The Trickle-Down Effect of First-Case Tardiness on Last-Case Cancellation Rates and Operating Room Overutilization Involving Scheduled Surgical Patients in a University Hospital

Objective: To observe the frequency and causes of first-case tardiness and its consequences.Material and Methods: Six months of data from scheduled surgical patients from 18 operating rooms (OR), under 13 surgical subspecialties, between September 2014 and February 2015, in a tertiary-care university hospital, were collected. We aimed to identify: (1) the rate and tardy time of first-case tardiness, (2) the time of overutilization caused by first-case tardiness, and (3) the cancellation rate due to first-case tardiness.Results: From a total of 3,965 elective surgical cases, 1,343 qualified as first cases and were included for analysis. Six hundred forty-four cases (48%) started more than 10 minutes later than the scheduled time. The mean (S.D.) tardy time was 25.1 (16.9) minutes. The total tardy time due to first-case tardiness was 16,146 minutes (33.6 8-hour OR days). The late physical presence of surgeons was responsible for most tardy first cases (80.6%). Of a designated OR, in which the first case was delayed, the 419 final cases in the schedule of ORs continued beyond working hours and 65 cases were cancelled. Moreover, of the 52,028 minutes (108.4 8-hour OR days) of OR overutilization, 9,465 minutes (19.7 8-hour OR days) were due to first-case tardiness.Conclusion: First-case tardiness creates substantial futile time and a trickle-down effect on the subsequent cases of a designated OR-either case cancelation or operating room overutilization.