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First Case ON-TIME Starts: The Perfect Performance

Posted by Patricia May on Oct 10, 2017 8:39:59 AM
Patricia May

First Case One Time Starts FCOTS

First Case On-Time Starts (FCOTS) can be an extremely daunting, daily challenge. It seems amazing that any patient goes into the operating room on time, given all the moving parts involved in just one surgery. Add in additional patients and multiple ORs, and you risk a chaotic situation unless you are able to orchestrate a carefully choreographed performance of all the moving parts. 

 The Opening Number…

It all starts with the surgeon’s office making the decision to schedule a case. Operating room schedulers are faced daily with obtaining the correct case booking information for each and every case they schedule. Ideally, all phone numbers are correctly documented, procedures are aligned with accurate CPT codes, vendor information is correct and instrumentation, equipment and supplies are all in order and at the ready.

 Unfortunately, that’s often not the case and the show begins to unravel with the smallest of details. The patient’s phone number is incorrect, making contacting the patient nearly impossible which begins the back and forth of phone tag with the surgeon’s office and hopefully the patient. If the procedure and codes aren’t correctly aligned, the wrong supplies, instruments and equipment may be pulled leading to delays once the patient is waiting in the wings. Was the required special instrumentation requested, does the vendor need to be present?

 All of these things need to be considered when a case is first scheduled.

 The Interlude…

 Pre-op testing and correct documentation of both patient information and patient instructions is vital at this stage of the production. Making sure the correct tests are ordered and carried out and the patient receives the correct pre-op instructions help ensure both patient safety, and an on-time start.

 This comes down to the pre-op department doing their job as efficiently as possible. They must make sure the testing is sufficient, necessary and performed in the acceptable timeframe. They also need to determine if the patient should come to the hospital for a pre-op visit or if they can simply have an assessment phone call while ensuring the correct consent forms, medical history, labs and clearance reports are obtained prior to the day of surgery.

 Without these items marked off the checklist, the on-time start everyone was hoping for will be a distant memory.

 The Grand Finale…

 It’s show time. The principle players are in place and ready to make their move. Seasoned professionals carefully maneuver their way through the start of the day ensuring the patient arrives at the correct time while having successfully avoided delays by pre-registering the patient prior to the day of surgery.

 The patient arrives in the pre-op department on time with all necessary documents from pre-anesthesia testing ready and waiting. No mad dash to search for and retrieve the correct consents and results is needed thanks to proper scheduling and pre-op processes being performed with efficiency and timeliness.

 The pre-op nurse’s job of performing the patient’s nursing assessment is easier due to proper documentation being completed and readily available. Thankfully, PAT was able to connect with the patient prior to the day of surgery to complete the nursing history and collect the correct medical history without having to make repeated calls to the surgeon’s office to gather correct contact information.

 Anesthesia previously coordinated with the surgeon for pre-op orders and protocols and both are able to see the patient in a timely manner prior to the surgery, allowing enough time for a potential last minute change in orders helping the patient move through pre-op without a delay. This results in making a much smoother process for the patient on the day of surgery and alleviating the anxiety they’re certainly feeling.

 Meanwhile, the OR nurse and surgical tech are preparing the first case of the day. They’re busy ensuring the correct preference cards were picked. The correct supplies, instruments and equipment are in the OR ready for use. The counts are completed and the room is ready for the patient to arrive in the OR.   

 Finally, the OR nurse and CRNA arrive in pre-op, allowing enough time to interview the patient, ensuring all safety measures are met, required labs and paperwork are completed with results listed in the chart, consents are signed, H&P update is completed and the site marking is done. 

 The hand-off from pre-op nurse to OR staff is completed and the patient is transported to the OR for a successful wheels in on-time start. 


Phew, that’s a lot of moving parts! Managing each function not only the day of surgery, but prior to day of surgery adds up to the patient arriving in the OR at the scheduled time.    

However, as you’ve seen, by addressing process and efficiency issues, setting timeline expectations for all members of the perioperative team and holding everyone accountable. A great way to keep all perioperative staff surgeons and anesthesia informed is to post daily on time results within an hour of the first case time. Posting the on time daily percentages in multiple locations allows all members of perioperative team know it is being tracked. Hardwiring this can be one of the most difficult initiative an OR director can take on. But with buy in from surgeons, anesthesia and OR staff, it is possible to achieve that elusive perfect performance, resulting in consistent first case on-time starts. And yes, surgeon, anesthesia and staff’s day is all a little brighter and a little less stressful when the patient starts in the OR on time.

 To learn more about improved processes in the OR, be sure to check out our resource page at http://bit.ly/2onR22W

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Tags: FCOTS, First Case On Time Starts

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