A Quality Improvement Initiative to Improve First-Case On-Time Starts for Elective Surgeries

Background: Surgical delays can lead to patient dissatisfaction and negatively affect hospital revenue. Maximizing operating room (OR) efficiencies is a high priority. A common metric for OR efficiency is first-case on-time start (FCOTS). Objective: The aims were to increase FCOTS rates to at least 50% and reduce delay time lost in minutes in the OR by 50%. Methods: A multidisciplinary/multifaceted approach was implemented and consisted of restructuring the preoperative assessment process, modifying the preoperative checklist, conducting a perioperative educational program, revising the anesthesia nurse practitioner (NP) work schedule, and notifying surgeons about losing first-case privileges if they arrived late. A total of 300 (150 retrospective and 150 prospective) charts were reviewed. After 3 months, pre- and postintervention data were analyzed. Results: The FCOTS rate increased from 15.3% to 30.7%, and the OR time lost in minutes decreased from 2,309 to 1,029. Conclusions: Delays in care negatively affect patient satisfaction and the hospital budget. A multidisciplinary/multifaceted approach is effective in reducing FCOTS rates. Implications for Nursing: Evidence-based strategies such as those used in this initiative may be implemented by NPs in institutions providing surgical services to optimize efficiency, decrease costs, and improve patient satisfaction.