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Original Investigation | Pacific Coast Surgical Association

Effect of a Novel Financial Incentive Program on Operating Room Efficiency

Thomas M. Scalea, MD1; Darlene Carco, RN1; Melissa Reece, RN1; Yvette L. Fouche, MD1; Andrew N. Pollak, MD1; Sushruta S. Nagarkatti, MD1
[+] Author Affiliations
1R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore
JAMA Surg. 2014;149(9):920-924. doi:10.1001/jamasurg.2014.1233.
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Importance  Operating room (OR) turnaround times (TATs) and on-time first-case starts (FCSs) are commonly used measures of OR efficiency. Prolonged TATs and late FCSs occur frequently at academic medical centers.

Objective  To test the hypothesis that establishing a financial incentive program (FIP) for OR teams would improve efficiency, leading to decreased TATs and improved on-time FCSs.

Design, Setting, and Participants  Prospective study to evaluate the effect of an FIP on OR efficiency between March 1, 2013, and December 31, 2013, at a freestanding academic trauma hospital. Participants were all OR team members and included anesthesiologists, certified registered nurse anesthetists, nurses, and technicians.

Interventions  Operating room efficiency awareness education was conducted before FIP implementation beginning in February 2013. Each eligible OR team member achieving a TAT of 60 minutes or less or an on-time FCS was awarded 1 point. Reports listing individual performances were posted. Pay bonuses were awarded for achieving 1 of 3 progressive point totals in any month.

Main Outcomes and Measures  Outcomes were TAT, which was defined as “wheels out” to “wheels in,” and on-time FCS, which was defined as “wheels in” within 6 minutes of the scheduled start time.

Results  Before FIP implementation, the mean TAT varied between 77 and 83 minutes, with only 18% to 26% of TATs being 60 minutes or less; on-time FCSs averaged 29% to 34%. After FIP implementation, on-time FCSs improved from 31% to 64% (P < .001), and TATs of 60 minutes or less increased from 24% to 52% (P < .001). The cost of a 2-month FIP was $8340. We saved 13 minutes per TAT, for an estimated savings of $177 000. We estimate an additional savings of $33 000 for on-time FCSs, for a total hospital savings of $210 000.

Conclusions and Relevance  A novel FIP improved OR efficiency. Given the small amount of money involved, it seems unlikely that financial incentives were solely responsible. Effectively communicating the importance of TATs and on-time FCSs and publishing individual results more likely increased staff awareness. Teamwork created by linking assignment of points to a team result likely contributed to success.

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Figure 1.
Operating Room (OR) Turnaround Time Form

The form is used to record and determine bonus incentive pay for each OR team member. CRNA indicates certified registered nurse anesthetist; RN, registered nurse; STC, shock trauma center.

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Figure 2.
Percentages of Shock Trauma Turnaround Times and On-Time First-Case Starts

Shown are data by month before and after implementation of the financial incentive program in February 2013.

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Figure 3.
Variation in the Cost of the Financial Incentive Program

The effect of the financial incentive program was evaluated between March and December 2013.

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