Causes of Start-Time Delays in the Operating Room – The Perioperative Perspective

There are several reasons why surgeries start late in the Operating Room..

Anyone working in the perioperative arena is familiar with the importance of first case on-time starts, i.e. starting the first cases scheduled for the day in each operating room on time.  When these cases run late, it has a cascading effect on cases scheduled afterward, leading to overruns and inefficient use of costly operating room resources including staff.

PREOPERATIVE

Patient not screened or assessed appropriately to ensure readiness for surgery (e.g., fit for anesthesia or surgery)

Patient not educated about procedure or prepared for surgery

Incomplete diagnostic tests; incomplete patient chart or paperwork

Medication allergies or other complex conditions not identified or recorded

Requirements by surgeons for specific operating room resources or equipment not identified in advance

Scheduling of case mix is not done to optimize use of operating room time and staff availability

Postsurgical arrangements not considered in advance (e.g., discharge planning, home care, supports)

Patient does not show up for surgery due to miscommunication or transportation problem

OPERATIVE

Delays getting patient transferred from other areas of hospital (e.g., ward) to operating room

Surgeon, anesthesiologist, OR nurse, or other team members not available (e.g., sick, late, other duties)

Proper surgical supplies, tools, or equipment are missing/not prepared in advance by central supply department

Delayed start in first surgical case causes ripple effect of delays

Insufficient leadership, communication or teamwork in the OR

Equipment failure

Predicted case duration not accurate; case overrun delays subsequent scheduled surgery starts or causes cancellations

Prolonged turnover in preparation for next case

Urgent and emergent cases added-on at last minute, delaying or cancelling scheduled cases

POSTOPERATIVE

Bed not available in post-anaesthetic recovery unit, critical care unit, or ward for postoperative patients

Unavailable or insufficient nursing and postoperative support staff to care for recovering patients

Postoperative care needs or instructions not transmitted from preoperative or operative

phases (e.g., medication, allergies, etc.)

Patient is either ready and not discharged in a timely manner, or has not recovered and is

discharged too soon

Failure to arrange in advance for discharge support and patient transportation

No long-term care or alternative level of care beds available for patients to transfer to

No arrangements made for patient recovery support at home or in the community

Patient readmission due to complications

Can you add to the list above?

Source: doctorsofbc.ca