Optimizing first case on-time starts in Veterans Affairs operating rooms: A quality improvement initiative.

Delays in operating room start times lead to inefficiencies, decreased patient satisfaction, and significant hospital costs. FCOTS (first case on-time start) is a widely used performance metric, yet interventions to improve it remain understudied in VA settings. The 4 Disciplines of Execution (4DX) model was implemented to target an 85% on-time start rate. Weekly FCOTS data from January to December 2023 were analyzed using statistical process control charts, and causes of delays were reviewed by a multidisciplinary panel. Among 1467 first-start cases, baseline FCOTS rates averaged 76% (weeks 1-19), declined to 68% during the early intervention period (weeks 20-45), and improved to 87% (weeks 46-52). Control chart analysis demonstrated special-cause variation late in the study period. Mean weekly delay-related costs decreased from approximately $5000 to $3000 (p < 0.05), corresponding to an estimated annual savings of $200,000. Structured multidisciplinary approaches can significantly improve operating room efficiency and reduce costs.