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BACKGROUND: Operating rooms are expensive to run, and hospitals strive to be efficient. The purpose of this study was to evaluate an initiative to improve starting on time in the operating room in an academic pediatric hospital. METHODS: We used an 8-step approach to transforming an organization. A multidisciplinary team defined on-time starts, identified reasons for delays and instituted changes, including improving the same-day admission process, instituting a huddle of operating room staff each morning and providing feedback about on-time starts to staff. RESULTS: The most common reasons for delay were surgeon and anesthesiologist unavailability and lack of preparedness of patients. The percentage of operations that began on time, defined as the patient being in the room, increased from about 6% to 60% over a 9-month period. CONCLUSION: A targeted, multifaceted and multidisciplinary approach can increase the percentage of operations that begin on time in a pediatric hospital.


Journal article


Canadian journal of surgery. Journal canadien de chirurgie

Publication Date





167 - 170


Child Health Evaluative Sciences, Research Institute, the Hospital for Sick Children, and the Departments of Surgery, Public Health Sciences and Health Policy, Management and Evaluations, University of Toronto, Toronto, Ont., Canada.


Humans, Time Factors, Operating Rooms, Appointments and Schedules, Efficiency, Organizational, Organizational Culture, Organizational Innovation