Does the Implementation of a Preoperative Time-Based Target for Perioperative Nurses Decrease First Case On Time Start (FCOTS) Delays Attributed to Nursing Staff: A Quality Improvement Project

Author(s) Information

Sherri CrumleyFollow

Nature and scope of the project

Delays in the operating room can lead to increased hospital costs as well as patient and provider dissatisfaction. Beginning the first case on time in the operating room is a functional measure that many hospitals utilize to measure efficiency. Loyola University Medical Center’s Ambulatory Surgery Center (ASC) has struggled to improve ASC’s FCOTS from the current monthly average of 59% (N=1,121) towards the organizational goal of 80%. Delays attributed to nursing staff were identified in 25% of cases.

Synthesis and analysis of supporting literature

Common delay drivers impacting FCOTS that consistently emerge in the literature are pre-operative preparation of the patient and operating room readiness. Evidence supports the use of conducting time-motion studies to identify areas of opportunity and time waste in the process of preparing patients for surgery as there appears to be a higher variability in this process due to a lack of standardized protocols.

Project implementation

Using Kotter’s Eight-Step Plan for Implementing Change, preoperative and intra-operative nursing teams will have a target of completing their work five minutes before the patient is expected in the operating room with the aid of standard work documents. Time and case delay data will be captured through the electronic health record (EHR). Data will be collected over 12 weeks.

Evaluation criteria

To evaluate the project, data from a FCOTS dashboard will used to trend FCOTS compliance over a three-month implementation period. FCOTS dashboard data will be collected automatically through the existing interface from the organization’s current EHR. The project will be deemed successful if nursing nursing-associated delay codes decrease from their current rate of 25%.

Outcomes

Completion of this project will have implications for perioperative nursing practice by potentially offering a unique and cost-effective mechanism to improve FCOTS. If successful, this project will be one of a few nursing-led initiatives in the space of surgical quality improvement projects aimed at improving FCOTS.

Recommendations

This project has the exciting potential to demonstrate how modifications to nursing-specific workflows impact other disciplines. In an era where nursing is seeking to justify and validate the impact nursing makes in healthcare, this project may also offer a unique perspective on team and team dynamics in the perioperative space.