A Multidisciplinary Approach to Improving First Case On-Time Starts in Interventional Radiology.

Purpose: Interventional Radiology (IR) delivers a wide range of minimally invasive procedures across outpatient, inpatient, and emergency settings, creating workflow challenges related to scheduling and turnaround time. First case start time (FCST) is a key determinant of daily operational efficiency, with delays leading to downstream case postponements, reduced throughput, and decreased patient and staff satisfaction. The goal of this quality improvement (QI) initiative was to increase the percentage of on-time FCSTs to 75%.

Methods/Materials: This QI project was conducted within the Division of IR at a tertiary academic medical center and did not meet the definition of research per local IRB. A multidisciplinary team—including physicians, advanced practice providers, radiologic technologists, and nurses—was assembled. Data were collected through manual entry and analytical reports, capturing multiple time points throughout the procedural workflow. An A3 performance improvement framework was used to identify root causes of delays and establish key drivers. Interventions were tested and implemented through rapid Plan-Do-Study-Act (PDSA) cycles.

Results: The project spanned six months (March–September 2025) and included a 2-month baseline period, a 2-month awareness phase, and a 2-month post-intervention phase. Baseline on-time FCST was 42%, improving to 59% during the awareness phase. Targeted interventions focused on consistent communication, team-based collaboration, standardized patient preparation, and transparent data reporting. Following implementation, on-time FCST increased to 71% (p < 0.0001), representing a 69% relative improvement from baseline.

Conclusions: A structured, multidisciplinary performance improvement initiative significantly improved on-time FCST within an academic IR division, approaching the target goal of 75%. This approach provides a scalable model for addressing operational inefficiencies across procedural services.