Understanding First Case On Time Starts
First case on-time starts (FCOTS) are an important OR efficiency metric. First case delays can have a ripple effect on OR operations for the remainder of the day, delaying subsequent cases, frustrating patients, decreasing efficiency, and increasing costs. Once you’ve set up your account with Apella, you can track FCOTS automatically on the Apella Dashboard.
Using FCOTS in your business
FCOTS is an industry standard metric that helps hospitals understand how well they are able to set the day up for success by starting their first cases on schedule. On its own, FCOTS gives an overview of how often rooms start on-time.
Combining FCOTS with the delay duration can provide a clear picture of total time lost, and the extent of inefficiencies happening in your OR. These delays can be caused by a number of factors including those inside the operating room’s sphere of control (i.e. room readiness) as well as pre-op and patient readiness.
Definitions
Scheduled start time: The planned time when a case is intended to begin, as determined by the EHR.
Actual case start time: The actual time a patient is wheeled into the operating room, as determined by Apella’s advanced computer vision “wheels in” algorithm.
Delay: A condition in which the actual start time is later than the scheduled start time. Apella logs all delays longer than 59 seconds.
First case: The first case scheduled in the room on that day. Cases must be scheduled between 7AM and 9AM. There must be no indication from the EHR that the case is Urgent/Emergent, classified as an Add-on case, or canceled.
Flip rooms: If a surgeon is running multiple rooms,the first, scheduled case will be considered the first case. If multiple cases are scheduled at the same time, then the case with the first “wheels in” event will be considered first. Hospitals with high numbers of excluded cases may experience more volatile shifts in metrics due to a low number of qualifying cases.
Calculating FCOTS and related metrics
FCOTS is determined by dividing the number of on-time first cases from the total number of first cases and is expressed as a percentage (%)
Average delay is determined by dividing the total delay (in minutes) by the total number of delayed cases. When used in conjunction with FCOTS, only delays related to first cases are considered.
Customization
At the time of writing, February 2023, Apella does not offer customization tools to update parameters that determine FCOTS (such as grace periods and variable delays). We understand some hospitals use different parameters for First Cases and Late Starts, and plan to release custom parameters in a future update.
References
- Cox-Bauer, C. M., Greer, D. M., Vander-Wyst, K. B., & Kamelle, S. A. (2016). First-case operating room delays: Patterns across urban hospitals within a single health care system. Journal of Patient-Centered Research and Reviews, 3(3):125-35
- Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times?
- A Quality Improvement Project to Improve First Case On-time Starts in the Pediatric Operating Room