Problem: Delays to first case start times (FCST) are defined as the time the first scheduled patient enters the procedure room. A large urban university hospital in the mid-Atlantic region’s Interventional Radiology (IR) current success rate of timely FCST was 35%, resulting in significant interruptions in treatment and reflected in 33% Press Ganey patient satisfaction scores, compared with a 58% target. Purpose: The aim of this project was to improve FCST (at 0800) for IR to 80%, using three interventions to address the key drivers of delayed cases: pre-op nurse arrival time, advance practice provider (APP) availability, and prioritizing inpatients as first cases. Method: Three of the seven procedure rooms started with a prepared inpatient procedure. Preoperative and charge nurses revised shifts started at 0630, the same time first case outpatients were instructed to arrive. Finally, priority was given for one APP to be available to answer procedure questions and consent patients. The charge nurse completed a survey daily for each 0800 procedure to measure compliance with and outcomes for these interventions. The Press Ganey Survey measured patients’ overall satisfaction with their experience and their likelihood to recommend department services to others. Results: At the end of intervention implementation, FCST success rate increased to 56% and ‘likely to recommend’ and patient Press Ganey satisfaction scores increased to 77%. Adjustment of shift times resulted in 100% compliance. APP availability resulted in a 5% improvement to FCSTs. Outpatients (n=72) had more successful start times compared to inpatients (n=60) of the 237 recorded cases. Conclusion Though the 80% goal was not achieved, the project demonstrated resiliency and adaptability seen as the interventions were still implemented daily despite challenges faced with opening a new hospital sector, staffing reallocations, and software disruptions.