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.

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.

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%.

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.