Improving Operating Room Start Times

Abstract The Pre-Surgical Testing program at Cohen Children's Medical Center launched in 2012. We evaluate approximately 7,000 patients per year who are scheduled for outpatient and inpatient surgeries from all pediatric surgical services. The Pre-Surgical Testing program providers are pediatric and family nurse practitioners (NPs). In 2017, the NP role expanded into the inpatient setting. We started to evaluate patients scheduled for emergency procedures, sedated radiology studies, and invasive procedures. We identified high-risk patients, which provided anesthesiologists with the critical information they needed to deliver safe patient care. In 2018, the NPs further expanded into the ambulatory setting. Our role includes preoperative orders, managing postoperative pain, entering discharge medications, and providing continuing education to nursing staff. From February 2018 to August 2018, first-case start times have improved by 20%. The combination of clinical knowledge and experience makes NPs uniquely qualified to identify high-risk patients scheduled for surgery. Other institutions may consider NPs in their postoperative areas to improve OR start times and, more generally, patient safety.