NR 631 Week 3 Needs Assessment Example

Needs Assessment: What the Existing Operating Room Reports Show About First-Case Readiness, Who Released Each One and the Report That Was Refused

Student Name

College of Nursing, Chamberlain University

NR 631: Nurse Executive Concluding Graduate Experience I

Instructor Name

Month Day, Year

Needs Assessment: What the Existing Operating Room Reports Show About First-Case Readiness, Who Released Each One and the Report That Was Refused

How This Assessment Was Built

I asked for what already exists before collecting anything new. Every figure below names the report it came from, the months covered, the definition the report itself uses and the role that released it. A survey of staff opinion was not used, because asking whether late starts are a problem would return yes and size nothing.

Existing Reports

What the Reports Show

The quality packet gives the suite-wide figure: 893 of 1,452 weekday elective first cases on time, 61.5%. For rooms 3 to 6 the first-case detail report gives 271 of 468, 58%.

The delay code report shows that in rooms 3 to 6, preoperative readiness was the primary code for 71 of 197 late starts. Within readiness, the codes split as follows: history and physical not updated, 26; consent not signed or missing, 19; laboratory or type-and-screen result pending, 14; patient did not follow arrival or fasting instructions, 12. Surgeon late was coded 41 times, anesthesia 27, patient late arrival 22, equipment 12, room not ready 6 and no code 18.

The pre-admission testing log shows 178 of 468 first-case patients in the four rooms had phone-only contact. Of the 71 readiness delays, 39 were in phone-only patients, a higher share than their share of first cases.

The staffing summary shows preoperative holding is staffed from 05:30 with four nurses for 16 bays and that worked hours matched scheduled hours in all but three weeks. That matters because it points away from staffing shortfalls as the cause.

Using Each Report's Own Definition

The quality packet and the detail report use the same definition, so the figures can be compared. The anesthesia group reportedly uses a stricter one, measured to anesthesia start rather than in-room time; mixing the two would make the four rooms look worse than the hospital's own standard says they are. Published work shows how much the definition matters: one hospital chose incision time with no grace period and reached 73.6% under that stricter standard (Allen et al., 2019). This assessment keeps the hospital's definition throughout.

A Refused Report Is a Finding

The anesthesia group's practice manager declined to release its report on when pre-op anesthesia evaluations are completed, citing the group's contract. That refusal is recorded rather than worked around. It means the project cannot see whether anesthesia evaluation timing interacts with nursing readiness, and it tells the director that any change touching the anesthesia evaluation would need the group's agreement, not only the hospital's.

A Small, Dated Observation

From 14 to 17 September 2026, I recorded, for each of the 20 first cases in rooms 3 to 6, which readiness items were still open at 06:30 and when each was closed. Seven patients had at least one open item at 06:30: three updated histories and physicals, two consents, one pending type-and-screen and one patient who had taken a full breakfast. Four of those seven went into the room late. In five of the seven, the missing item was something a phone call to the surgeon's office or the patient the afternoon before could probably have resolved.

Twenty cases over four days cannot be generalized. They are reported because they are recent, dated and observed directly, and because they match the pattern in the six-month reports. A nurse-led study using an observer and an audit form found a similar mix of controllable and uncontrollable causes of first-case delay (Blair et al., 2024).

What Leaders Already Say

The OR Executive Committee minutes for August 2026 record the 61% figure and a request to the director for proposals. Among the nursing goals drafted for the fiscal year that opens on 1 October, first-case starts appear by name. Neither document assigns the work to anyone yet. Hospitals that sustained gains made the measure visible and gave it an owner (Phieffer et al., 2017), which is what these documents have not yet done.

What the Evidence Could Not See

The delay code allows one cause per case, chosen by the circulator under time pressure. It cannot show cases with two problems, and it may favor whatever cause is most visible in the room. Eighteen late starts had no code.

The reports do not record when a missing item was first noticed, so the hour at which each problem could have been found is inferred from the observation, not measured.

Surgeon arrival times are not recorded separately from in-room times.

Without the anesthesia report, the overlap between nursing readiness and anesthesia evaluation is unknown.

What Was Not Collected, and Why

No staff survey, for the reason given at the start. No patient interviews, because the project's question is about process timing, not experience, and interviews would need review the timetable cannot fit. No data from the other eight rooms beyond the suite total, since the scope is four rooms and the other eight serve as a later comparison. No surgeon-level breakdown, because the committee chair's office asked that individuals not be ranked, and because the readiness codes do not depend on which surgeon operates.

What the Assessment Supports

A readiness gap concentrated in phone-only patients, centered on items that are resolvable while surgeons' offices are open, in rooms with stable staffing. It supports a project that moves the readiness check to the afternoon before. It does not support any claim about surgeons, anesthesia staff or preoperative nurses as individuals.

References

Allen, R. W., Taaffe, K. M., Neilley, V., & Busby, E. (2019). First case on-time starts measured by incision on-time and no grace period: A case study of operating room management. Journal of Healthcare Management, 64(2), 111-121. https://doi.org/10.1097/JHM-D-17-00203

Blair, K., Mijatovic, O., Thompson, M., Monroe, M., & Davies, C. C. (2024). A nurse-driven plan to diminish first-case operating room delays. The Journal of Nursing Administration, 54(9), 503-506. https://doi.org/10.1097/NNA.0000000000001467

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