Archive September 2016 XVII, No. 9

Staffing: Start Every First Case of the Day On Time

A punctual start to the morning sets the tone for the rest of the day.

Kimberly Valentine, MSN, RN


Richard Fleeger, MSN, RN, CSSM


first cases start on time RIGHT ON TIME Every facet of your facility benefits when the day's first cases start on time.

Nothing gets your day off on the wrong foot like failing to start the first case on time. Even a delay of 15 minutes can throw your schedule off track, frustrating patients as well as the entire OR team. If you're struggling to start the surgical day on schedule, follow these 3 steps to improve your rate of on-time first-case starts.

Define "on-time start"
There are many different ways to measure an on-time start: wheels-in time, induction time or cut time. Your staff and surgeons must work off a standardized definition of on-time starts so you can identify the issues that are causing delays and zero in on solutions. We define an on-time start as wheeling the patients into the OR on or before the scheduled start time. If surgery is scheduled to begin at 7:15 a.m., that's when the patient needs to be in the room. If a patient is wheeled in just 1 minute later, we consider the case delayed. However you measure an on-time start is fine, as long as everybody's watches are set for the same time.

Document the reasons for late starts
Create delay codes to help categorize the reason for start-time delays. Was the surgeon late arriving at the facility? Was the anesthesia provider held up with another patient? Did the patient fail to show up at the required time? Was the IV difficult to start? Were instruments not ready? You want to gather accurate data and reduce the amount of entries coded as "other," so consult with your frontline staff to determine which codes would capture the issues they face in getting cases started on time. Create a spreadsheet, dashboard or some other communication tool so staff can quickly note the reason for a delayed start. Track the delay codes over a couple months to identify patterns of problem areas. Update your team on the results of the code tracking during staff meetings, through e-mail reminders or when you walk the floor.

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