Title : Operationalizing efficiency: Reducing procedural delays with cross-disciplinary coordination
Abstract:
Background: Delays in first case start (FCS) times within cardiac catheterization labs can lead to cascading inefficiencies, prolonged patient wait times, patient and staff dissatisfaction, and increased hospital costs. Identifying and addressing barriers to timely first case starts is critical for optimizing workflow, improving patient outcomes, and supporting interdisciplinary team satisfaction.
Purpose: The purpose of this performance improvement initiative was to implement a team-based intervention to improve first case start times in the pediatric cardiac catheterization lab at an academic medical center. The goal was to reduce
delays by identifying modifiable causes and establishing standardized pre-procedure workflows.
Methods: Using Plan-Do-Study-Act (PDSA) cycles, a multidisciplinary team conducted a
baseline audit of first case delays over a 5-month period, identifying contributing factors such as incomplete pre-procedure checklists, communication breakdowns, and unclear team roles. In collaboration with interventional cardiologists and anesthesiologists, the team implemented five key interventions: 1. Implementing EPIC workflow timestamps
2. Adjusting patient arrival time
3. Requiring verbal pre-med notification
4. Reinforcing daily huddle
5. Conducting real-time delay reviews. Data on first case on-time starts were tracked pre- and post-intervention over a 3-month period.
Results: Post-intervention data demonstrated a 38% improvement in on-time first case starts (from 42% baseline to 80%). Staff satisfaction scores related to workflow efficiency and team communication improved based on post-implementation surveys. Delays related to incomplete documentation or consent decreased significantly.
Conclusion: This performance improvement initiative successfully improved first case start times through
low-cost, team-driven interventions emphasizing standardization and communication. Sustained improvements suggest that clear protocols and shared accountability can meaningfully enhance efficiency in high-acuity procedural settings. Future efforts will focus on long-term sustainability and expanding the initiative to other procedural areas.
