How to improve outpatient first case starts

Editor's Note

Improving first case on-time starts (FCOTS) in an ambulatory surgery center (ASC) can improve overall efficiency. When the first case of the day starts on-time, it leads to a cascading effect that can prevent cancellations, improve patient satisfaction, and reduce stress for perioperative staff. It can also make it possible to increase case volume. One ambulatory surgery team boosted their FCOTS from 30% to 79% over the course of one year, according to a case study recently highlighted by AORN.

The team engaged several key processes to make the improvement, per the article. First, they assembled a multidisciplinary team, led by nursing, and used a Lean Six Sigma approach to map delay trends, such as miscommunication on case orders, patient arrival time, late surgical staff, prolonged morning huddles, issues with surgical equipment or supply issues, and delayed setup. Solutions included a preoperative checklist to assign concise tasks to each perioperative team member.

They also reassigned key staff to first-case tasks, such as interviews, IV access, preoperative clipping, and OR setup. Defined time for morning huddles, completed consents and medication orders the day before helped mitigate delays such as delivering medications prior to surgery, the case study described. To help improve team accountability, FCOTS data were shared during end-of-the-day huddles. These reported interventions contributed to a more streamlined perioperative workflow. After implementing improvement solutions, the centers FCOTS rates increased by 49%, which equated to cost savings measured at $62 per OR minute.