Ventura County Medical Center, Ventura, CA, USA.
Am Surg. 2020 Oct;86(10):1391-1395. doi: 10.1177/0003134820964491. Epub 2020 Nov 10.
The average cost of running an operating room (OR) is approximately $37.00 a minute. Therefore, every effort should be made to start in a timely manner. There are several factors at play that can cause OR delays. Attaining consistent start times is a multidisciplinary task, which requires good communication and rewards for efficiency.
At our institution, a "star system" was implemented to improve compliance with timely start times. All OR staff (scrub tech, OR nurse, anesthesiologist, and physician) get 1 star for every on time start. Once a person attains 10 stars, they are awarded a $20 gift card to a local bakery/coffee shop.
There was a significant difference in the 3 months pre- and post-implementation of the star system in regard to starting on time (54% vs. 71%, -value .047), and there were significantly less late starts within 6-10 minutes (14% vs. 4%, -value = <.01). There was no statistically significant difference in late starts >11 minutes or when comparing days of the week. The most common reasons for delay are as follows: surgeon running late (23%), anesthesiologist tardiness (11%), patient is late (9%), preoperative orders, or test not completed (7%).
The significant increase in the number of cases that start on time after implementation of the star system leads us to believe that late start times are multifactorial, and that incentives are a positive way to encourage the OR team to start on time.
运营手术室（OR）的平均成本约为每分钟 37.00 美元。因此，应尽一切努力及时开始。有几个因素会导致 OR 延迟。实现一致的开始时间是一项多学科任务，需要良好的沟通和对效率的奖励。
在我们的机构中，实施了“星级系统”以提高准时开始时间的合规性。所有手术室工作人员（洗手护士、手术室护士、麻醉师和医生）每准时开始一次可获得 1 颗星。一旦一个人获得 10 颗星，他们将获得一张价值 20 美元的当地面包店/咖啡店礼品卡。
在实施星级系统前后的 3 个月中，准时开始方面有显著差异（54%比 71%，-值.047），并且 6-10 分钟内的延迟开始明显减少（14%比 4%，-值<.01）。11 分钟以上或比较不同的日子时，延迟开始没有统计学上的显著差异。延迟的最常见原因如下：外科医生迟到（23%）、麻醉师迟到（11%）、患者迟到（9%）、术前医嘱或检查未完成（7%）。
实施星级系统后准时开始的案例数量显著增加，这使我们相信延迟开始时间是多因素的，激励措施是鼓励手术室团队准时开始的一种积极方式。
