Date of Award

Summer 2026

Abstract

Abstract

Background: Delays in first case on-time starts (FCOTS) contribute to decreased operating room (OR) efficiency, increased healthcare costs, workflow disruptions, and reduced staff and patient satisfaction. Evidence suggests that standardized workflows, improved communication, and Lean Six Sigma methodologies can improve perioperative efficiency and reduce delays.

Local Problem: Baseline data from a local OR microsystem demonstrated an FCOTS rate of 77%, below the organizational benchmark of 80%. Root cause analysis identified inconsistent preoperative workflows, communication gaps, and variable staff adherence to standardized processes as primary contributors to delayed first-case starts.

Methods: A quality improvement project utilizing the Define, Measure, Analyze, Improve, and Control (DMAIC) framework was implemented over a four-week period. Baseline and post-intervention data were collected using electronic health record timestamps, delay tracking forms, operating room reports, and a staff perception survey. Outcome measures included FCOTS performance, turnover times, and staff perceptions of workflow efficiency and communication. Process measures included staff education completion, compliance with the standardized workflow, and delay documentation.

Interventions: Interventions included implementation of a standardized preoperative workflow timeline, multidisciplinary communication strategies, staff education sessions, visual workflow reminders, routine compliance audits, and leadership feedback through performance dashboards. These evidence-based strategies were designed to improve team communication, accountability, and adherence to perioperative best practices.

Results: The FCOTS rate increased from 77% to 86.3% (44 of 51 first cases), exceeding the project aim. Standardized workflow compliance reached 88.24%, and 41 perioperative staff completed the educational intervention. Of 107 turnover events, 74 (69.2%) were completed in less than 30 minutes, improving operational efficiency. Seven documented delays were primarily due to factors outside the intervention’s scope, such as incomplete consents, surgeon arrival delays, add-on procedures, preoperative nursing delays, and IT issues. Ten of the intraoperative nurses completed the staff perception survey which showed positive perceptions of workflow standardization and communication.

Conclusions: Implementing a standardized, DMAIC-guided workflow improved first case on-time starts and strengthened perioperative process adherence in the operating room. Despite external system delays, the intervention showed that standardized workflows, staff engagement, and multidisciplinary collaboration can significantly improve operating room efficiency. Sustaining these improvements through auditing, leadership support, and staff education can further enhance perioperative performance and provide an adaptable model for improving surgical workflow in similar healthcare settings.

Document Type

Master's Thesis

First Advisor

Pamela Kallmerten

Second Advisor

Nicole Bauer

College or School

CHHS

Department or Program

School of Nursing

Degree Name

Master of Science

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