Reasons for delays in start of first elective case of the day at Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Background Delays in the first case start time increases scheduled theatre time wastage, overruns, and unplanned cancellations. This further causes unnecessary costs for the healthcare centres involved. Improving first-case start time is associated with higher theatre productivity. This study prospectively observed the reasons and causes of delays in starting of first elective cases in different operating theatres at a tertiary hospital in Johannesburg South Africa. Method A prospective study was conducted in a multi-disciplinary elective theatre suite over three months (3rd June to 8th August 2023). All adult and paediatric cases that started before or at the scheduled first case start time (in-room time, anaesthesia time, and procedure time) were deemed to be on-time cases. Cases that started after the scheduled first case start time were deemed delayed. A five-minute grace period was applied when analysing the data. Delay times were calculated using frequencies and mean with 95% confidence intervals at different stages per specialty. Similarly, reasons for delays were categorised and calculated accordingly. All the statistical analyses were performed using Stata 15 (StataCorp, USA). Results First-case start times were recorded in the study period. A delay prevalence of 97.5% was reported and only 2.5% started on time. The mean delay time was 47.5 minutes and a standard deviation of 53.2. The most frequent reasons for delays were surgeon-related factors accounting for 23.7%, followed by logistics-related factors at 17.7%. Most of these causative factors are preventable. Conclusion Over 95% of first cases are delayed and the reasons for delays are multifactorial but preventable. Multiple strategies can be employed to mitigate the causes of delays, thus improving theatre utilisation and saving costs.