NR 631 Week 2 Problem Statement Example

Problem Statement: First Cases in Four Operating Rooms Enter Late Because Readiness Is Checked After the Surgeons' Offices Have Closed

Student Name

College of Nursing, Chamberlain University

NR 631: Nurse Executive Concluding Graduate Experience I

Instructor Name

Month Day, Year

Problem Statement: First Cases in Four Operating Rooms Enter Late Because Readiness Is Checked After the Surgeons' Offices Have Closed

The Problem in One Paragraph

In the first six months of 2026, 58% of weekday elective first cases in operating rooms 3 to 6 entered the room within five minutes of their 07:30 start. The hospital's surgical services scheduling policy sets that five-minute window as the definition of on time, and the OR Executive Committee has set a target of 85%. In 36% of the late starts in these rooms, the cause recorded was preoperative readiness: a history and physical not updated in the record, a consent not signed, a laboratory or type-and-screen result not back or arrival instructions not followed. The readiness of first-case patients is checked between 06:00 and 07:10 on the day of surgery, when most of these problems can no longer be fixed in time.

The System as It Works Now

A first-case patient is scheduled by the surgeon's office, which is responsible for sending an updated history and physical and arranging the consent discussion. The pre-admission testing department sees some patients in clinic the week before and phones the rest; in the first half of 2026, 38% of first-case patients in these rooms had a phone call only. On the afternoon before surgery, nobody is assigned to look at the first cases as a group. The 15:30 schedule huddle reviews room assignments and equipment, not patient readiness.

On the morning of surgery, patients arrive at 06:00. The preoperative nurse admits the patient, starts the IV and works through the readiness checklist. When an item is missing, the nurse phones the surgeon's office, which opens at 08:00, or pages the surgeon, who is often driving in. The OR circulator records one primary delay code when the patient enters the room late.

Nothing in that sequence depends on any nurse working slowly. The readiness check happens at the only time the current process gives it, and that time is too late.

The Local Numbers

These numbers come from reports the department already produces. Outside figures appear only to show that the trouble is common and has responded to change elsewhere.

The Standard the Numbers Fall Short Of

The surgical services scheduling policy, last revised in March 2025, states that the first patient of the day is to be in the room at the scheduled time, with a five-minute allowance. The OR Executive Committee's target of 85% is recorded in its minutes. Measured against both, the four rooms fall short by 27 percentage points.

Other hospitals have reported similar starting points: an academic center with 49% before a multi-year effort (Phieffer et al., 2017) and a public safety-net hospital where the weekly elective rate was 23.5% before redesign in the preoperative holding area (Coffey et al., 2018). Those figures show that the gap is not unusual. They do not show anything about this hospital, which is why they are kept out of the argument.

Why Readiness, and Why Four Rooms

Readiness is the largest single code in these rooms, and it is the part of the morning that nursing controls. Surgeon arrival and anesthesia delays, together about a third of late starts, are left to the physician leaders who govern them.

Four rooms, two orthopedic and two general surgery, account for a third of first cases and have similar readiness problems. A smaller scope makes the work possible with ten pre-admission testing hours a week and lets the other eight rooms serve as a comparison.

What This Problem Is Not

It is not a statement that preoperative nurses, surgeons' offices or pre-admission testing staff are failing at their jobs. Each group works to the timing the current process gives them. It is also not a claim that fixing readiness will fix the day; later cases depend on many other factors.

The Cost of Leaving It

In the four rooms, the 197 late starts in six months had a median delay of 14 minutes. Patients wait in gowns, surgeons and anesthesia staff wait in the lounge and the minutes are carried into the afternoon. Research on start times suggests that better control of the morning process, rather than earlier staff arrival, is what reduces lateness (Tiwari et al., 2018), which matters to a department that cannot ask nurses to start earlier.

Who Is Affected, and How

Patients feel the problem first. A first-case patient who arrives at 06:00 for a 07:30 start and then waits until 07:50 has been fasting since midnight and has spent nearly two hours in a gown with an IV in place. Preoperative nurses spend the first hour on the phone instead of on the next admission. Circulating nurses and surgical technicians stand in a ready room. Surgeons who arrived on time lose part of their morning, which wears down their trust in the department. The director answers for the figure every month in the quality packet.

None of those effects needs a new measure to be seen; each is already visible on the unit, and each recurs on most weekdays rather than once in a while.

What Would Count as Solved

For this project, the problem is smaller when fewer first cases in rooms 3 to 6 are late for readiness reasons and the on-time share in those rooms rises toward the committee's target. The aim and measure brief will set the figure and date, using the same definition as the quality packet so that the result can sit beside the baseline.

Sentence for the Director

In rooms 3 to 6, more than a third of late first cases are late for readiness problems that are found at 06:30 and could have been fixed at 15:00 the day before.

Limits of These Data

The delay code is chosen by the circulator and only one is allowed, so a case with two problems carries one. Eighteen late starts had no code. The data are six months old by the time of the project and cover only weekdays.

References

Coffey, C., Jr., Cho, E. S., Wei, E., Luu, A., Ho, M., Amaya, R., Pecson, M., Dalton, F. V., Kahaku, D., Spellberg, B., & Sener, S. F. (2018). Lean methods to improve operating room elective first case on-time starts in a large, urban, safety net medical center. The American Journal of Surgery, 216(2), 194-201. https://doi.org/10.1016/j.amjsurg.2018.05.002

Phieffer, L., Hefner, J. L., Rahmanian, A., Swartz, J., Ellison, C. E., Harter, R., Lumbley, J., & Moffatt-Bruce, S. D. (2017). Improving operating room efficiency: First case on-time start project. Journal for Healthcare Quality, 39(5), e70-e78. https://doi.org/10.1097/JHQ.0000000000000018

Tiwari, V., Ehrenfeld, J. M., & Sandberg, W. S. (2018). Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times? British Journal of Anaesthesia, 121(5), 1148-1155. https://doi.org/10.1016/j.bja.2018.05.043