Optimization of a Push Notification System to Improve First-case Delays: A Quality Improvement Project

To increase first-case on-time start (FCOTS) rates at a large New England hospital by optimizing the use of a preoperative (pre-op) push notification system to reduce delays and improve operating room efficiency.

The project employed a quality improvement approach guided by the Model for Improvement from the Institute for Healthcare Improvement.

A push notification system integrated into the electronic health record was used to enhance communication between surgeons and pre-op nurses across three surgical pavilions. Mandatory education sessions were provided for all enrolled staff, and Plan-Do-Study-Act cycles were conducted to refine processes and monitor outcomes. Data on notification usage and FCOTS rates were tracked from pre implementation (August 2023) through the implementation phase (December 2023).

Training resulted in 87% (n = 60) of nurses completing the push notification education, and 31% (n = 28) of surgeons confirmed reviewing training materials. Initial implementation increased push notification use among nurses from 26% to a peak of 51% in October 2023, though this later declined to 39% by year-end with net gain of 17%. Among surgeons, push notification usage peaked at 18%, with a net gain of 2% over the baseline. The East pavilion maintained relatively high FCOTS rates, decreasing slightly from 82% in October to 78% by year-end. In the North and South pavilions, increased push notification usage by nurses aligned with gradual FCOTS improvements: the North pavilion rose from 63% to 65%, while the South pavilion experienced fluctuations, ultimately achieving a 12% increase from baseline to reach 57% in December.

These findings suggest that while increased push notification use among nurses helped improve FCOTS in some pavilions, limited surgeon participation may have hindered the overall impact on reducing delays. Future strategies should focus on increasing engagement from all staff, improving workflow integration, and implementing ongoing performance tracking to optimize surgical efficiency across all pavilions. Enhancing FCOTS not only improves the patient experience by reducing wait times and increasing satisfaction, but also benefits staff by streamlining workflows and reducing stress. Ultimately, these improvements support organizational goals for greater efficiency and cost-effectiveness in perioperative care.