Organizations must focus on efficient health care if they are to thrive in the current heath care climate (Phieffer et al., 2017). Reducing variation in FCOTS reduces waste of time, materials and effort, while increasing productivity (Coffey et al., 2018). Literature has shown primary causes of OR delays have been surgeons, patients, anesthesia, nursing and equipment (Cox Bauer, Greer, Vander Wyst, & Kamelle, 2016). Other studies showed transparency and timely sharing of FCOTS data with physicians and clinical staff had positive value and improved the perception of data integrity (Foglia, Ruiz, & Burkhalter ,2017). The purpose of this project was to evaluate the barriers that prevented consistent operating room (OR) first case on time starts (FCOTS) and inform an intervention aimed at improving the rate of FCOTS.
Methods:
We started collecting data on OR delays in October 2017. In April 2018, we implemented an intervention based on the recommendations of expert team members. The inter-professional team included the OR Circulator Registered Nurse (RN), Pre-Op RN, Pre- Admission Surgical Screen RN, the Certified Nurse Anesthetist, surgeon, anesthesiologist, OR Tech, Surgical Assist, OR scheduler, surgeon/office scheduler and the central sterile supply (C.S.S.) department. Since these teams were working in silos prior to the implementation of our intervention, collaboration, education and communication were key to the implementation of the new processes. We implemented OR morning huddles, weekly 2-week surgical case reviews, work/patient flow changes in pre op, daily review of next day schedule for potential barriers, educating office/OR scheduler of importance of accuracy of case and anesthesia type, and identifying barriers related to vendor trays, educating C.S.S. department on improving tray preparation. Each discipline was charged with an ongoing monitoring of their processes and giving feedback to the OR unit coordinator and the nurse lead for this project.
Results:
Preliminary results show improvement in FCOTS. Specifically, we had improvement in surgeon, staff and patient related delays in our analysis of data. For all cause delays, the percent of FCOTS increased by 66% (from 56% December 2017, to 93% December 2018). Daily, weekly and monthly trending of data shows a sharp improvement 4 months post implementation (January 2018 (at 72%) then a continued sustainment for February 2018 through May of 2019 averaging 86% FCOTS with a range of 77% to 94%. The data collection for this project is ongoing. Inferential statistics are expected to show statistically significant improvement in FCOTS.
Conclusion:
Sustained improvement of FCOTS required all key stakeholders to feel empowered to make decisions about their workflow through education and standardized strategies such as daily reviews of next day schedules (Scoville, Little, Rakover, Luther, & Mate, 2016). Autonomous decision making created a work environment and culture that focused on solution-oriented outcomes. Collaborative redesign of inefficient processes, contributed to improvement in workflow and an increase in FCOTS. The project is ongoing as we continue to monitor long term sustainability to FCOTS via data monitoring, education, and transparent data sharing. Future projects should investigate the effects of sustained FCOTS on productivity, staff satisfaction and patient and family satisfaction.