129 - Tick Tock: Enhancing Cardiac Cath Lab Efficiency by Improving First -Time Case Starts

Description: First case on-time starts (FCOTS) are imperative for maximizing efficiency in procedural areas such as the Cardiac Cath Lab (CCL), with delays leading to interruptions in procedural flow, potentially impacting revenue and patient outcomes. A community hospital's CCL's FCOTS was defined as the patient being in the procedural area at or before the scheduled case start time. CCL internal reviews showed that only 57% of first cases began on time, with case volume expected to grow.
Description of Team
An interprofessional FCOTS Taskforce was convened, comprising of the CCL Medical Director, CCL Nursing Leadership, and respected informal nursing and radiologic technologist leaders. The team was assembled to mobilize expertise, integrate varied role perspectives, and promote shared accountability in driving practice improvements. Each member brought strong dedication to improving FCOTS and a proven record for driving successful performance initiatives in the CCL.
Preparation, Planning, and Assessment
The Plan-Do-Study-Act (PDSA) framework was used to enhance FCOTS. With executive leadership support, the Taskforce set a goal to improve FCOTS by to 10%, setting the internal benchmark to 63% within one year. A retrospective chart review revealed that most consistent delays were provider tardiness and late patient arrivals. Further, open discussions about FCOTS were held with all CCL patients and staff to ensure that documented data accurately reflected real-time practices and experiences. Audit and discussion findings rooted in communication gaps and lack of education regarding procedural area start time expectations led improvement efforts.
Implementation
In the first two months, the Taskforce focused on improving compliance with FCOTS education sessions emphasizing the importance of timely starts and informed all CCL providers and staff that first cases would be monitored for timeliness and documentation accuracy. CCL staff received targeted training on tardy classifications to ensuing practice consistency, supported by daily huddle updates led by informal unit leaders. Initiative data was reported monthly to executive leadership during Cardiology Committee meetings for transparency. In months three and four, nursing leadership provided just-in-time coaching to address fallouts, fostering accountability and continuous improvement. Metric signage was installed in the CCL to highlight progress. During the fifth month communication interventions were added. Staff began calling patients at one week and one day before procedure intervals to confirm arrival times and provide education. Providers received reminder calls 45 minutes before case starts to complete any outstanding tasks necessary for timely case initiation.
Outcome
The CCL volume increased 14% during this project, and outperformed its initial FCOTS target, averaging a compliance rate of 68% within six months, and has sustained that goal. By 12 months, the internal benchmark raised to 70%, which the CCL exceeded with a sustained rate of 80.2%.
Implications for Perioperative Nursing
Timely first case starts in the CCL are essential for maximizing efficiency and ensuring timely patient care. FCOTS delays trigger a cascade of scheduling setbacks, and extend patient wait times. For perioperative and procedural nurses, consistent FCOTS punctuality supports effective resource allocation, reduces overtime, enhancing team performance and patient satisfaction.