Date of Graduation

Summer 7-30-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Dr. Sara Horton-Deutsch,Ph.D., RN, PMHCNS, FAAN, ANEF, SGAHN, Caritas Coach and Leader

Second Advisor

Dr. Liesel Buchner

Third Advisor

Dr. David Ainsworth

Abstract

Problem: A timely first-case start in the operating room (OR) is critical for optimizing departmental efficiency and resource utilization. Persistent delays in first-case start times disrupt the surgical schedule, leading to suboptimal OR use, diminished patient and staff satisfaction, reduced operational efficiency, and decreased overall productivity. Addressing these delays is essential to enhance the quality and efficiency of surgical services.

Context: The microsystem for this project is a Northern California operating room that handles a high volume of surgical procedures. There are 10 operating rooms, and the goal is to have 70% of first cases in the operating room on time i.e. 7/10 operating rooms start at 0745am.

Interventions: Three Plan, Do, Study, Act (PDSA) cycles were introduced, focusing on preventing room setup delays, supplies or equipment issue delays, and pharmacy delays. These tests of change data were gathered from January 2024 – June 2024. Daily updates on reasons for delays are presented to the staff.

Measures: An on-time start is defined as patients arriving in the operating room on or before 7:45 am, with any arrivals after this time considered delays. Reasons for these delays, as well as their lengths, are tracked through Health Connect. The outcome measure is to increase the rate of on-time starts from 55% to 70%. Process measures include the 100% of times there is no delay in operating room setup, 100% of the time implants, equipment, and instruments are available for the surgeries, and the availability of specialty medications before the 7:45 am start time 100% of the time. These measures are tracked through chart reviews in Health Connect.

Results: Data were collected from January 2024 to June 2024. In January, the first case on-time start (FCOTS) was at 55%. After implementing interventions, we observed rapid improvement in February, with a rate of 69%. In March, there was a slight decline to around 68%. April saw an increase to 75%, but the rate dipped to 64% in May, and by June, we reached 71%.

Conclusions: In conclusion, we increased on-time starts from 55% to 71% over five months. Although there was a decrease in on-time starts in May, it was recovered the following month, and the progress is significant.

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