We define the on-time start as a patient being in the OR within 5 minutes of the set start time (ie, before 7:35 am for 7:30 am start time). As there are two anesthesiologists who each run two ORs, they start 2 out of 7 cases at 7:45 am (8:45 am on Fridays). The first case start time is 7:30 am on Mondays to Thursdays, and 8.30 am on Fridays due to educational activities. Fifteen anesthesiologists and a staff of approximately 50 nurses and technicians work in the pediatric ORs. Thirty-one surgeons operate regularly, with each doing more than 60 cases per year. A total of 105 credentialed surgeons from both Yale School of Medicine and the greater community perform approximately 6,600 surgical procedures every year in 7 operating rooms. Yale-New Haven Children’s Hospital is a major tertiary care children’s hospital in Connecticut. 1 We aimed to increase the average rate of first case on-time starts per week from a baseline of 62%–75% over 52 weeks. To our knowledge, only one involves a pediatric OR. 1, 3– 9 Most studies were performed in adult ORs. Many studies have attempted to improve first case on-time starts by adding personnel, providing extra resources, or introducing positive or negative financial reinforcements. Delay in any of the above factors can cause a delay in starting the case on time. Additionally, they must complete all preoperative assessments and prepare appropriate OR equipment. It requires the patient, surgeon, anesthesiologist, and OR nurses to be physically present and prepared before the start time. Beginning the first case on-time in the OR is a complex process. If the first case does not start on time, it has cascading effects leading to delays in subsequent cases and decreased efficiency throughout the day. Maximal OR utilization requires on-time starts for the first case, minimal turnover time between cases, and an accurate allotment of time per case. 2 Additionally, OR inefficiency can be a significant source of frustration for patients and healthcare providers. The most widely accepted cost estimate of an OR minute is $62 with a range of $21–$133. OR inefficiency can lead to significant financial consequences as OR minutes are among the most precious minutes in the hospital. 1 However, the intense clinical activity, the number of trained personnel, and the multiple types of expensive equipment required for each OR case also generate high costs. The operating room (OR) is an integral part of any children’s hospital and is a significant contributor to hospital revenue.
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