Improving First Case Start Times Using Lean in an Academic Medical Center
Abstract Background Lean is a process improvement strategy that can improve efficiency of the peri-operative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. Methods A retrospective review of all first...
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| Veröffentlicht in: | The American journal of surgery 2017-06, Vol.213 (6), p.991-995 |
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| container_title | The American journal of surgery |
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| creator | Deldar, Romina, BS Solemani, Tahereh, MD, MPH Harmon, Carol, RN Stevens, Larry H., MD Sood, Rajiv, MD Tholpady, Sunil S., MD, PhD Chu, Michael W., MD |
| description | Abstract Background Lean is a process improvement strategy that can improve efficiency of the peri-operative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. Methods A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases seven months before and after implementation were analyzed. Results A 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 |
| doi_str_mv | 10.1016/j.amjsurg.2016.08.025 |
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The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. Methods A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases seven months before and after implementation were analyzed. Results A 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<0.01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to pre-operative assessment (14.9% vs. 9.9%, p<0.01), and more likely due to patient-related (16.5% vs. 22.3%, p<0.01) or chaplain (1.8% vs. 4.0%, p<0.01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (p<0.01). Conclusions Modifying pre-operative tasks using Lean methods can improve operating room efficiency and increase on-time starts.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2016.08.025</identifier><identifier>PMID: 27810133</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Academic Medical Centers ; Anesthesiology ; Cold ; Confidence intervals ; Efficiency ; Efficiency, Organizational ; Etiology ; Health care facilities ; Hospital costs ; Humans ; Lean ; Lean manufacturing ; On-time starts ; Perioperative Care ; Process Assessment (Health Care) ; Productivity ; Quality Improvement ; Retrospective Studies ; Risk Factors ; Seasons ; Six Sigma ; Surgeons ; Surgery ; Time Factors ; Weather</subject><ispartof>The American journal of surgery, 2017-06, Vol.213 (6), p.991-995</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-9333ab4ad60424970470390ace1160c1f3fd5aab15f6ac4005b242ba869d09ff3</citedby><cites>FETCH-LOGICAL-c448t-9333ab4ad60424970470390ace1160c1f3fd5aab15f6ac4005b242ba869d09ff3</cites><orcidid>0000-0003-4551-7436</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1902501589?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27810133$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Deldar, Romina, BS</creatorcontrib><creatorcontrib>Solemani, Tahereh, MD, MPH</creatorcontrib><creatorcontrib>Harmon, Carol, RN</creatorcontrib><creatorcontrib>Stevens, Larry H., MD</creatorcontrib><creatorcontrib>Sood, Rajiv, MD</creatorcontrib><creatorcontrib>Tholpady, Sunil S., MD, PhD</creatorcontrib><creatorcontrib>Chu, Michael W., MD</creatorcontrib><title>Improving First Case Start Times Using Lean in an Academic Medical Center</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background Lean is a process improvement strategy that can improve efficiency of the peri-operative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. Methods A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases seven months before and after implementation were analyzed. Results A 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<0.01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to pre-operative assessment (14.9% vs. 9.9%, p<0.01), and more likely due to patient-related (16.5% vs. 22.3%, p<0.01) or chaplain (1.8% vs. 4.0%, p<0.01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (p<0.01). Conclusions Modifying pre-operative tasks using Lean methods can improve operating room efficiency and increase on-time starts.</description><subject>Academic Medical Centers</subject><subject>Anesthesiology</subject><subject>Cold</subject><subject>Confidence intervals</subject><subject>Efficiency</subject><subject>Efficiency, Organizational</subject><subject>Etiology</subject><subject>Health care facilities</subject><subject>Hospital costs</subject><subject>Humans</subject><subject>Lean</subject><subject>Lean manufacturing</subject><subject>On-time starts</subject><subject>Perioperative Care</subject><subject>Process Assessment (Health Care)</subject><subject>Productivity</subject><subject>Quality Improvement</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Seasons</subject><subject>Six Sigma</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Weather</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUFv1DAQhS0EokvhJ4AiceGSMBM7jn0BVStKV1rEoe3ZcpxJ5ZBki51U6r_H0S4g9dKLrZHfezP-hrH3CAUCys99Ycc-LuGuKFNZgCqgrF6wDapa56gUf8k2AFDmWiKcsTcx9qlEFPw1OytrlUI437DdbrwPhwc_3WWXPsQ529pI2fVsw5zd-JFidhvXxz3ZKfNTls4LZ1savct-UOudHbItTTOFt-xVZ4dI7073Obu9_Hazvcr3P7_vthf73Amh5lxzzm0jbCtBlELXIGrgGqwjRAkOO961lbUNVp20TgBUTSnKxiqpW9Bdx8_Zp2Numvv3QnE2o4-OhsFOdFiiQcVlzZFrTNKPT6T9YQlTms6gTrgAK6WTqjqqXDjEGKgz98GPNjwaBLOyNr05sTYrawPKJHPyfTilL81I7T_XX7hJ8PUooITjwVMw0XmaXMIWyM2mPfhnW3x5kuAGP63Qf9Ejxf-_MbE0YK7Xha_7RslBopD8D0nkpIc</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Deldar, Romina, BS</creator><creator>Solemani, Tahereh, MD, MPH</creator><creator>Harmon, Carol, RN</creator><creator>Stevens, Larry H., MD</creator><creator>Sood, Rajiv, MD</creator><creator>Tholpady, Sunil S., MD, PhD</creator><creator>Chu, Michael W., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4551-7436</orcidid></search><sort><creationdate>20170601</creationdate><title>Improving First Case Start Times Using Lean in an Academic Medical Center</title><author>Deldar, Romina, BS ; Solemani, Tahereh, MD, MPH ; Harmon, Carol, RN ; Stevens, Larry H., MD ; Sood, Rajiv, MD ; Tholpady, Sunil S., MD, PhD ; Chu, Michael W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-9333ab4ad60424970470390ace1160c1f3fd5aab15f6ac4005b242ba869d09ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Academic Medical Centers</topic><topic>Anesthesiology</topic><topic>Cold</topic><topic>Confidence intervals</topic><topic>Efficiency</topic><topic>Efficiency, Organizational</topic><topic>Etiology</topic><topic>Health care facilities</topic><topic>Hospital costs</topic><topic>Humans</topic><topic>Lean</topic><topic>Lean manufacturing</topic><topic>On-time starts</topic><topic>Perioperative Care</topic><topic>Process Assessment (Health Care)</topic><topic>Productivity</topic><topic>Quality Improvement</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Seasons</topic><topic>Six Sigma</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Weather</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deldar, Romina, BS</creatorcontrib><creatorcontrib>Solemani, Tahereh, MD, MPH</creatorcontrib><creatorcontrib>Harmon, Carol, RN</creatorcontrib><creatorcontrib>Stevens, Larry H., MD</creatorcontrib><creatorcontrib>Sood, Rajiv, MD</creatorcontrib><creatorcontrib>Tholpady, Sunil S., MD, PhD</creatorcontrib><creatorcontrib>Chu, Michael W., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deldar, Romina, BS</au><au>Solemani, Tahereh, MD, MPH</au><au>Harmon, Carol, RN</au><au>Stevens, Larry H., MD</au><au>Sood, Rajiv, MD</au><au>Tholpady, Sunil S., MD, PhD</au><au>Chu, Michael W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving First Case Start Times Using Lean in an Academic Medical Center</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>213</volume><issue>6</issue><spage>991</spage><epage>995</epage><pages>991-995</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Abstract Background Lean is a process improvement strategy that can improve efficiency of the peri-operative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. Methods A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases seven months before and after implementation were analyzed. Results A 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<0.01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to pre-operative assessment (14.9% vs. 9.9%, p<0.01), and more likely due to patient-related (16.5% vs. 22.3%, p<0.01) or chaplain (1.8% vs. 4.0%, p<0.01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (p<0.01). Conclusions Modifying pre-operative tasks using Lean methods can improve operating room efficiency and increase on-time starts.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27810133</pmid><doi>10.1016/j.amjsurg.2016.08.025</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0003-4551-7436</orcidid></addata></record> |
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| subjects | Academic Medical Centers Anesthesiology Cold Confidence intervals Efficiency Efficiency, Organizational Etiology Health care facilities Hospital costs Humans Lean Lean manufacturing On-time starts Perioperative Care Process Assessment (Health Care) Productivity Quality Improvement Retrospective Studies Risk Factors Seasons Six Sigma Surgeons Surgery Time Factors Weather |
| title | Improving First Case Start Times Using Lean in an Academic Medical Center |
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