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First Case On-Time Starts Measured by Incision On-Time and No Grace Period

A Case Study of Operating Room Management

Allen, Robert W., PhD; Taaffe, Kevin M., PhD; Neilley, Vivian; Busby, Erik, MD

doi: 10.1097/JHM-D-17-00203

EXECUTIVE SUMMARY A delay in first case on-time starts (FCOTS) can lead to less operating room (OR) utilization, greater facility costs, and dissatisfaction among staff and patients. FCOTS is usually measured by the patient in-room metric with a small grace period. For this study, the partnering hospital elected to target and improve delays by aggressively defining FCOTS as time of incision with no grace period. Metric standardization, goal setting, and organizational focus contributed to a 9-month implementation plan to improve the newly defined FCOTS metric. The target was achieved during implementation, with 73.6% of first cases starting on time. Annual impact showed 80,587 min, or 1,343 hr, of saved OR time, which led to $771,000 in annual savings for variable OR labor costs. This redefined metric and related interventions contributed to significant reduction in delays and savings to the hospital. Engaged physician leadership played a key role in this improvement initiative, as well. The methods employed here can be used in other hospitals looking to improve FCOTS metrics in their procedural areas.

perioperative services research engineer, Greenville Health System, Greenville, South Carolina

associate professor, industrial engineering, Clemson University, Clemson, South Carolina

Clemson University

surgeon, urology and oncology, Greenville Health System

For more information about the concepts in this article, contact Dr. Allen at

The authors declare no conflicts of interest.

© 2019 Foundation of the American College of Healthcare Executives
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