Abstract
Introduction: First-case on-time starts (FCOTS) is an established metric of perioperative efficiency, impacting global perioperative throughput. Late-arriving surgeons are a common cause of late operating room (OR) starts. This project reflects a quality improvement effort to reduce late surgeon arrivals by 30% for 24 months and improve FCOTS. Methods: A multidisciplinary perioperative leadership team developed clear expectations, including tracking, roles, review processes, and consequences. These were broadly communicated among stakeholders, and feedback was incorporated. A new same-day surgeon-to-surgeon feedback mechanism was instituted for late surgeon arrivals, allowing for surgeon feedback and reiteration of expectations. Results were prospectively tracked for 24 months before and following implementation. Results: Late surgeon arrivals decreased by 45%, from 23.6 to 13 per month for 24 months before and following implementation, respectively (P < 0.001). Balancing measures did not see increases for the same periods. FCOTS increased from 66% to 72% postimplementation (P < 0.001). Statistical process control P-charts demonstrated centerline shifts for both metrics. Conclusions: Development and communication of a clear framework of expectations, review, and consequences, with ongoing monitoring, clear performance expectations, and timely feedback, can reduce late surgeon arrival and improve FCOTS. Direct and timely communication provided immediate feedback to late surgeons and indicated reporting errors, providing more accurate data on late starts. Consistent policy enforcement is critical for credibility. Copyright © 2025 the Author(s).