Department of Surgery, Washington University School of Medicine, St Louis, MO.
Department of Surgery, Washington University School of Medicine, St Louis, MO.
J Am Coll Surg. 2020 Feb;230(2):182-189.e4. doi: 10.1016/j.jamcollsurg.2019.10.017. Epub 2019 Dec 13.
Inefficient operating room (OR) use wastes resources. Studies have suggested "first case on-time starts" (FCOTS) reduce OR "idle time," yet no direct association between FCOTS and markers of OR efficiency, like "last case on-time end" (LCOTE) or overtime costs, have been reported. We performed this study to evaluate factors associated with FCOTS, LCOTE, and OR overtime costs.
In April 2017, our medical center launched an FCOTS improvement initiative. Prospectively collected data concerning cases performed in the 6-month pre- (October 2016 to March 2017) and post-intervention (October 2017 to March 2018) periods were retrospectively analyzed. Elective, nontraumatic cases performed by orthopaedics, gynecology, urology, minimally invasive surgery, or colorectal surgery were eligible. Univariate and multivariable analyses were used to evaluate 3 outcomes of interest: the association between FCOTS and LCOTE (primary), the change in FCOTS rates after intervention implementation (secondary), and estimated overtime cost savings associated with FCOTS (secondary).
We analyzed 12,073 cases (6,095 pre- vs 5,978 post-intervention) performed over 2,631 OR days (1,401 pre vs 1,230 post). The FCOTS rate increased after intervention (76.1% vs 86.6%, p < 0.001), with post-intervention cases twice as likely to start on time (adjusted odds ratio [aOR] 2.07; 95% CI 1.73 to 2.46, p < 0.001). Additionally, starting on time was associated with a higher likelihood of LCOTE (aOR 1.76; 95% CI 1.38 to 2.24, p < 0.001) and 21.8 fewer overtime minutes (95% CI 13.7 to 29.8, p < 0.001) per OR day. Post-intervention estimated savings of $87,954 in direct OR costs over 6 months were associated with the FCOTS initiative.
The FCOTS initiative was associated with higher frequency of FCOTS, which was independently associated with LCOTE. This achieved an estimated 6-month cost savings of more than $80,000 in direct OR expenditures.
手术室（OR）效率低下会浪费资源。有研究表明，“第一台手术准时开始”（FCOTS）可以减少 OR 的“空闲时间”，但尚未有研究直接表明 FCOTS 与 OR 效率的标志物，如“最后一台手术准时结束”（LCOTE）或加班成本之间存在关联。我们进行这项研究旨在评估与 FCOTS、LCOTE 和 OR 加班成本相关的因素。
2017 年 4 月，我们的医疗中心启动了一项 FCOTS 改进计划。回顾性分析了在干预前（2016 年 10 月至 2017 年 3 月）和干预后（2017 年 10 月至 2018 年 3 月）6 个月期间采集的有关手术的前瞻性数据。符合条件的是由矫形外科、妇科、泌尿科、微创外科或结直肠外科进行的择期、非创伤性病例。使用单变量和多变量分析评估了 3 个感兴趣的结果：FCOTS 与 LCOTE 的关联（主要）、干预实施后 FCOTS 率的变化（次要）以及与 FCOTS 相关的估计加班成本节省（次要）。
我们分析了 12073 例手术（6095 例干预前 vs 5978 例干预后），涉及 2631 个 OR 日（1401 例干预前 vs 1230 例干预后）。干预后 FCOTS 率增加（76.1% vs 86.6%，p < 0.001），干预后病例按时开始的可能性是前者的两倍（调整后的优势比[aOR]2.07；95%CI 1.73 至 2.46，p < 0.001）。此外，按时开始与 LCOTE 更高的可能性相关（aOR 1.76；95%CI 1.38 至 2.24，p < 0.001）和每个 OR 日减少 21.8 分钟的加班时间（95%CI 13.7 至 29.8，p < 0.001）。干预后 6 个月内，直接 OR 成本节省了 87954 美元，与 FCOTS 计划有关。
FCOTS 计划与更高的 FCOTS 频率相关，这与 LCOTE 独立相关。这实现了超过 80000 美元的直接 OR 支出的 6 个月成本节省。
