Why First Case On-Time Starts Matter – And Why We’re Missing the Mark

If you've ever spent a day in the cath or electrophysiology (EP) lab, you know that how the day starts often dictates how the rest of it unfolds. A delayed first case can create a ripple effect that impacts patient flow, staff morale, provider satisfaction and even financial performance, but labs across the country are struggling to get that first case started on time.

In MedAxiom's recent 2025 Cath and EP Lab Utilization and Staffing Survey Report, 78% of programs reported actively measuring first case on-time starts. The average target? Eighty-percent on time. The reality? Just 58% of cases are starting on time on average with some programs as low as 10%. Clearly, there's a gap between aspiration and execution.

Why First Case On-Time Starts Matter

Starting the day late creates a cascade of delays. Patients are kept waiting, physicians are frustrated, staff may need to stay late (which could mean overtime pay), and labs miss opportunities to maximize throughput. This impacts:

• Case volume and revenue.
• Staff satisfaction and burnout.
• Physician engagement.
• Patient experience and safety.

When the first case runs late, it's nearly impossible to recover that time during the day.

Barriers to Success

Survey respondents identified several barriers to achieving on-time starts:

• Staffing Challenges: Limited personnel can delay patient prep and room readiness.
• Physician Delays: Morning meetings, rounding or late arrivals slow the start.
• Anesthesia Delays: Issues with consent timing or anesthesia availability are common.
• Patient Prep Delays: Delayed check-in or lab draws create early bottlenecks.
• Inconsistent Processes: Variability in workflow or unclear responsibilities.
• Lack of Urgency: Without accountability, teams may not prioritize timeliness.
• Lack of a Standard Start Time: If "on-time" isn’t clearly defined, it’s hard to meet it.

Defining "On Time:" A Critical First Step

One finding from the survey was surprising: there’s no consistent definition of what "on time" means. Among survey respondents:

• 60% define it as Patient in Room.
• 32% define it as Stick Time.
• 4% define it as Physician in Room.
• 4% define it as Anesthesia in Room.

It’s difficult to set industry standards that can be benchmarked if there isn’t a clear definition. It’s crucial to compare apples to apples across facilities in the same organization or across different organizations.

Strategies to Improve First Case Starts

So what can be done to improve first case on-time starts?

• Standardize the Definition: Have all team members agree on a single definition of "on time." As an industry, we can ideally come to an agreement on this definition to begin benchmarking externally. MedAxiom recommendation = The patient being physically in the procedure room by the scheduled start time (e.g., 7:30 a.m.), ready for the procedure to begin.
• Start-Time Huddles: Brief morning meetings to confirm readiness.
• Prep Protocols: Ensure the first patient is consistently prepped early.
• Physician Expectations: Clarify arrival times and reinforce accountability.
• Data Transparency: Share performance metrics regularly with staff and providers.

Consider incorporating readiness steps into a simple dashboard or visual management board to track progress and flag delays.

Conclusion

Improving first case on-time starts doesn’t require massive change – it requires consistent, coordinated action. Standardization, accountability and a shared commitment to readiness can make a major difference. Programs that succeed start with clear definitions, data-driven awareness and actionable daily processes.

Illustration by: Lee Sauer