NR 632 Week 5 Outcome Comparison Example

Outcome Comparison: Six Baseline Months Against Four Pilot Weeks for First-Case Starts in Rooms 3 to 6, Whole Numbers First and Each Difference Given a Direction

Student Name

College of Nursing, Chamberlain University

NR 632: Nurse Executive Concluding Graduate Experience II

Instructor Name

Month Day, Year

Outcome Comparison: Six Baseline Months Against Four Pilot Weeks for First-Case Starts in Rooms 3 to 6, Whole Numbers First and Each Difference Given a Direction

The Two Periods, Described First

Baseline: 26 weeks, January to June 2026. Weekdays only. It included a two-week influenza surge in January, a pre-admission testing vacancy in March and April and the spring school holiday week, when elective volume was lower. No other change to first-case processes was running.

Pilot: four weeks, the week beginning 16 November and the three weeks running up to 18 December 2026, with Thanksgiving week left out. It included the first week after an operating room system upgrade, a continuing pre-admission testing vacancy, the early weeks of influenza season and the run-up to the holidays, when surgeons tend to fill their lists. No other first-case change was running, but the monthly quality packet now displays first-case figures more prominently, which staff noticed.

Whole Numbers First

Only after the counts: the on-time share was 58% at baseline and 70% in the pilot. Readiness-coded late starts were 15 per 100 first cases at baseline and 5 per 100 in the pilot. Other late starts were 27 per 100 and 24 per 100. The aim was 75%; the pilot reached 70%.

By Day of Surgery

The process summary predicted that any effect would show mainly on Tuesday to Friday, since Monday cases were rarely checked.

The prediction holds. Three of the four readiness-coded late starts in the pilot were Monday cases.

Week by Week

The weekly figures rise from 67% to 74%. Because each week holds under 20 first cases, one patient more or less shifts the weekly share by over five points, so the rise across four points is suggestive and no more.

Comparison Rooms

The other eight rooms, which had no readiness calls, went from 622 of 984 (63%) at baseline to 104 of 162 (64%) in the pilot weeks. Whatever moved rooms 3 to 6 did not move the suite as a whole.

When Two Sources Disagree

Two records hold an in-room time: the circulating nurse's entry in the operating room system and the anesthesia record. They differed by more than two minutes in 9 of the 74 pilot cases. In two of those, the anesthesia time made the case late. Using the anesthesia record, the pilot figure would be 50 of 74, 68%. The project uses the circulator's time, because the baseline and the hospital's quality packet both use it. The anesthesia group's figures, if they are ever released, will be lower.

The quality packet's November figure for rooms 3 to 6 was 61%. It counts the whole calendar month, including two weeks before the pilot and Thanksgiving week, and it is not comparable with the pilot figure.

Which Way Each Difference Pushes

The upgrade week likely made week one look worse, since retrospective entries delayed recorded times; this pushes the pilot figure down.

Pre-holiday lists filled by surgeons may bring more motivated, earlier-arriving surgeons; this pushes the pilot figure up.

Influenza season in the pilot and the January surge at baseline roughly balance.

Attention to the figure in the quality packet and from the project pushes up, and cannot be separated from the calls.

The pre-admission testing vacancy was present in parts of both periods.

Four weeks of about 18 cases each produce wide random swings; a single week can move ten points by chance.

The Balancing Measures

Same-day cancellations fell from 9 in 468 first cases to 1 in 74, roughly two per hundred to one per hundred; both counts are too small to read much into. Three first cases were moved to another day during the afternoon call because an updated history could not be obtained in time. There is no baseline for that figure, since nobody recorded day-before reschedules before the pilot. Each of the three would otherwise probably have been a late start or a same-day cancellation, which is the trade the readiness call is meant to make: a short notice change the day before in place of a delay or a cancellation on the morning. The patients involved were rescheduled within a week, and the student confirmed from the schedule that none was moved more than once. The balancing measure does not suggest harm, but the reader should know these three cases exist.

What Can Be Said

The on-time share in the four rooms rose by twelve points, the rise was concentrated in the days when the calls actually ran, readiness-coded late starts fell by two thirds and the comparison rooms did not change. That pattern is consistent with the calls working.

What Cannot Be Said

That the calls caused the change. Four weeks is short, the attention effect cannot be removed and the run chart rules for a sustained shift need more points than four (Perla et al., 2011). Published first-case gains have faded over time, as at one academic center that peaked at 92% and later settled at 78% (Phieffer et al., 2017).

A Close That Says Neither

The pilot was designed to show whether the call could run and whether the figure moved where it ran. On both counts the answer is a qualified yes, and that is as far as this comparison goes. The evaluation report will set out what the director might do with a qualified yes, including the option of stopping.

The pilot neither proves nor disproves the readiness call. It shows a change in the expected place, of a plausible size, over too short a time to rule out chance and attention. Successful first-case work elsewhere narrowed the spread of start times rather than moving everything earlier (Tiwari et al., 2018); in the pilot, the median delay among late cases fell from 14 to 12 minutes, too small a change on 22 cases to read either way.

References

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895

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