A Plan-Do-Study-Act Cycle to Enhance Operational Efficiency in a Newly Established Paediatric Cardiac Operating Room

Objectives: This quality improvement project aimed to enhance operating room efficiency in a newly established paediatric cardiac operating room by focusing on key performance indicators (KPI), including (1) first case on-time start (FCOTS), (2) turnover time (TOT), and (3) case cancellation rate through targeted interventions. Methods: This initiative was conducted at the Division of Cardiothoracic Sciences, Sindh Institute of Urology and Transplantation (SIUT), from July 2023 to June 2024, using a stepwise Plan-Do-Study-Act (PDSA) methodology for each KPI, including baseline data, interventions, and outcome analysis. Root Cause Analysis with Fishbone and 5 Whys identified gaps, guiding targeted improvements. Weekly performance was tracked on a spreadsheet, and messaging updates were provided, while control charts and feedback sessions ensured progress. Leadership maintained accountability. Pre- and post-intervention results were compared using control charts for FCOTS, case cancellation rate, and for TOT. Results: Following implementation of targeted QI interventions, FCOTS compliance improved from 50% to 91%, mean TOT decreased from 34 to 27 minutes, and case cancellation rate dropped from 30% to 7%. Conclusions: Significant improvements in operating room efficiency can be achieved through practical, scalable quality improvement methods using available resources. Our findings support the implementation of KPI-driven QI models in similar resource-limited paediatric surgical settings.