# ACS First Start OR Protocol
**Purpose**
To ensure efficient utilization of operating room (OR) resources and timely case starts by outlining responsibilities for case reassignment at 6:00 a.m
**Scope**
Applies to all ACS surgeons, OR charge nurses, and ACS staff involved in scheduling and assignment OR cases
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**Proposed Plan**
**1. Morning Check**
- At 6:00 a.m., the OR charge nurse will review the schedule for OR 1.
- If multiple cases are scheduled in OR 1 and additional rooms are available, the OR charge nurse will text the attending surgeon who has the first-start case scheduled under their name
**2. Case Reassignment by Surgeon Type**
- **Elective-case or Trauma Red Surgeons:**
- Upon receiving the text, the surgeon should direct the OR to move the next case (if scheduled under another surgeon) into the additional room.
- It is understood that the surgeon will arrive in time for a 7:30 a.m. case start.
- **Emergency General Surgery (EGS) Surgeon:**
- The EGS surgeon may choose which case to move into the additional room.
- The moved case should be assigned under the CWIT surgeon.
- **If No CWIT Surgeon Available:**
- If the CWIT surgeon is unavailable (e.g., already operating), the case should be assigned under the Trauma Blue surgeon.
**3. Coverage During Morning Hand-off**
- During morning hand-off, if the CWIT or Trauma Blue surgeon is unavailable at the time of case start, an alternate covering surgeon will be identified.
- The OR charge nurse will be notified of the assigned covering surgeon.
**4. Surgeon Responsibility for Case Timing**
- Any surgeon scheduling a case in advance who cannot be present to start the case as a first-start must indicate this during the case request process.
- This ensures the OR charge nurse will not move the case earlier inadvertently.
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**Compliance**
Adherence to this protocol ensures timely starts and efficient use of OR resources.
*Approved on 11/19/2025 by Dr. Charity Evans and Dr. W. T. Hillman Terzian*