Operation Theatre cancellations highly associated with poor OT time management: 8 month cross-sectional study at a tertiary center in Ethiopia

Background Improving Operating Theater (OT) efficiency enhances productivity, reduces patient waiting time, and boosts satisfaction. First case start time determines operating table utilization, making the first patient the "golden patient." Delays in first case incision time can lead to case cancellations. This study aimed to identify factors affecting first elective case incision time (FCIT) and operating room (OR) cancellations at Jimma University Medical Center (JUMC). Objective To assess the prevalence and causes of OR cancellation and delayed first case start in elective major surgical procedures at JUMC between September 2022 and April 2023. Methods A prospective cross-sectional study was conducted on elective surgeries in four OTs at JUMC. Data on patient entry (wheels-in), anesthesia initiation, incision time, anesthesia completion, and patient exit (wheels-out) were recorded. Factors like hospital stay, consent status, and pre-anesthetic evaluations were also documented. Data were collected by trained nurses and analyzed using SPSS version 23 and Excel. Results & Discussion Of 1,292 scheduled elective surgeries (M:F = 1:1.2, mean age 29 ± 22 years), 519 (40.2%) were planned first cases, out of which 479 (91.6%) were delayed. Key delay reasons were OR material preparation (53%), staff issues (15.3%), and patient condition (5.6%). The surgical cancellation rate was 20%, with time insufficiency (41%) and patient-related conditions (28%) as main causes. Consent was unsigned in 12% of cases. The average wheels-in time was 8:18 AM, with anesthesia induction at 8:38 AM. OR utilization was 1.8 cases/day, below the recommended 3 cases/day. Conclusion Most delays and cancellations were modifiable. A quality improvement (QI) project focused on timeliness with planned sustainability could enhance OR efficiency.