Part of 3 of Access’s Improving the Economy of Surgical Services series
In our most recent article in this series, we mapped out the patient’s journey through the Surgical Services process. It is quite clear there are many moving parts in this process. The general rule of thumb in the engineering world is the more moving parts you have, the more opportunity there is for something to break and go wrong. The Surgical Services process is no different, and it is fraught with opportunities for the process to go awry.
Before we get into common reasons for delays in Surgical Services, let’s first be clear about one thing: any delay in “first case of the day” surgeries can have a cascading effect, causing delays in all subsequent surgeries sharing the same OR. In the next article in this series, I’ll specifically focus on the fall-out of delays in these “first case of the day” surgeries, and I’ll dive into why, in one study, 84% of “first case of the day” surgeries start late.1 For now, let’s focus on the top five reasons why most surgeries are delayed.
- Surgeons and Anesthesiologists Arriving Late
As simple as it sounds, the main cause for delays in Surgical Services can be attributed to the late arrival of surgeons or anesthesiologists. A study performed at New York University Langone Medical Center found this to be true for their institution. It could be said that corporate culture and undefined expectations contributed to this frequent challenge.
NYU instituted a plan to alter the culture, including Chiefs of Surgery personally speaking with surgeons who arrived late. And emails were sent to surgeons reminding them to arrive 20 minutes prior to their surgery. The combination of these steps resulted in vast improvements of on-time surgeries (from 24% to 80% on-time starts.)2
- Patients Arriving Late
According to one study, 65% of patients arrive late. If a patient arrives late, the odds of a delayed start to the surgery increase by 35%. Furthermore, the data suggests the odds of a delay increase 9% with every 10 year increase in patient age.
- No Recovery Room Available
In one study, it was determined that of all delayed procedures, 31.8% were delayed due to no post-operative bed being available.1 Again, this may be attributed to a breakdown in communication or process in the pre-hospital/scheduling phase of the patient journey.
- Missing or Incomplete Informed Consents
There are many studies with sample sizes of greater than 1,000 surgeries that cite 85% or more of patients either had missing or incomplete paperwork. Clearly, this is a very common occurrence, but advancements in EMR technology have helped solve this challenge to a large degree. However, according to one study, 66% of patients were specifically missing Informed Consents, which caused a delay in 14% of surgical cases.3
- Staff Too Busy
It seems unthinkable that “We’re too busy” would be a real response from a healthcare provider to a scheduled and waiting surgery patient. Yet, one study reported 9% of surgical delays were attributed to staff citing their “being too busy” to accept patients. The reasons for this particular finding could be numerous, but clearly related to inefficiencies or perhaps low staffing within the Surgical Services area.
What are the primary reasons for delays in Surgical Services in your hospital? Are patients constantly arriving late? Do you see a correlation in patient’s age and their propensity to arrive late? Could implementing a text message alert program or something similar potentially reduce this cause for delays?
Or do you need to look beyond the patient, and examine Surgical Services delays rooted in a cultural problem that may be impacting you both financially and in overall staff morale?
Whatever the root cause for delays, it’s without question in your hospital’s best fiscal interest to solve the problem, considering the OR is one of the highest revenue-producing areas of the hospital and one of the most costly. Taking strategic steps now to improve process efficiency and adherence can have broad and significant impacts on staff productivity and morale, the reputation of your hospital and your bottom line.
Check back next week for article four in our Improving the Economy of Surgical Services series.
1Van Winkle, Rachelle A., Mary T. Champagne, Meri Gilman-Mays, and Julia Aucoin. 2016. “Operating Room Delays: Meaningful Use in Electronic Health Record.” Computers, Informatics, Nursing: CIN 34 (6): 247–53.Fezza, Maria, and Gina Bledsoe Palermo. 2011. “Simple Solutions for Reducing First-Procedure Delays.” AORN Journal 93 (4): 450–54.
2Fezza, M. and Palermo, G. B. (2011), Simple Solutions for Reducing First‐Procedure Delays. AORN Journal, 93: 450-454. Doi:1
3Garonzik-Wang, Jacqueline M., Gabriel Brat, Jose H. Salazar, Andrew Dhanasopon, Anthony Lin, Adesola Akinkuotu, Andres O’Daly, et al. 2013. “Missing Consent Forms in the Preoperative Area: A Single-Center Assessment of the Scope of the Problem and Its Downstream Effects.” JAMA Surgery 148 (9): 886–89.