muhammad zulfadli syahrul, Muthia Sukma



Due to the high cost of operating room, hospitals should optimized operating room (OR) efficiency. One parameter that has been used to predict OR efficiency is First Case On-Time Start (FCOTS). Delayed of FCOTS causes disruption to patient flow, waste of resources, reduces hospital performance and patient satisfaction. Objective: To determined associated factors of delayed of FCOTS in elective surgery Methods: Article searches were carried out through the PubMed and ScienceDirect databases using keywords (delay) AND (first case on time start) AND (elective surgery OR surgical OR case) AND (Factor associated OR reason OR cause). 265 articles were found, but only 13 articles and 2 book fit the review. Result: There are multiples factors in delayed of surgery. This literature review demonstrates health care provider related factor (e.g lack of discipline of the surgeon and anesthesiologist), hospital-related causes (e.g. unavailable operation room, inappropriate scheduling policy, and lack of beds), followed by work-up related causes (e.g. medically unfit and changes in the treatment plan), and patient-related causes (e.g. financial problem and patient refusal).Conclusion: Delayed FCOTS of elective surgery are influenced by three essential factors: health care provider related factors, hospital system related factors, and patient related factors.

Keywords: delay, elective surgery, start time



Akibat tingginya biaya pengelolaan kamar operasi, rumah sakit dituntut mengoptimalkan efisiensi kamar operasi. Salah satu parameter yang digunakan untuk memprediksi efisiensi kamar operasi adalah waktu mulai operasi elektif pasien pertama. Keterlambatan ini  menyebabkan penumpukan pasien bedah elektif, pemborosan sumber daya, serta mengurangi kinerja rumah sakit dan kepuasan pasien. Tujuan: Mengetahui faktor penyebab keterlambatan dimulainya operasi pasien elektif pertama. Metode: Penelusuran artikel dilakukan melalui database PubMed dan Sciencedirect, menggunakan kata kunci  (delay) AND (first case on time start) AND (elective surgery OR surgical OR case) AND (Factor associated OR reason OR cause).  Total temuan artikel sebanyak 265, tetapi hanya 13 artikel dan 2 buku yang sesuai untuk dimasukkan dalam ulasan ini. Hasil: Ada berbagai faktor yang menyebabkan keterlambatan mulai operasi pertama pasien elektif. Literatur review ini menunjukkan adanya faktor terkait penyedia layanan kesehatan (misalnya kurangnya disiplin dokter bedah dan anestesi) merupakan alasan utama penundaan operasi, diikuti oleh faktor sistem rumah sakit (misalnya tidak tersedia ruang operasi, penjadwalan yang tidak baik, dan kurangnya tempat tidur), lalu ada faktor terkait pasien (misalnya masalah finansial dan penolakan pasien). Simpulan: Keterlambatan mulai operasi pertama pasien elektif dipengaruhi oleh 3 faktor penting yaitu faktor terkait penyedia layanan kesehatan,, faktor sistem rumah sakit, dan faktor pasien.

Kata kunci: keterlambatan, operasi elektif, waktu mulai

Full Text:



Vali-Siar MM, Gholami S, RAmezanian R. Multi-period and multi-resource operating room scheduling under uncertainty: a case study. Comput Ind Eng. 2018;1:549–68.

Guerriero. F GR. Operational Research In The Management Of The Operathing Theathre : A Survey. Heal Care Manag Sci. 2011;14:89–114.

Wong J, Khu K.J. Delays in the operating room: signs of an imperfect system. Can J Surgery. 2010;53(3):189–95.

Bauer C, Greer DM, Vander W, Kamelle SA. First-case operating room delays: patterns across urban hospitals within a single health care system. J Patient-Centered Res Rev. 2016;3(3):125–35.

Blake S, Ketelaar El, Yaish A. Assesing Root Causes of First Case On-Time Start (FCOTS) Delay in the Orthopedic Departemen at a Busy Level II Community Teaching Hospital. Spartan Med Res J. 2022;7(2).

Ciechanowicz et al. Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda. Int J Heal Policy Manag. 2017;7(11):1024–39.

Yamuragiye A. Starting time delay in operating theatre at University Teaching Hospital Of Kigali (UTHK). Kigali,Rwanda: College Of Medicine and Health Sciences School Of Health Science University of Rwanda; 2017.

Kumar M, Malhotra S, Singla V. Analysis of Start Time Delay in Operation Theatre Lists. J Appl Med Sci. 2016;4(5):1762–9.

Robert P, Foglia, Juan ER LS. An Evolutionary Change in First Case on Time Starts Using Perioperative Process Improvement, Communication and Enhanced Data Integrity. Glob J Perioper Med. 2017;2641–3124.

Pan X, Zhang J. The Effect Of Instructional Supervision By Operating Room Assistant On First Case Starts. J Perianesthesia Nurs. 2016;32(1):58–63.

Panni M, Shah S, Chavvaro C RM, Wojnarwsky K. Improving Operating Room First Start Efficiency – Value Of Both Checklist And A Pre-Operative Facilitator. Acta Anaesthesiol Scand Found. 2013;57(9):1118–23.

Adamy M. Manajemen Sumberdaya Manusia: Teori, Praktik, Penelitian. Ljokseumawe: Unimal Press; 2016.

Gabriel RA, Wu A, Huang CC. National incidences and prediction of inefficiencies in perioperative care. J Clin Anesth. 2016;31:238–46.

Lydia J, Bundotich JA, Oloo, Nguka G. Predictive Factors for Operating Room Utilization in Elective Orthopedic and Ear Nose and Throat Surgeries at Moi Teaching and Referral Hospital. Int J Life Sci. 2018;7(3):82–91.

Dimitriadis PA, Iyer S, Evgeniou E. The chalange of cancellation on the day of surgery. Int J Surg. 2013;11:1126–30.

Okeke CJ, Obi AO, Tjani KH. Cencellation of elective surgical cases in a Nigerian teaching hospital : frequency and reasons. Niger J Clin Pr. 2020;23:965–9.

Van Winkle RA, Champagne MT, Gilman-Mays M AJ. Operating Room Delays: Meaningful Use in Electronic Health Record. Comput Inf Nurs. 2016;34(6):247–53.

Omar BA. Factors affecting surgical delay. J Heal Sci. 2017;9(12).

DOI: http://dx.doi.org/10.32883/hcj.v8i1.2334


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Published by Universitas Fort De Kock, Bukittinggi, Indonesia
© Human Care Journal  e-ISSN : 2528-665X P-ISSN : 2685-5798

View Human Care Journal Stats