Improving Surgical Start Times by Improving Wayfinding

Purpose: This performance improvement project was undertaken to reduce costly delays in first-case, operating room (OR) start times.

Design: Two Plan, Do, Study, Act (PDSA) cycles.

Methods: In PDSA 1, student nurses observed 30 patients' paths of travel from hospital entrance to OR and documented time spent at key stopping points. Directional signs were placed after PDSA 1. PDSA 2 consisted of an electronic medical record (EMR) review of pre- and postsignage cases (n = 492 and n = 538 respectively).

Findings: In the initial PDSA cycle (n = 30), one reason for delay was the time patients spent finding the preoperative area (POA). Signage was placed at strategic points noted to confuse patients. PDSA cycle 2 found median presignage POA arrival times (34 minutes) were significantly higher than postsignage POA arrival times (20 minutes) (U = 51,618.0, z = -16.934, P < .001).

Conclusions: Delayed wayfinding contributed to delayed OR starts but improved with appropriate signage.