Successful interventions to reduce first-case tardiness in Dutch university medical centers: Results of a nationwide operating room benchmark study

Elizabeth van Veen-Berkx*, Sylvia G. Elkhuizen, Cor J. Kalkman, Wolfgang F. Buhre, Geert Kazemier

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: First-case tardiness is still a common source of frustration. In this study, a nationwide operating room (OR) Benchmark database was used to assess the effectiveness of interventions implemented to reduce tardiness and calculate its economic impact. METHODS: Data from 8 University Medical Centers over 7 years were included: 190,295 elective inpatient first cases. Data were analyzed with SPSS statistics and multidisciplinary focus-group study meetings. Analysis of variance with contrast analysis measured the influence of interventions. RESULTS: Seven thousand ninety-four hours were lost annually to first-case tardiness, which has a considerable economic impact. Four University Medical Centers implemented interventions and effectuated a significant reduction in tardiness, eg providing feedbacks directly when ORs started too late, new agreements between OR and intensive care unit departments concerning "intensive care unit bed release'' policy, and a shift in responsibilities regarding transport of patients to the OR. CONCLUSIONS: Nationwide benchmarking can be applied to identify and measure the effectiveness of interventions to reduce first-case tardiness in a university hospital OR environment. The implemented interventions in 4 centers were successful in significantly reducing first-case tardiness.
Original languageEnglish
Pages (from-to)949-959
JournalAmerican Journal of Surgery
Issue number6
Publication statusPublished - Jun 2014


  • Operating room
  • First-case tardiness
  • Utilization
  • Economic impact
  • Performance indicators
  • Benchmarking

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