242 - First Case on Time Starts: Does Documentation Improves Effectiveness?
Description: FIRST CASE ON TIME STARTS: DOES DOCUMENTATION IMPROVE EFFECTIVENESS? Simone Nicholson MSN, RN, CNOR Eunice Heck, BSN, RN, CNOR Clinical Issue A delay in first case on time starts can lead to decreased utilization in the operating room, displeased patients and cost inefficiencies. Description of Team The multidisciplinary team consisted of all surgical staff including the clinical director of perioperative services, nurse manager, charge nurse, surgeons, anesthesia personnel and staff nurses in the operating room. Preparation and Planning Perioperative services are one of the major entities of finances in a medical institution. Conversations and suggestions surrounding optimization in the surgical services area consistently occurs. The suggestion of tracking first case on time starts (FCOTS) was presented to improve surgical time, efficiency and patient satisfaction. Assessment The common goal for Perioperative Services is to increase efficiency. Starting surgery on time decreases delays in the day and creates opportunities for more cases to be completed. While working with the OR committee the top 12 reasons for case delays was discussed and approved for documenting delays. The goal for the documentation of FCOTS is to have all scheduled first cases enter the operating room prior to the documented surgical start time. Having 100% compliance of first cases on time starts daily was the ultimate goal set by perioperative services administration. Implementation An electronic record was initiated and created utilizing an excel program to document the room being utilized, the surgeon, on time status of yes or no, and 1 of 12 primary delay codes with an area to transcribe comments. A staff meeting was held to present the new process, which ensured that the circulating nurses completed appropriate documentation of delays. The full surgical team in the OR discusses the reason for any delay and this reason is then communicated to the charge nurse. The charge nurse is responsible for daily documentation of FCOTS in the excel record. The charge nurse is also responsible for sending an email of the daily results to the department chairs and Surgical Services administration. This email and results are tracked Monday through Friday excluding holidays. Outcomes Since starting documentation of FCOTS our institution has increased efficiency of first cases being on time. Surgeons have become more aware and accountable for being on time and staff has increased their accountability to be on time as well. Implications for Perioperative Efficiency within the operating room has become a priority for our institution. Patient satisfaction and cost containment are vital to our area and improving workflow by being on time has positively affected our institution.