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Can one improve OR efficiency in the labor and delivery unit?
Abstract Number: T1C-249
Abstract Type: Original Research
Operating room (OR) efficiency is critical in the health care environment as providers and administrators attempt to meet an increasing demand for high quality and effective healthcare systems. On-time surgical start is a metric of quality, however most Labor & Delivery units struggle to meet general OR efficiency targets, due to the nature of obstetric care with urgent cases delaying scheduled cesarean deliveries (CDs). As part of an ongoing QI initiative, all actionable factors interfering with on-time start of scheduled CDs are currently evaluated. We decided to examine on-time start (OTS) rates over 6 months, hypothesizing that it improved over time in response to several initiatives & team efforts.
Using anesthesia electronic records, all scheduled CDs between June and mid-December 2018 were identified. Patient demographics (age & BMI), procedure characteristics (day, month, 1st case of the day, primary CD, high-risk OB/MFM case), and anesthesia factors (level of training of residents, years of practice of attending) were recorded, as well as patient entry in the OR. ‘Late-start’ was defined when patient entry in the OR occurred > 20 min after scheduled time. Multivariable analysis was applied to identify factors associated with ‘late-start’.
There were 323 scheduled CDs during the study period; OTS rate was 40.6% (Table). First case of the day increased the odds for OTS (p=0.015; aOR 0.47, 95%CI 0.29-076). There was variability month by month (p<0.001) with highest odds for OTS in November (aOR 0.34, 95%CI 0.15-0.78; Table). Anesthesia providers had no impact on ‘late-start’. Causes for late-start were patient tardiness (10%), delays in blood products availability (valid type & screen ± blood ready; 15%), availability of obstetricians (other than urgent OR case; 15%), anesthesiologists (0), nursing staff or scrub technician (5%), NICU team (5%), and other emergency ‘bumping’ the scheduled case (44%).
OR efficiency in the obstetric setting is contingent to unique factors which are not all actionable. Our finding that over 40% of delayed cases are due to other urgent CDs underscores the premise that Labor & Delivery units operate differently from general ORs. We identified specific issues with blood type screening and products readiness that are currently addressed. While it appears that OR efficiency in our unit is far from optimal, OTS seems to improve and our aim is to achieve 70-80% within the next 6 months.