Many healthcare organizations have adopted Lean processes to save money, improve workflow, and reduce waste. But it’s not just process change that drives success. It’s the individuals—especially those on the front lines—who work together to identify problems and solutions. It’s also ongoing efforts to sustain changes once they have been…

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Editor's Note In this study, implementation of Lean interventions to redesign the workflow in the preoperative holding area of a large urban medical center was linked to significantly improved rates of elective first case on-time starts. Data from 23,891 surgical procedures performed over 415 days were examined−86 days before, 35…

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Anyone who has been involved in an OR design and construction project knows it is a labor-intensive, time-consuming effort—and usually far from seamless. There’s almost always something no one thinks of until it is too late, and the staff must learn to live with the flaws. But a multidisciplinary team…

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To improve healthcare delivery and eliminate duplication, hospitals are banding together into systems in which specialties such as labor and delivery and smaller surgical cases are performed at satellite hospitals, and larger, more complex procedures are done at the main campus. This is the approach taken at the Cleveland Clinic,…

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Among the many variables that influence on-time starts of surgical cases are the arrival times of patients and staff, as well as the verifications and documentation required before patients are brought to the OR. Increasing on-time starts was a key initiative at Fox Chase Cancer Center. By exploring the influences…

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Effective use of a daily huddle and customized software for scheduling have had a dramatic impact on efficiency at NYU Langone Orthopedic Hospital in New York City. Cancellations on the day of surgery have dropped from a rate of about 10% prior to implementation of huddles to less than 1%,…

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When launching a new ambulatory surgery center (ASC), owners must consider a myriad of issues—financing, design, building construction or purchase, regulatory compliance, certification, staffing, and marketing. Underlying all of these considerations are which procedures the center will provide and whether the ASC will be single specialty, like gastrointestinal (GI) or…

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Editor's Note Implementation of an enhanced recovery pathway (ERP) for colorectal surgical patients substantially reduced length of stay, total hospital costs, and direct pharmacy costs without increasing complications or readmission rates in this study. The study, which included 160 colorectal patients before ERP was implemented and 146 patients after implementation,…

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Editor's Note Postoperative mortality rises as the day of the week of elective surgery approaches the weekend and is higher after admission for urgent/emergent surgery on the weekend, this meta-analysis from the University of Calgary finds. The analysis included 10 studies that involved about 6.7 million patients having elective procedures…

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Throughput inefficiencies are a growing problem in surgical services departments. Patients are held in the OR because there is no room in the postanesthesia care unit (PACU), and patients are held in the PACU because there are no beds available in the patient care unit or because outpatients having major…

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