Date of Award

Summer 2026

Abstract

 

BACKGROUND: First Case On-Time Starts (FCOTS) are a key indicator of perioperative efficiency and influence operating room (OR) utilization, staff productivity, patient satisfaction, and healthcare costs. Baseline data from an ambulatory perioperative unit demonstrated persistent variability in FCOTS performance and inconsistent interdisciplinary communication regarding surgical delays.

Local Problem: Inconsistent communication and documentation of first-case delays limited interdisciplinary awareness of workflow barriers and contributed to ongoing variability in FCOTS performance.

Intervention: A standardized, HIPAA-compliant daily communication process was implemented, consisting of an end-of-day email summarizing FCOTS delays and the documented reasons for delays. Educational materials and standardized documentation tools were introduced to improve communication, increase transparency, and promote awareness of recurring workflow barriers.

Methods: A quality improvement project guided by the Plan-Do-Study-Act framework evaluated operational outcomes using existing OR performance data. Quantitative measures included FCOTS rates, delay severity, total OR delay time, and documentation completeness. Qualitative staff feedback was collected to evaluate perceptions of communication effectiveness and implementation.

Results: FCOTS improved from 36% during the initial implementation period to 64% during the second implementation period. Documentation completeness improved, with no delays categorized as "No Reason Listed." Staff reported increased awareness of recurring workflow barriers; however, some participants perceived the communication process as punitive, highlighting opportunities to strengthen collaborative, systems-based communication strategies.

Conclusion: The intervention demonstrated that a standardized daily communication process is feasible, low-cost, and sustainable within the perioperative setting. Although the project did not achieve the target FCOTS rate of greater than 80%, improvements in communication, documentation, and operational awareness established a foundation for future quality improvement initiatives aimed at improving perioperative efficiency.

Keywords: First Case On-Time Start (FCOTS), quality improvement, Plan-Do-Study-Act (PDSA), operating room efficiency, perioperative process improvement, surgical workflow efficiency, interdisciplinary communication.

Document Type

Master's Thesis

First Advisor

Dr. Pamela Kallmerten

Second Advisor

Dr. April Phelps

College or School

CHHS

Department or Program

Direct Entry Masters Nursing Program

Degree Name

Other

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