{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T21:04:13Z","timestamp":1772658253337,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T00:00:00Z","timestamp":1651017600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Failure to complete surgery within the scheduled timeframe impairs operating room efficiency leading to patient dissatisfaction and unplanned labor costs. We sought to improve timely completion (within 30\u2009min of scheduled time) of first\u2010case spine fusion surgery (for idiopathic scoliosis) from a baseline of 25%\u201380% over 12\u2009months. We also targeted timely completion of perioperative stages within predetermined target completion times.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The project was conducted in three overlapping phases over 16\u2009months. A simplified process map outlining five sequential perioperative stages, preintervention baselines (<jats:italic>N<\/jats:italic>\u00a0=\u00a024) and time targets were defined. A multidisciplinary team conducted a series of tests of change addressing the aims. The key drivers included effective scheduling, team communications, family engagement, data collection veracity, standardized pathways, and situational awareness. Data collected by an independent data collector and from electronic medical records were analyzed using control charts and statistical process control methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Post\u2010intervention, timely case completion increased from 25% to 68% (<jats:italic>N<\/jats:italic>\u00a0=\u00a049) (95% CI 15.1\u201362.7), (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.003) and was sustained (<jats:italic>N<\/jats:italic>\u00a0=\u00a014). Implementation of prediction model for case\u2010scheduling decreased difference between scheduled and actual case end\u2010time (33 vs. 53\u2009min [baseline]) and variance [lower\/upper control limits ([\u221226, 51] vs. [\u2212109, 216]\u00a0min [baseline]). Average start time delay decreased from 6 to 2\u00a0min and on\u2010time surgical starts improved from 50% to 70% (95% CI 3.2\u201341.6%). Timely completion increased for anesthesia induction (60% to 85%), surgical procedure (26% to 48%) and emergence from anesthesia (44% to 80%) but not for intraoperative patient preparation (30% to 25%) perioperative stages. Families reported satisfaction with preoperative processes (<jats:italic>N<\/jats:italic>\u00a0=\u00a014), and no untoward intraoperative safety events occurred.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Application of QI methodology reduced time variation of several tasks and improved timely completion of spine surgery. Beyond the study period, sustained team behavior, adaptive changes, and vigilant monitoring are imperative for continued success.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14466","type":"journal-article","created":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T10:26:02Z","timestamp":1650536762000},"page":"926-936","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Timely completion of spinal fusion: A multidisciplinary quality improvement initiative to improve operating room efficiency"],"prefix":"10.1111","volume":"32","author":[{"given":"Trung","family":"Du","sequence":"first","affiliation":[{"name":"Department of Anesthesia Cincinnati Children's Hospital Medical Center  Cincinnati Ohio 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