Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours Courtney J. Warner, MD, MS, Daniel B. Walsh,

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Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours Courtney J. Warner, MD, MS, Daniel B. Walsh, MD, Alexander J. Horvath, BA, Teri R. Walsh, RN, Daniel P. Herrick, BA, Steven J. Prentiss, MEng, Richard J. Powell, MD Journal of Vascular Surgery Volume 58, Issue 5, Pages 1417-1422 (November 2013) DOI: 10.1016/j.jvs.2013.05.007 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Vascular surgery rounding process map. CRCs, Clinical resource coordinators. Journal of Vascular Surgery 2013 58, 1417-1422DOI: (10.1016/j.jvs.2013.05.007) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Change in percent on-time first case starts pre- and postintervention. This is a statistical process control chart. P value refers to difference in the percent on-time starts pre- and postintervention. The dashed lines represent upper and lower control limits; the red lines represent average lines. RPIW, Rapid Process Improvement Workshop (intervention with process changes). Journal of Vascular Surgery 2013 58, 1417-1422DOI: (10.1016/j.jvs.2013.05.007) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Impact of process improvement on resident arrival to the preoperative holding unit. The black line represents the goal time for resident arrival in the preoperative holding unit. RPIW, Rapid Process Improvement Workshop (intervention with process changes). Journal of Vascular Surgery 2013 58, 1417-1422DOI: (10.1016/j.jvs.2013.05.007) Copyright © 2013 Society for Vascular Surgery Terms and Conditions