Date of Doctor of Nursing Practice Project Completion
2026
Faculty Advisor
Dr. LaDawna Goering
Abstract
Purpose
Delays in first case on-time starts (FCOTS) impact operating room (OR) efficiency, causing compounding schedule delays. This quality improvement (QI) project implemented a visual readiness tool to standardize communication and increase FCOTS rates.
Background
The project was implemented in a 5-room OR in an academic teaching hospital in the Texas Medical Center.
Methodology
Plan-Do-Study-Act (PDSA) cycles and the Consolidated Framework for Implementation Research (CFIR) guided continuous improvement and contextual factors evaluation. Following multidisciplinary education, the visual tool was implemented. De-identified FCOTS data was extracted from the electronic health record (EHR). Qualitative feedback was gathered via Qualtrics (n=17 pre-implementation) and Microsoft Forms (n=2 post-implementation). Data was analyzed using run and bar charts, pausing for winter break to maintain data integrity (Dec 2025 – Jan 2026).
Results
Tool use compliance peaked at 74%. The frequency of meeting the 80% FCOTS goal improved from 75% at baseline to 77%, and achieving an 85% or higher FCOTS rate improved from 56% to nearly 62%. Although the post-survey response rate was low, the multidisciplinary team provided strong anecdotal support for the tool’s utility indicating high potential for long-term sustainability and spread.
Implications
Visual communication tools are effective for reducing OR delays and improving interdisciplinary communication. Despite limitations including a small survey sample size and external variability, the findings suggest meaningful workflow standardization. Sustainability efforts should focus on continuous auditing, standardizing workflows, implementing a Unit Champion, and expanding these practices.
Keywords
First Case On-Time Starts, FCOTS, PDSA, CFIR, Quality Improvement, Visual Readiness Tool, Operating Room
Recommended Citation
Xochitl I. Miranda-Khayat, "Improving First Case-On-Time Starts in the Operating Room by Implementing A Visual Patient Readiness Assessment Tool: A Pilot Quality Improvement Project" (2026). Doctor of Nursing Practice Final Project Abstract. 222.
https://digitalcommons.library.tmc.edu/dnp_abstract/222