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NRS 490 Topic 2 DQ 1During your practicum, determine what clinical problem or issue the organization is facing. Discuss two implications for nursing.The clinical issue facing this organization is first case on-time starts and turn-over time in the operating room. Given the importance of operating room (OR) productivity in both efforts to improve access for patients and the financial solvency of a hospital, many studies have been conducted to improve OR efficiency by increasing the number of on-time starts for first cases, decreasing turnaround times between procedures, and reducing idle non-operative time. A number of these studies utilized a systems-based approach, relatively few have used lean principles to frame, develop, and implement solutions to improve OR efficiency. From these studies, many factors are identified that contribute to OR inefficiencies, such as communications between members of a multi-disciplinary group, variability in the proportion of emergency and urgent versus elective operations, and case cancellations, just to name a few. These inefficiencies impact overall revenue for hospitals, as labor costs remain fixed in the face of decreasing OR productivity (Coffey et al, 2018). The high frequency of delayed first-cases appears to contribute to cancellations of cases scheduled later in the day, long surgical lines, consistently high hospital census, and low morale amongst attending physicians, nurses, and other OR staff members.