Running head: ON TIME STARTS 1

On Time Starts

Rebecca Nappi

Bon Secours Memorial College of Nursing

Synthesis of Nursing Practice

NUR 4242

Wendi Livermen

October 18, 2018

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On Time Starts

Every minute in an operating room is expensive. The overhead to maintain an operating

room is high. The salaries of many individuals that are needed to come together to allow a

surgery to take place adds up. The supplies for even the simplest procedures contribute to the

overall cost of surgery. The exact dollar amount of a minute in the operating room is difficult to

determine but a study that collected data from 2005 to 2014 averaged the per minute cost of a

surgical suite to be estimated at $36 (Kaitlynn, 2018). In an effort to be good stewards for our

patients and improve our utilization to allow increased volume for the benefit of patients needing

surgeries and for financial incentive for the department this project focused on getting patients in

the operating room at the scheduled time each and every morning and starting their surgery on

time.

Each morning the surgical department begins each day around 6:30am and the first

patients of the day are the 7:30 starts. This means that the patient needs to be transported from

the pre-op department into the surgical suite by 7:00am to have a start time of 7:30. The start of a

surgery is defined as cut time. This means the surgeon is gowned and time out prior to procedure

has occurred and surgeon can begin. At the start of the process improvement on time starts were

averaging around a 50% success rate. The surgeons were complaining constantly that they could

never get started on time. This forced them to be late for the rest of the day and even cut them

short from being able to perform additional surgeries. Patient satisfaction with timeliness of their

experience was lacking.

After observing closely to the morning routine of the staff it was obvious that a major

barrier was the team not prepared in the morning. There was always a reason or an excuse as to
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why the nurse was not able to retrieve her patient from pre-op until after 7am. We first

communicated with the staff that we were not performing well in this area and requested

feedback from the staff. It was very surprising that their first recommendation was to move the

surgeries from 7:30am start to 8:00am start. This would cut 30 minutes of productivity right off

the top for the department and surgeons. This was never going to happen. We did not want to

change the arrival time to the hospital by staff because we feared this would be too drastic and

would cause people to be angry. We instead only asked that the staff report to their room no later

than 7:00am. All staff are required to be clocked in by 6:45am. This allowed them 15 minutes to

change into scrubs and get to their rooms. Ideally, they were in their room much earlier but this

process change, of communicating a detailed expectation had an excellent effect. It was always

just an unsaid expectation that you come to work and get to your room and prepare for your day

but taking the time in a staff meeting and clearly communicating this and giving reasoning and

examples seemed to be what the staff needed. Team members still need reminding and even a

little push at times but overall the staff has responded appropriately.

Our next cycle is to work on surgeon compliance. We need the surgeons arriving on time

and assessing their patient in pre-op and giving pre-op orders prior to the day of surgery so the

pre-op department can correctly get patients ready. This is going to be a big challenge, but it is

the next biggest barrier to getting patients in the operating room on time. We need to keep

pushing for high percentage of on time starts because we understand now what the wasted

charges are of an empty operating room and although difficult to get on a spread sheet it is

significant (Macario, 2010).

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References

Kaitlynn, E. (2018). What Are the Implications of the Costs of Operating Room Time? The

American Journal of Managed Care. Retrieved from

https://www.ajmc.com/newsroom/what-are-the-implications-of-the-costs-of-operating-

room-time

Macario, A. (2010). What does one minute of operating room time cost? Journal of Clinical

Anesthesia , 233-236. Retrieved from

http://ether.stanford.edu/asc/documents/management2.pdf