Date of Award

Summer 2023

Project Type


College or School




Program or Major


Degree Name

Master of Science

First Advisor

Elizabeth Evans

Second Advisor

Pamela Kallmerten


Background: Surgical services are an important source of revenue and important economic driver of hospital systems. Surgical services account for approximately 42% of a hospital’s annual revenue, however, it also constitutes 40% of facility operating costs (Gupta, et al., 2022 & Morel & Gomez, 2021). Despite the high costs associated with surgical services delays remain a significant issue across the nation. On-time starts for the first surgical cases of the day is a key performance metric tracked by surgical facilities to determine efficiency. Currently, 50 – 90% of first surgical cases are delayed throughout the United States and the most common cause of delay include surgeon and patient tardiness, workflow inefficiencies, equipment malfunctions, and medication administration issues (Gupta, et al., 2022).

Local Problem: Throughout the 2022 calendar year, only 36.75% of first surgical cases of the day made it into the operating room at their scheduled time. This is well below the facility goal of 75% of first cases and below the corporation average of 56%. The most commonly identified delays included surgeon tardiness, patient toileting needs, and delays in medication orders or administration.

Methods: Using the define, measure, analyze, improve, control (DMAIC) model, a multipronged quality improvement initiative was developed to address and improve the frequency and length of delays in start times for the first surgical cases of the day.

Intervention: This quality improvement initiative aimed to address pre-operative delays and improve first surgical case on time start performance through means of a multifaceted approach. Signs were hung in patient areas to improve patient navigation to the surgical waiting room and simplify the patient check-in process. In addition, an infographic outlining the costliness of delays were hung in the staff breakroom.

Results: Prior to the intervention implementation 68.57% of all first surgical cases started late and the average length of delay was 16.88 minutes. Following the interventions 75% of all first surgical cases started late with an average delay of 19 minutes. Prior to the interventions 51% of patients arrived after their scheduled arrival time by an average of 6.79 minutes. In addition, 20% of patients voiced difficulties either finding the waiting room or using the phone to call the nursing desk to alert staff to their arrival. Following intervention implementation only 41.67% of patients arrived late and the length of delay when patients did arrive late was reduced to six minutes. In addition, no patients expressed difficulty finding the waiting room or using the phone to call the nursing desk on arrival.

Conclusion: Surgical delays were more frequent, and the average length of delays was longer following intervention implementation, however, since surgical delays are unique to each facility it does not mean these interventions would not be effective in a different setting. It is important that a thorough root cause analysis is conducted prior to addressing surgical delays in order to identify the interventions that are more likely to be effective.

Included in

Surgery Commons