In early 2024, the surgical and ear, nose, and throat departments (ENT) at UCSF Benioff Children’s Hospital San Francisco saw their stars align. ENT cases were backlogged without enough surgical rooms to keep up with demand. At the same time, total operating room (OR) volume was stagnant, with blocks being underused every week.
Leaders from both departments partnered on a solution that solved both problems at once. After reviewing schedules across the OR, they designated underused time blocks from neurosurgery for simple ENT surgeries one day a month. They called these “fast-track days” and limited procedures to straightforward ear tubes, adenoidectomies, and myringotomies on only healthy patients.
Fast-track days increased total ENT throughput by 15 cases or so a month — and freed up regular OR capacity for complex procedures. After a year, ENT backlog decreased 16%. Volume for all ENT cases grew by 13% and included more complex cases in the regular time blocks.
A tight ship
Making fast-track days successful requires high levels of coordination across disciplines and departments:
- ENT clinic coordinators manage consents and select patients by surgeon preference and earliest availability.
- Anesthesia assigns two providers per room (an attending plus resident or fellow) to split pre-op assessments and OR setup.
- Nursing leaders manually adjust scheduling time blocks to match rapid turnover and send regular staffing reminders.
- Sterile processing teams prioritize instrument cleansing during room turnover and maintain dual carts (clean and dirty) to minimize delays.
- Equipment techs help turn over rooms, move and make beds, bring in equipment, balance microscopes, and transport specimens.
- Environmental services streamlines room turnover with a single shared trash bag and targeted surface cleaning.
- Pharmacy ensures fast-track carts carry requisite medications to avoid midday restocking.
To improve efficiency, fast-track rooms use two nurses instead of the typical one in other operating rooms. The additional nurse checks the next cases, recovers medications, and sometimes checks in the next patient. They also serve as relief for the team.
“Having someone already familiar with the flow just makes it so much easier than reporting off to someone else and not continuing the flow of their room,” said Rowena B. Banda MSN, RN, CNOR, assistant director of the hospital’s pediatric operating room.
During pre-op, a couple factors help speed up the procedure. When possible, peripheral IVs are avoided and meds are given intranasal or intramuscular. Instead of face masks, endotracheal tubes are used for adenoidectomies and laryngeal mask airways for ear tubes and myringotomies.
"This frees the anesthesiologist’s hands to document and gives the surgeons better access to the patient without inadvertently moving the patient during surgery,” Banda said.
Overcoming challenges with OR scheduling and turnover time
At the beginning, the OR team struggled to confirm the surgery schedule with the ENT clinic as early as they needed. That led to understaffing in pre-op and recovery and delayed surgeries. Improving communication between ENT and OR staff helped align staffing needs.
The fast-track cases were truly fast. While that was the goal, the rapid turnover led to supply issues. The Pyxis machine ran out of medicine, the PACU overfilled, and all the myringotomy and tonsil sets got used up before the day was over. They had pharmacy include additional select medicines in Pyxis and doubled their number of instrument sets. With those changes and adjusted staffing, the PACU beds turned over more quickly.
Charting often took longer than the surgeries because the Epic template was too bloated for these straightforward cases. So Epic analysts built a streamlined fast-track charting template with fewer required fields. The work paid off. The number of fast-track cases grew from seven to around 15 per day, often concluding by 4 p.m. or earlier.
Lessons learned and next steps
Early planning and clear communication were key: block allocations, staffing rosters, and supply requests must be locked in several weeks ahead to align all stakeholders. Instrument and medication readiness require ongoing attention, and even minor charting tweaks can yield outsized efficiency gains.
As the team looks forward, they plan to explore scaling similar models to other high-volume, low-complexity service lines, unlocking additional OR capacity for advanced surgical care.
This article is based on a presentation at the Children’s Hospital Association’s 2025 Transforming Quality Conference.
