Costs of the use of an operating room are significant, with each minute of a routine operating room estimated to cost $69. Thus, the costs of unused operating room time can add up to a significant cost. Every day, the operating rooms are scheduled to start at 7:30 AM. To get the patient ready to be in the operating room at this time takes a concerted effort by the nurse in the operating room and in the preoperative area, the anesthesia team, the surgeons, and the OR staff.

Unfortunately, more often than not the patient is not in the operating room by 7:30 due to delays for one reason or another. However, the first case of the day has the best chance of being on time, because there are no hold-ups in the operating room from previous cases and everyone is aware of and plans for a scheduled start time of 7:30. Choosing a random day in the operating room at Parnassus last week, there were 21 scheduled 7:30 (first-start) cases. Of those, in only 7 (33%) of those cases were the patients taken back to the operating room within a 5 minute window of 7:30. The average time delay past 7:30 was 8.3 minutes, totalling 175 minutes of delay and costing a total of $12,075 using the $69/minute cost. This becomes a daily expense of unused OR time and also delayed time for the patient, the staff, the surgeon, and the entire team.

I propose that we use a monetary incentive to reward teams that are able to bring the patient back to the operating room within 5 minutes of the scheduled 7:30 case start for any routine scheduled cases with a 7:30 start. This will motivate all members of the team to have the patient back to the operating room on time so that the case can be started on time and valuable OR time will not be wasted. This could lead to a substantial reduction in cost on a daily routine basis. This program could be instituted at UCSF Health System and/or San Francisco General Hospital.