Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA.
Santa Clara County Medical Center, San Jose, California, USA.
J Card Surg. 2022 Oct;37(10):3092-3098. doi: 10.1111/jocs.16756. Epub 2022 Jul 17.
Late surgical start times have been associated with a multitude of adverse consequences such as increased cost, delay in treatment, increase in medical errors, and patient complications. From October 1, 2018 to September 30, 2019, 47% (67/144) of non-emergent cardiac cases in our institution had a late start by our institutional standard. Our objective was to decrease the percentage of late start non-emergent cardiac cases from 47% to 37% by October 2020.
All non-emergent cardiac surgical procedures as first start cases in a single institution were included in our study. Preintervention cardiac surgical cases were reviewed from October 1, 2018 to February 28, 2020 to determine key drivers contributing to late start times. A multidisciplinary team was formed and utilized A3 process and problem-solving strategies to address our objective. A multipronged intervention approach was used to address key drivers contributing to late start times.
All interventions were implemented in March 2020. Postintervention data was collected from March 1, 2020 to February 28, 2021, on all non-emergent cardiac surgical procedures. The percentage of non-emergent cardiac cases starting after 8:00 a.m. decreased to 27% (17/62). The decrease in late start cases translated into saving an average of 45min of operating room (OR) time (average cost savings of ~$5,000/case). Additionally, staff reported improved job satisfaction.
Delayed surgical case start times can have negative effects on patients, employees, and lead to increase costs of medical care. Our research has shown adherence to on-time surgical start can improve OR efficiency, decrease cost, and improve employee satisfaction.
手术开始时间较晚与诸多不良后果相关，如增加成本、治疗延迟、医疗错误增加和患者并发症。自 2018 年 10 月 1 日至 2019 年 9 月 30 日，我院 47%（67/144）的非紧急心脏病例按照我院的标准较晚开始。我们的目标是在 2020 年 10 月前将非紧急心脏病例开始较晚的比例从 47%降至 37%。
我们的研究纳入了我院所有作为第一台手术的非紧急心脏外科手术。回顾了 2018 年 10 月 1 日至 2020 年 2 月 28 日的非紧急心脏外科手术病例，以确定导致手术开始较晚的主要因素。成立了一个多学科团队，利用 A3 流程和问题解决策略来实现我们的目标。采用多管齐下的干预方法来解决导致手术开始较晚的主要因素。
所有干预措施均于 2020 年 3 月实施。2020 年 3 月 1 日至 2021 年 2 月 28 日收集了所有非紧急心脏外科手术的术后数据。8 点以后开始的非紧急心脏病例比例下降到 27%（17/62）。非紧急心脏病例开始较晚的减少转化为平均节省 45 分钟手术室（OR）时间（平均每例节省约 5000 美元）。此外，员工报告工作满意度提高。
手术开始时间延迟会对患者、员工产生负面影响，并导致医疗成本增加。我们的研究表明，按时开始手术可以提高手术室效率，降低成本，提高员工满意度。
