21 - Kickstart the Day with NO OR delays!!

Description: New York Presbyterian Hospital, Queens, is a level I trauma center with a robust perioperative service department supporting 21 Operating rooms. The surgical team includes a diverse and highly skilled workforce composed of Registered Nurses, Surgical Technologists, Anesthesia Providers, and support staff. As a Level I Facility, the hospital operates 24/7, providing comprehensive surgical services across a wide range of services and specialties. Including trauma, orthopedics, neurosurgery, cardiovascular, general surgery and the use of robotics equipment, such as the Mako and Davinci robot.
NYPQ Perioperative Department was challenged with meeting the goal of getting greater than 90% of first cases into the OR on time. Inability to meet this goal resulted in delays with subsequent cases which, in turn, negatively affected the OR room utilization and the patient experience.
Upon investigation with stakeholders, shared accountability through standardized preoperative workflows, proactive communication, and data-driven feedback loops can help align team objectives and improve efficiency. Moreover, from the patient perspective, timely surgery starts times contribute to reduced anxiety, shorter fasting periods, and an overall sense of trust and professionalism in care delivery.
Efforts to improve FCOTS aim to explore structured interventions that promote a collaborative approach, improve operational performance, and enhance the patient's experience.
A baseline assessment was conducted at the beginning of the year, showing an average on-time start rate of mid-40%. Contributing factors were categorized into Perioperative readiness, provider punctuality and scheduling inefficiencies and lack of communication.

Key Initiatives included:
-Review of tasks and responsibilities that need completion from a multi-disciplinary approach (surgeons, anesthesiologist and nursing) to ensure accountability from each respective discipline
-Creation of clock template to establish predetermined times for completion of the following: pre-op assessment, anesthesia interview & clearance, surgeon consent & site marking, intra-op nurse interview and final check.
-Re-education of staff on the function of SONAR as an interdisciplinary communication tool.
-Creation of room set up checklist to ensure the rooms are accurately prepared the night prior for the first case of the day.
-Hand-off process implemented from the Overnight RN to Leadership at 6:30am to establish any missing trays or anticipated delays to start the day.
-Daily email sent to all chiefs of department to ensure accountability and buy in as to the delays for the day getting in to OR on time.
-Implementation of bathroom rounds 30-45 minutes prior to OR start time.
-Implement firm OR staff daily quick huddles at 7:00am

After implementation, the first case on-time starts improved from mid 40% to high 80%, eventually reaching the goal of 90%. Operating room utilization improved, and patient satisfaction scores improved over time. Staff engagement improved with improved communication across surgical disciplines.
This initiative highlights the critical role of Nurses leading System-wide improvements through coordination, accountability and communication. The success of this project demonstrates that targeted interventions led by nursing can significantly enhance operational efficiency and patient care quality in the surgical setting.