First Case On-Time Starts

by  |  October 5 2021 4 min read

One of our most popular reports is First Case On Time Start rate, and I want to explain a bit about why that is.

First, it’s a really big problem if you can’t start your rooms on time. The first case: if it gets delayed, it’s gonna have a ripple effect for all subsequent cases. Getting off the ground on time is of critical importance for the rest of the day, and if you are delayed across all of your cases, and you get decreased productivity for that block, there’s a temptation to open up more OR locations to take care of your case volumes, and that’ll increase your cost, and it’s really because you’re just not starting on time. In addition to cost, it’s a patient dissatisfier, right?

So let’s say you have that first patient scheduled to go to surgery at 7:30am, but you get started 15 or 20 minutes late. As that late start ripples throughout the day,the delay extends itself, and you’re going to end up with patients that could be delayed for 30, 45 minutes, an hour. While that obviously decreases the patients’ satisfaction, it also decreases the satisfaction of the surgeons. They have clinic in the afternoon, and if they can’t start on time, they’re going to be late for those patients. Such a powerful downstream effect is created that getting that first case off the ground becomes critically important.

The other reason First Case On Time Starts is a popular report is that it doesn’t take a great deal of data to get really informative, rich analytics. You typically already have a lot of the data that you need, which is the anesthesia start time, the surgeon’s name, the anesthesiologist or the CRNA’s name, the OR location. All of that information is already on your chart. In order to get these kinds of really rich analytics, you only need to add three extra fields:

  1. Is this a First Case start?
    And if it is, then:
  2. What was the scheduled case start time?
    And if that was in fact a delayed case, then your third question is:
  3. What was the delay reason?

All three questions don’t need to be answered for every case. If it’s not a First Case, then you don’t need to record First Case Scheduled Start Time. You also don’t need to record either the Delay Reason or whether or not the case started on time. So, even though you have three extra data points to capture, you’re not required to do so for every case. That means the overall data capture burden to achieve these kinds of analytics is very low, and you get a high value in return. The types of analytics that you can get out of this are really interesting, because you’re not only getting a percent of your on-time start rate. Say I have a 90% on-time start rate, or my goal is 75% and I’m only at 52%. Well, that’s one way to gauge it: the percentage that you have delayed.

But I actually think a much more meaningful measurement is demonstrated in a report that shows the number of minutes for that delay.

Why? Think about it this way. While one facility may start on-time 74% of the time, it may still have more delay minutes than another facility that has a 62% on-time start rate. So, the actual number of cases that you can get going on time may not actually be the most important measurement. It’s really the extent of the delaythat matters most.

Look, if it’s a three-minute delay, then it’s not much of a big deal. If it’s a 15-20 minute delay, that’s where more cost is going to get picked up. And so, being able to track the actual number of delay minutes rather than just the total number of delayed cases, I think, is one key aspect of that report.

The other key aspect is that you need to be able–in your analytic tool–to be able to aggregate by the surgeon, by the anesthesiologist, by the CRNA, and by the OR location. Then you need to aggregate by the delay reasons. And if you look at those different aggregations in a visually informative way, a story begins to unfold that tells you: “What is the root cause?” Is it a systemic issue? Is it a personnel issue? Is it an equipment issue? Without that kind of visualization, you’re really stuck in a world of opinions, which could be informed and correct, but that could also be incorrect.

And so, when you can visualize this data and these results, you can look at trends and ask, “What does the last quarter look like?” “Year-to-date, what does it look like?” or “We made changes in Q2 of this year, did those changes have a measurable impact? How are things different now than they were before?” Answering those types of questions for your management is key. And that’s how you make reports, like First Case On-Time Starts, meaningful and helpful. It allows you an opportunity to demonstrate to the hospital administration that you’re committed to operational excellence and to improving any deficiencies. It strengthens your brand. It improves patient satisfaction if you can start on time. It improves surgeons’ satisfaction knowing that they can start on time. Or knowing that, at least for them, there is a documented reason for things being delayed, and we are actively working on that and moving towards improvement. I think it’s always an improvement process, and if you’re not doing well, then just make sure you’re headed in the right direction.

First Case On-Time Starts is a fantastic report. It doesn’t take a lot of data, and it really provides a lot of bottom-line meaning to the operations in the OR.