Increasing First Case On Time Starts in the Operating Room Using an Electronic Readiness Dashboard: A Quality Improvement Project

Abstract

IntroductionFirst case surgical delays cause domino effects resulting in subsequent case delays, staff overtime pay, and patient dissatisfaction. A total of 23,690 minutes were lost during March to June 2022. The project goal was to implement the surgical enhanced readiness dashboard (SERD) to increase efficiency, resulting in the increased first case on-time starts (FCOTS) by 5% in the March-June/fiscal year (FY) 2022 versus March-June/FY 2021. Materials/MethodsFCOTS were captured by an institutional data analysis program. Data was pulled from the electronic health record from when the nurse recorded time the in the operating room (OR) time. A pre-and post-implementation survey was distributed to OR nurses and analyzed. Data was collected for one quarter and compared to the previous year's quarter. A statistical T-test was used to compare the pre-and post-implementation data and the pre-and post-implementation surveys. Theory/CalculationThe Donabedian Model evaluated the safety and quality of the SERD's structure, process, and outcome. Data collected from the project provided quality metrics that led to transformative change. ResultsOf the 35 anonymous surveys submitted, 54.3% of participants value using the SERD as a surgical readiness tool to improve their workflow. FCOTS during the implementation period of FY 2022 March-June averaged 72.3%, an overall increase of 0.6 % of the same time frame in FY 2021 (71.7%). DiscussionThe SERD's central location in the preoperative area and incorporation into the nursing workflow standardize the preoperative process and bridge communication gaps between nurses, anesthesia, residents, and surgeons. Efficient transitions through the preoperative area decrease healthcare organizations' overall costs. ConclusionDelays in patient surgery are costly to healthcare organizations. Patients scheduled for first surgical cases arrive early and expect to be prepared for surgery efficiently. Implementing an electronic dashboard to increase the number of FCOTS will be instrumental in streamlining patients throughout the perioperative stay. The data collected will help drive perioperative nurses to decrease costly delays in patient care.