How to Make Every Minute Count in Surgical Care

In the United States, approximately 40 to 50 million people have major surgery yearly. In perioperative health care, the timeliness of care is of paramount importance. Timely care improves patient outcomes, including decreasing mortality, reducing complications, and shortening hospital stays.² Novice nurses can help enhance patient care by prioritizing punctuality in commencing the first case, efficiently managing turnaround times, and implementing evidence-based protocols. This article will explore ways to make every minute count in patient care.

Improving First Case Start Times

Starting the first case of the day on time improves the chance of successfully completing the remainder of the cases on the list. As such, new nurses should help ensure that surgeries begin promptly as scheduled.

Tips for Improving First Case Start Times

• Turn up on time, ready to work and expect the same of those around you. High-performing organizations aim for 90% of first cases starting on time. Don’t be the reason for a late start—it will cost your patients.
• Lead by example, such as arriving with enough time to change into surgical attire and to have a team huddle and knowing your team’s cases for the day.
• Turn up and speak up. Communicating and escalating concerns about late starts encourages a culture of patient-positive advocacy.

Managing Turnaround Time

Expecting clinicians to work past the planned finish time is stressful and costly. Finishing early (and canceling afternoon cases) has a critical impact on patients. Shortening the time between cases saves valuable minutes and reduces the need for overtime or an empty OR. Novice nurses should help with efficiently preparing the OR for the next procedure.

Tips for Managing Turnaround Time

• Estimate and communicate finishing times (when there are 15 minutes to go) to help manage upstream and downstream activity. Simple-to-use digital solutions can help communicate patient flow with multiple teams.
• Ask lots of questions, including when the case is expected to finish and what you can do to prepare for the next patient.
• Communicate case progress to perioperative management to help manage activity.
• With the team, evaluate the remaining case list at a mid-list huddle. Ask what steps you can take to help ensure an ideal finish (where the patients and the staff go home at the right time).

Optimizing Surgical Scheduling

Optimizing the scheduling of surgeries can maximize efficiency. Each year, perioperative services should review and plan for the year ahead. It should be noted that regularly evaluating and predicting emergency surgery needs helps smooth variation; thus, predictive analysis based on historical data should also include emergency activity.

Nurses, especially novice nurses, play a key role by observing and reporting patterns in patient flow, contributing valuable frontline insights. By understanding these patterns, novice nurses can better anticipate resource needs, prepare proactively for periods of high demand, and support scheduling and staffing decisions that enhance patient safety and team efficiency. Sharing observations with senior staff or perioperative planners ensures that clinical experience informs strategic planning.

Tips for Optimizing Surgical Scheduling

• Inject your thoughts on what works well and what could be improved. Although much of the perioperative service planning occurs in the preceding year, don’t be afraid to get involved. It’s often with fresh eyes that the first steps are taken toward improving.
• Consider when your facility is busiest and tell your manager about your experiences. Keep in mind that emergency surgery is subject to seasonal variation. Frequent and robust conversation about emergency and elective surgical activity helps senior planners correctly match supply and demand.

Implementing Evidence-Based Protocols

Implementing established evidence-based protocols, such as Enhanced Recovery After Surgery protocols, helps prepare patients for surgery based on scientific evidence and subsequently helps free capacity in the system. When nurses confirm and follow a patient's surgical protocol, it minimizes last-minute delays, reduces cancelations, and ensures required preop steps are completed on time. This directly improves first-case start times, shortens the turnover between cases, and decreases the overall length of stay. For novice nurses, consistently following protocols helps ensure readiness, improves patient outcomes, and contributes to efficient and predictable surgical workflows.

Tips for Implementing Evidence-Based Protocols

• Ask if the patient has a protocol for their surgery and use it, knowing it can make a difference.

Conclusion

Nurses have a powerful responsibility to take ownership of their patients’ minutes. The tips outlined in this article can help novice nurses reduce waiting times, enhance patient outcomes, and ensure patients receive the care they need on time. Novice nurses: Remember the core values of perioperative nursing and your own personal values and deliver on these values every time you turn up for work.

References

1. Dobson GP. Trauma of major surgery: a global problem that is not going away. Int J Surg. 2020;81:47-54.
2. Hip fracture: management. National Institue of Health and Care Excellence. June 11, 2011. Accessed June 23, 2025.

AORN Resources

Open access:

• 5 Steps to Bring Teams Together for More Efficient & Effective OR Turnovers – Periop Today

AORN members can access:

• Improving first case on-time starts – AORN Journal
• Reducing turnover times to increase surgical volumes – AORN Journal

If your facility subscribes to AORN eGuidelines+ you can access:

• Room Turnover at a Glance – AORN eGuidelines+