In the first post of our Vital Stats series, we explored why EHRs are too slow for the OR and how laggy and inaccurate surgical data can lead to delays, underutilization, and overtime. In fact, the all-too-common 19-minute delay in recording wheels-in typically leads to tens of thousands of dollars in waste and inefficiency. In the second post of our series, we explore the relationship between FCOTS and delays.
Starting the day on time doesn’t guarantee a smooth finish
Even with an on-time start, OR days remain unpredictable. And that unpredictability leads to staff overtime, patient delays, and frustrated teams. To manage unpredictability, many perioperative teams focus on one key metric: first-case on-time start (FCOTS). The logic is simple: start the day on time, and everything else should follow suit. But the data tells a different story.
Check out our complete ebook on Vital Stats: Uncovering Hidden Inefficiencies in the OR to learn about the blind spots that ambient AI exposes and traditional documentation in the EHR often overlooks.
An analysis of thousands of cases conducted across 39 hospitals for the time period January to August 2025 showed that even though 88% of operating room days began on time, 44% still ended behind schedule. A first case that starts on time doesn’t guarantee an efficient day; once the schedule starts to slip, the rest of the day often follows. FCOTS isn’t the failsafe we think it is.
The root of the issue
The problem isn’t the first case. It’s everything that happens after. As the day unfolds:
- Timely, accurate data is hard to capture.
- Manual EHR entries lag behind real-time activity, disrupting flow.
- Add-on cases throw off even the best-laid plans
In a system this complex, manual processes just can’t keep up. Forward-thinking surgical teams aren't just focused on hitting a number. They're staying agile and adjusting as the day unfolds.
Apella’s ambient AI passively captures in-room activity and translates it into real-time insights, all without dependency on manual inputs. This enables teams to respond in the moment, even with frequent add-ons and mid-day changes.
Unpredictability is part of surgery. But with better visibility and real-time data, teams can stay one step ahead. FCOTS is a helpful checkpoint, but it only tells you how the day started. What matters more is how the day actually unfolds.
Check out our complete ebook on Vital Stats: Uncovering Hidden Inefficiencies in the OR to learn about the blind spots that ambient AI exposes and traditional documentation in the EHR often overlooks.