How Baptist Memorial Doubled On-Time Starts and Reduced End-of-Day Delays
Improving operating room efficiency starts with understanding where delays are occurring. But what happens when the data on which hospitals rely doesn't accurately reflect what's happening in the operating room?
For perioperative teams, delays can mean more than just a disrupted surgical schedule. They can extend shifts and make it difficult for staff to know when their workday will end. Without reliable data, identifying and addressing the causes of those delays becomes even harder.
That was the challenge faced by Jessica Gillentine, Director of Perioperative Services at Baptist Memorial Hospital-Memphis. Improving first-case on-time starts (FCOTS) was a priority, but the hospital's reported performance didn't match surgeons' experiences. Although the data suggested cases started on time, surgeons kept raising concerns about delays, making it hard to determine the extent of the problem.
With Apella’s ground-truth data automation, Baptist Memorial found that the surgeons’ concerns were founded in fact: more cases started late than its EHR data showed. This gave the team a reliable baseline to identify where improvements were most needed and to prioritize the changes most likely to keep cases on schedule throughout the day.
Within nine months, FCOTS more than doubled from 36% to 78%, while average late minutes on OR days running more than 30 minutes long decreased by 56%.
Why accurate data matters for OR efficiency
FCOTS have long been a standard benchmark for OR efficiency. But as we explored in our earlier post, first-case on-time starts only shows part of how an operating room performs throughout the day.
At Baptist Memorial, the first challenge to address was establishing an accurate baseline. "We didn't have a true picture. Surgeons were complaining [about late starts] though it looked like cases were on time in Epic," said Gillentine.
After implementing Apella in October 2025, the Baptist Memorial team found Apella's AI-detected timestamps showed only 36% of first cases starting on time, while manually-recorded EHR data showed nearly half. That discrepancy revealed a larger opportunity for improvement than the existing data suggested. It also provided the team with an objective baseline for measuring progress.
Moreover, Apella's visibility extended beyond first cases, revealing additional challenges across the surgical day:
- All-case on-time starts: Only 30% of surgical cases started on time.
- End-of-day performance: 55% of OR days finished more than 30 minutes later than scheduled.
- Average overrun: On those late-running days, the average overrun was 72 minutes.
These findings showed that improving first-case starts was only part of the challenge. Baptist Memorial also needed to understand how delays accumulated throughout the day and contributed to late finishes, which are often main contributors to staff burnout and low morale.
Learn how Baptist Memorial improved on-time starts for all cases throughout the day.
Read the case study
Turning accurate data into operational improvements
With a more reliable understanding of efficiency in the OR, Gillentine and her team began incorporating Apella into their daily workflows.
One significant change was moving the hospital's operational review from noon to 8am, shortly after first cases began. This allowed anesthesia, service-line leaders, nurse managers, and other operational teams to review delays while the events were still fresh.
Using Apella's objective timestamps, leaders could identify where delays originated and focus conversations on root causes rather than competing explanations. Beyond these daily reviews, real-time visibility helped managers and frontline teams identify potential delays and intervene before they disrupted the schedule.
Improving performance across the entire surgical day
Within nine months of implementing Apella, Baptist Memorial achieved substantial improvements in on-time performance, extending well beyond first-case starts.
- First-case on-time starts doubled, increasing from 36% to 78%.
- All-case on-time starts increased from 30% to 58%.
- OR days running more than 30 minutes late decreased from 55% to 30%.
- Average late minutes on those days decreased by 56%, from 72 to 32 minutes.
Building a more predictable surgical day
Baptist Memorial's progress extended beyond the metrics. With objective data built into daily operations, nurse managers, service-line leaders, and frontline staff took greater ownership of performance and identified opportunities for improvement.
FCOTS remain an important measure of surgical efficiency. But keeping operating rooms on schedule requires understanding what happens throughout the entire day. Baptist Memorial's experience shows how accurate data and real-time visibility help teams address delays as they occur, improve on-time performance, and create a more predictable surgical schedule for the teams that depend on it.
Learn how Baptist Memorial improved on-time starts for all cases throughout the day.
Read the case study