Ida Jonathan B, Schechter Jamie H, Olmstead John, Menon Archana, Iafelice Mary Beth, Sawardekar Amod, Leavitt Olga, Lavin Jennifer M
From the Department of Otolaryngology, Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Division of Pediatric Otolaryngology, Head and Neck Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Ill.
Pediatr Qual Saf. 2025 Jan 7;10(1):e784. doi: 10.1097/pq9.0000000000000784. eCollection 2025 Jan-Feb.
First-case on-time starts (FCOTS) is an established metric of perioperative efficiency, impacting global perioperative throughput. Late-arriving surgeons are a common cause of late operating room (OR) starts. This project reflects a quality improvement effort to reduce late surgeon arrivals by 30% for 24 months and improve FCOTS.
A multidisciplinary perioperative leadership team developed clear expectations, including tracking, roles, review processes, and consequences. These were broadly communicated among stakeholders, and feedback was incorporated. A new same-day surgeon-to-surgeon feedback mechanism was instituted for late surgeon arrivals, allowing for surgeon feedback and reiteration of expectations. Results were prospectively tracked for 24 months before and following implementation.
Late surgeon arrivals decreased by 45%, from 23.6 to 13 per month for 24 months before and following implementation, respectively ( < 0.001). Balancing measures did not see increases for the same periods. FCOTS increased from 66% to 72% postimplementation ( < 0.001). Statistical process control P-charts demonstrated centerline shifts for both metrics.
Development and communication of a clear framework of expectations, review, and consequences, with ongoing monitoring, clear performance expectations, and timely feedback, can reduce late surgeon arrival and improve FCOTS. Direct and timely communication provided immediate feedback to late surgeons and indicated reporting errors, providing more accurate data on late starts. Consistent policy enforcement is critical for credibility.
首例手术准时开始（FCOTS）是围手术期效率的既定指标，影响着全球围手术期的周转率。外科医生迟到是手术室（OR）开始时间延迟的常见原因。本项目旨在通过质量改进措施，在24个月内将外科医生迟到率降低30%，并提高FCOTS。
一个多学科围手术期领导团队制定了明确的期望，包括跟踪、职责、审查流程和后果。这些期望在利益相关者中广泛传达，并纳入了反馈意见。针对外科医生迟到情况建立了一种新的当日外科医生之间的反馈机制，以便外科医生进行反馈并再次强调期望。在实施前后分别前瞻性地跟踪结果24个月。
外科医生迟到率下降了45%，实施前24个月每月平均为23.6次，实施后为13次（<0.001）。同期平衡指标未见增加。实施后FCOTS从66%提高到72%（<0.001）。统计过程控制P图显示这两个指标的中心线均发生了偏移。
制定并传达一个清晰的期望、审查和后果框架，持续进行监测，明确绩效期望并及时反馈，可以减少外科医生迟到现象并提高FCOTS。直接及时的沟通为迟到的外科医生提供了即时反馈，并指出报告错误，从而提供了更准确的手术开始延迟数据。持续执行政策对于建立可信度至关重要。
