before the target time, positive values after target time
See this image and copyright information in PMC

Comment in

References

    1. Schuster M, Bauer M. Bauer M, Welk I, editors. Prozessorganisation OP-Management: Von der Theorie zur Praxis. Springer. 2011:188–209.
    1. Truong A, Tessler M, Kleimann S, Bensimon M. Late operating room starts: experience with an education trial. Can J Anaesth. 1996;43:1233–1236. - PubMed
    1. Mazzei WJ. Operating room start times and turnover times in a university hospital. J Clin Anesth. 1994;6:405–408. - PubMed
    1. Overdyk FJ, Harvey SC, Fishman RL, Shippey F. Successful strategies for improving operating room efficiency at academic institutions. Anesth Analg. 1998;86:896–906. - PubMed
    1. Dexter F, Epstein R. Typical savings from each reduction in tardy first case of the day starts. Anesth Analg. 2009;108:1262–1267. - PubMed

Publication types

MeSH terms