173 - First Case On-Time Starts: A Multidisciplinary Approach to Reliability and Efficiency

Description: With operating room (OR) time costing an average of $36–$50 per minute, delays in surgical starts have significant financial and operational implications. At The Valley Hospital, we launched a multi-pronged strategy to improve first case on-time starts (OTS), enhance reliability, and optimize perioperative efficiency.

Our initiative began with standardizing the procedure booking process. We developed a comprehensive booking sheet that identifies all necessary supplies, equipment, and implants at the time of scheduling—reducing day-of-surgery disruptions and ensuring case readiness.

Next, we strengthened our pre-surgical screening process. Registered nurses proactively call patients to confirm medical clearance, NPO status, and readiness—minimizing day-of cancellations and late arrivals.

In September 2018, we adjusted OR staff start times from 0700 to 0630, giving teams ample time to complete room setup, verify case carts, and resolve potential issues before patient arrival.

These coordinated efforts resulted in a significant improvement in OTS rates—from 14% in 2017 to 43% in both 2023 and 2024. In 2025, our monthly performance rose from 38% in January to 75% in April. Although our goal remains 80%, the data reflects meaningful cultural and operational progress.

This presentation will highlight the steps taken to drive change, the collaboration required across departments, and the measurable results achieved. Attendees will leave with practical tools for enhancing OR efficiency and advancing a culture of accountability and readiness.