Reasons for delays in start of first elective case of the day at Charlotte Maxeke Academic Hospital: a prospective study.

Abstract

Background First case start time measures operating theatre and patient readiness, and it may contribute to perioperative delays. Improving the first case start time is associated with higher theatre productivity. The aim of this study was to determine the first elective case start time and identify reasons for delays at Charlotte Maxeke Johannesburg Academic Hospital, a multidisciplinary tertiary theatre complex. Method A prospective observational study was conducted on all first elective cases of the day from June to August 2023. Times and reasons for delays in patient flow were documented, starting from theatre arrival until the beginning of the procedure. The times were analysed in relation to the departmental protocol for first case start times. p < 0.05 was considered statistically significant. All the statistical analyses were performed via Stata 15 (StataCorp, USA). Results A delay prevalence of 97.5% was reported, with only 10 cases having started on time. The mean delay time was 47.5 minutes (IQR 33–85), and the standard deviation was 53.2. The most frequent reasons for delays were surgeon-related factors accounting for 23.7%, followed by logistics-related factors accounting for 17.7%. Most of these causative factors are preventable. Conclusion A majority of the first cases at CMJAH 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.