Date of Graduation

Fall 12-17-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


Kaiser cohort MSN capstone

First Advisor

Cynthia Huff, DNP, MSN, RN, OCN, CRNI, CNL


Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction.

Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%.

Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide for neurosurgical procedures was created for placement required equipment and bed. Testing was from September 2-23, 2021, and the visual guide was presented to staff on October 12, 2021.

Measures: On-time to the OR is 7:45 a.m. or earlier. The delay minutes and reasons were tracked. The worksheet was a yes/no form confirming if the room had the case cart, equipment, and bed made each morning.

Results: August 2021 delay minutes totaled 279, September total was 259, with an improvement of 7.2%. October total was 189 minutes, with an improvement of 32.3%. Overall, surgeon-related delays led the cause for not achieving first case on-time starts; OR-related delays decreased.

Conclusion: Identifying the causes of late on-time starts is key to changing practice and to improving metrics. Deeper dives can help streamline and standardize care for the patients. Staff and leadership buy-in is needed for success.