Increasing the percentage of first case on-time starts in the labour and delivery operating room

Background Delays in first case on-time starts (FCOTS) can lead to inefficiencies in the operating room (OR), dissatisfaction among patients with their providers and staff, and increased facility costs. While the literature has established standards for improving main OR efficiency, further research is needed in labour and delivery (L&D) units. Therefore, we aimed to identify the barriers to on-time case starts in L&D ORs and to develop interventions to reduce OR case delays. Methods This quality improvement study was conducted at a safety-net hospital, where the average FCOTS was 12% before our initiative. Starting in November 2022, a multidisciplinary team was formed, including representatives from quality, obstetrics, anaesthesiology, nursing and scheduling. We developed failure modes and effects analysis, process mapping and interventions using the Institute for Healthcare Improvement Model for Improvement, testing them through rapid Plan-Do-Study-Act cycles. We used Montgomery rules with statistical process control charts to measure statistically significant changes in both outcome and process measures. Results Contributors to the delays at the patient, provider and systems levels were identified. Interventions targeting structure, process, team members and patient engagement were implemented from December 2022 through December 2023. A 41% increase in the average percentage of on-time first cases compared with the baseline (12%) was observed, based on data collected from August 2022 through November 2022 to postintervention (53%), and this improvement was sustained for 4 months. Additionally, a 69% decrease in the average case delay in minutes from baseline (178 min) was noted 6 months after project initiation (55 min). Conclusions Interventions at the patient, provider and systems levels were identified and implemented, effectively increasing OR on-time case starts on L&D. These can be used in other L&D units to improve FCOTS.