Improving first case start times using Lean in an academic medical center

- Etiologies of late surgery starts were identified in the preoperative period.
- Preoperative tasks were modified using Lean process improvement methods.
- Post-Lean implementation was associated with higher on-time surgery starts.
- Surgeon-related factors were the most common delay etiology.

BackgroundLean is a process improvement strategy that can improve efficiency of the perioperative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects.MethodsA retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases 7 months before and after implementation were analyzed.ResultsA total of 4,492 first-start cases were included; 2,181 were pre-Lean and 2,311 were post-Lean. The post-Lean group had significantly higher on-time starts than the pre-Lean group (69.0% vs 57.0%, P < .01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to preoperative assessment (14.9% vs 9.9%, P < .01) and more likely due to patient-related (16.5% vs 22.3%, P < .01) or chaplain (1.8% vs 4.0%, P < .01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (P < .01).ConclusionsModifying preoperative tasks using Lean methods can improve operating room efficiency and increase on-time starts.