Ideas That Work: Starting Cases on Time Is Part of the Game

Practical pearls from your colleagues

Adding gamification to your First Case On-Time Starts (FCOTS) practices could yield immediate results.

Just ask Fox Chase Cancer Center in Philadelphia, which managed to increase its FCOTS from 40% in August 2023 to 78% in March 2024 simply by offering prizes to staff for having ORs ready to go on time.

“A punch card system was created to keep record of nurses and surgical technologists having their patient in the room on time daily,” says Fox Chase’s Regina Lynch, BS, BSN, RN, CNOR. “Each staff member had their own punch card, and 10 punches earned received a prize. Staff handed in their punch cards to choose a prize from the FCOTS prize box.”

FCOTS is a unit-wide goal at Fox Chase this is measured monthly to improve efficiency of OR time. The incentive program began in January 2024. Just three months later, 78% of cases started on time, 89% started within five minutes of their scheduled start times and 95% began within 10 minutes of their scheduled start times.

Fox Chase’s goal is to have first-case patients in the OR by 7:30 a.m., and its data reflects this. The data doesn’t include cases when the room was ready at 7:30 a.m. but the patient was late or otherwise unready.

“While there are several factors outside of the OR staff’s control, FCOTS improved consecutively for the three months gamification was utilized,” says Ms. Lynch. “Gamification can be used as a tool to improve FCOTS in terms of room preparedness by the OR circulator and scrub for each room.” OSM