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Perioperative inefficiency can increase cost. We describe a process improvement initiative that addressed preoperative delays on an academic vascular surgery service. First case vascular surgeries from July 2019–January 2020 were retrospectively reviewed for delays, defined as late arrival to the operating room (OR). A stakeholder group spearheaded by a surgeon-informaticist analyzed this process and implemented a novel electronic medical records (EMR) preoperative tool with improved preoperative workflow and role delegation; results were reviewed for 3 months after implementation. 57% of cases had first case on-time starts with average delay of 19 min. Inappropriate preoperative orders were identified as a dominant delay source (average delay = 38 min). Three months post-implementation, 53% of first cases had on-time starts with average delay of 11 min (P < 0.05). No delays were due to missing orders. Inconsistent preoperative workflows led to inappropriate orders and delays, increasing cost and decreasing quality. A novel EMR tool subsequently reduced delays with projected savings of $1,200/case. Workflow standardization utilizing informatics can increase efficiency, raising the value of surgical care. •Standardization of workflows is a critical quality improvement tool.•Inconsistent results can decrease the quality and value of patient care.•Informatics can be utilized to study issues and implement change in healthcare.•Perioperative inefficiency is a major source of waste in healthcare.

Reduced surgical efficiency and productivity, delayed patient discharges, and prolonged use of hospital resources are the results of an OR that is unable to move patients to the postanesthesia care unit or other patient units. A primary reason for perioperative patient flow delay is the lack of hospital beds to accommodate surgical patients, which consequently causes backups of patients currently in the surgical suite. In one facility, implementing Six Sigma methodology helped to improve OR patient flow by identifying ways that frontline staff members could work more intelligently and more efficiently, and with less stress to streamline workflow and eliminate redundancy and waste in ways that did not necessitate reducing the number of employees. The results were improved employee morale, job satisfaction and safety, and an enhanced patient experience.

Improving OR first‐case on‐time starts (FCOTS) is a multifactorial challenge for perioperative nurses and leaders seeking to improve efficiency. This article describes the implementation of a quality improvement project at a hospital‐based ambulatory surgery center to decrease FCOTS delays, which did not allow the organization to meet its FCOTS adherence goal of 80% or higher, averaging 59% in 2023. Through the creation and adoption of standard work documents to reduce variability, nurses were given a preoperative time frame within which to complete the nursing components required to prepare a patient for the OR. When comparing intervention and baseline data after the three‐month intervention period, a significant reduction in total minutes delayed was noted—from 1,422 to 799 minutes (P < .001)—as well as an improvement in FCOTS compliance to 82%. Estimated cost savings were $35,111 for the three‐month intervention period, demonstrating that modifications to nursing workflows alone can improve perioperative efficiencies.

INTRODUCTION:Divergent recommendations for periprocedural management of glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1 RA) medications rely on limited evidence. We performed a systematic review and meta-analysis to provide quantitative measures of gastric emptying relevant to mechanisms of weight loss and to periprocedural management of GLP-1 RA. We hypothesized that the magnitude of gastric emptying delay would be low and of limited clinical significance to procedural sedation risks.METHODS:A protocolized search identified studies on GLP-1 RA that quantified gastric emptying measures. Pooled estimates using random effects were presented as a weighted mean difference with 95% confidence intervals (CIs). Univariate meta-regression was performed to assess the influence of GLP-1 RA type, short-acting vs long-acting mechanism of action, and duration of treatment on gastric emptying.RESULTS:Fifteen studies met the inclusion criteria. Five studies (n = 247) utilized gastric emptying scintigraphy. Mean T1/2 was 138.4 minutes (95% CI 74.5-202.3) for GLP-1 RA vs 95.0 minutes (95% CI 54.9-135.0) for placebo, with a pooled mean difference of 36.0 minutes (95% CI 17.0-55.0, P < 0.01, I2 = 79.4%). Ten studies (n = 411) utilized the acetaminophen absorption test, with no significant delay in gastric emptying measured by Tmax, area under the curve (AUC)4hr, and AUC5hr with GLP-1 RA (P > 0.05). On meta-regression, the type of GLP-1 RA, mechanism of action, and treatment duration did not impact gastric emptying (P > 0.05).DISCUSSION:While a gastric emptying delay of ∼36 minutes is quantifiable on GLP-1 RA medications, it is of limited magnitude relative to standard periprocedural fasting periods. There were no substantial differences in gastric emptying on modalities reflective of liquid emptying (acetaminophen absorption test), particularly at time points relevant to periprocedural care.

ABSTRACTThe use of a surgical safety checklist can help prevent sentinel events; however, a lack of adherence to the checklist can result in inadequate preoperative patient readiness and negative outcomes. The purpose of this quality improvement project was to address preoperative concerns that prevent patient readiness in a military hospital. To change practice, the project involved the use of an evidence‐based practice model and Kurt Lewin's change theory. The primary investigator provided an educational initiative on the required checklist for perioperative personnel and collected data on key elements (ie, consent completion, laboratory test results, antibiotic availability, checklist completion) for 30 days after the initiative. Consent completion rates were 100% both before and after the intervention. Statistical analysis (chi‐square [ χ2]) showed significant improvement for the remaining three elements. The results were the most significant for laboratory test results ( χ21 = 33.496, P < .00001).

The operating room suite can be one of the most costly units within the hospital. Some of these costs stem from postoperative unplanned admissions, case cancellations, case delays, and extended recovery room times. The objective is to determine the clinical predictors of these operating room inefficiencies. Retrospective data analysis. Operating room, postoperative recovery area. Surgical patients whose perioperative data were reported to the Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry from 2010 to 2015. We identified all cases that reported unplanned admissions, case cancellations, case delays, and extended recovery room times. Patient demographics, intraoperative characteristics, and provider information were collected for each case. Univariate and multivariate logistic regressions were fitted to determine if these various characteristics were associated with the outcomes of interest. The incidence of unplanned admissions (0.18%), case cancellations (0.05%), extended recovery room stays (1.12%), and case delays (14.43%) were reported. A positive predictor for unplanned admissions included elderly patients (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.16-1.48), whereas cases not performed under general anesthesia had lower rates (P<.001). For case cancellations, higher American Society of Anesthesiologists classes had the highest risk (OR, 2.17; 95% CI, 1.81-2.60). Longer cases and elderly patients are the main predictors for extended postanesthetic care unit stays among all surgeries (OR, 1.54; 95% CI, 1.47-1.62; OR, 1.42; 95% CI, 1.34-1.50, respectively). Pediatric patients and monitored anesthetic care cases had highest odds for case delays (OR, 3.02; 95% CI, 2.93-3.11; OR, 4.98; 95% CI, 4.88-5.07, respectively). This study reports the national incidence and various clinical predictors for these 4 operating room metrics. This can serve as both a resource for operating room managers to compare their practice to national trends and a tool for strategically identifying at-risk surgical cases. •Elderly patients and general anesthesia cases have higher rates of unplanned admissions.•Higher American Society of Anesthesiologists class, older age, and male sex correlate with case cancellations.•Longer cases, general anesthesia cases, and older age are predictors of extended postanesthetic care unit stays.•Pediatric patients and monitored anesthetic care cases had increased risk of case delays.

ABSTRACTFew studies have examined variability in OR utilization across weekdays. We conducted a retrospective analysis to determine OR utilization differences by day of the week and the source and financial effects of any variability. We extracted 55 months of data from a surgical data repository to calculate OR utilization, late starts, idle times, and delays for each weekday. Declines in OR utilization occurred as the week progressed and were attributed to compounding changes in late start, delay, and idle time. The average weekly cost for each OR associated with unused staffed minutes below a target OR utilization of 85% was $19,383, and the comparable lost weekly revenue was $60,256. Perioperative leaders should identify sources of OR utilization variability when developing strategies that enhance outcomes for patients, minimize costs, and maximize revenue.

Introduction Treatment delay may have detrimental effects on cancer outcomes. The impact of longer delays on colorectal cancer outcomes remains poorly described. The objective of this study was to determine the effect of delays to curative-intent surgical resection on survival in colorectal cancer patients. Methods All adult patients undergoing elective resection of primary non-metastatic colorectal adenocarcinoma from January 2009 to December 2014 were reviewed. Treatment delays were defined as the time from tissue diagnosis to definitive surgery, categorized as < 4, 4 to < 8, and ≥ 8 weeks. Primary outcomes were 5-year disease-free (DFS) and overall survival (OS). Statistical analysis included Kaplan–Meier curves and Cox regression models. Results A total of 408 patients were included (83.2% colon;15.8% rectal) with a mean follow-up of 58.4 months (SD29.9). Fourteen percent (14.0%) of patients underwent resection < 4 weeks, 40.0% 4 to < 8 weeks, and 46.1% ≥ 8 weeks. More rectal cancer patients had treatment delay ≥ 8 weeks compared with colonic tumors (69.8% vs. 41.4%, p  < 0.001). Cumulative 5-year DFS and OS were similar between groups ( p  = 0.558; p  = 0.572). After adjusting for confounders, surgical delays were not independently associated with DFS and OS. Conclusions Treatment delays > 4 weeks were not associated with worse oncologic outcomes. Delaying surgery to optimize patients can safely be considered without compromising survival.

Specimen management is a critical component of safe patient care. Incorrect results or misdiagnoses may cause delayed or improper treatment and delayed or adverse outcomes. We piloted a quality improvement project to address labeling errors in a surgical suite at a large Midwestern academic medical center. We created a gynecology‐specific source aid to assist intraoperative team members define the tissue source according to anatomic location and pathology department regulations. The aid also provided tips on preparing and transporting specimens. Staff member feedback showed that the source aid was user‐friendly and helpful. Most specimen errors after the implementation of the aid were related to nonreportable, fixation delays; and we implemented a second phase to address the delays. Collaboration and education during this project fostered staff member empowerment to manage specimens effectively using the source aid and promote safe patient care.

Background It has been considered that allowing patients to return to daily life earlier after surgery helps recovery of physiological function and reduces postoperative complications and hospital stay. We investigated the usefulness of fast-track management in perioperative care of patients undergoing pancreaticoduodenectomy (PD). Methods Patients ( n  = 90) who received conventional perioperative management from 2005 to 2009 were included as the ‘conventional group’ (historical control group), and patients who received perioperative care with fast-track management ( n  = 100) from 2010 to March 2013 were included as the ‘fast-track group’. To evaluate the efficacy of perioperative care with fast-track management, the incidence of postoperative complications and the length of hospital stay were compared between the two groups (comparative study). For statistical analysis, univariate analysis was performed using the χ 2 test or Fisher’s exact test. Results There was no significant difference between the two groups in sex, mean age, presence/absence of diabetes mellitus, preoperative drainage for jaundice, previous disease, operative procedure, mean duration of operation, or blood loss ( p  < 0.01). The incidence of surgical site infection in the conventional group and fast-track group was 28.9 and 14.0 %, respectively, with a significant difference between the two groups ( p  = 0.019). In addition, the incidence of pancreatic fistula (grade B, C) significantly differed between the two groups (27.8 % in the conventional group, 9.0 % in the fast-track group; p  = 0.001). The mean postoperative hospital stay was 36.3 days in the conventional group and 21.9 days in the fast-track group ( p  < 0.001). Conclusions Perioperative care with fast-track management may reduce postoperative complications and decrease the length of hospital stay in patients undergoing PD.