Surgical smoke is a hazardous byproduct of any surgery involving a laser or an electrosurgical unit. Although research and professional organizations identified surgical smoke as harmful many years ago, this byproduct continues to be a safety hazard in the OR. An interdisciplinary team at a large academic medical center sought to address the exposure of patients and perioperative team members to surgical smoke. The team used the nursing process to resolve the lack of smoke-evacuator equipment and surgical smoke staff member knowledge. To increase awareness of the hazards of surgical smoke, we gave presentations to nursing staff members and surgeons, who then completed educational modules. We conducted audits in all ORs to monitor compliance. The use of smoke evacuation supplies has more than quadrupled since education began. Additional unit-based education continues every day and is a constant reminder that safety is the responsibility of all perioperative team members.

First-procedure delays in the OR result in loss of revenue and subsequent procedure delays for patients, staff members, and other surgeons. Members of a committee at New York University Medical Hospital determined that the major cause of the delays in the OR was late arrival of surgeons, and they developed a plan to reduce first-procedure delays in the OR through a physician accountability initiative. Committee members attempted to modify surgeon behavior by requiring the documentation of surgeons' arrival times and by reporting their daily attendance time. They sent daily e-mail reminders asking surgeons with scheduled procedures to arrive 20 minutes before the procedure. This resulted in a 13% decrease in first-procedure delays within two weeks and improvement continued. Overall, the plan improved first-procedure delays from an initial on-time start rate of 24% to 80%.