Problem: First case on-time start (FCOTS) is frequently used to evaluate operating room (OR) efficiency. This performance measure influences budgeting, staffing, scheduling, and patient safety and satisfaction. Contributing factors to delays include perioperative handoff, information omission, and documentation errors. At a large community hospital, in the ambulatory surgical area, FCOTS reports show that in April, May, and June 2024, 31% of late cases had delays involving pre-operative nursing handoff and tasks. Impacts of this problem directly involve patients, surgeon and anesthesiologist compensation, increased hospital costs, and much more. Purpose: The purpose of this quality improvement project is to decrease first case delays to the OR and improve documentation compliance by implementing a standardized, Situation- Background-Assessment-Recommendation (SBAR) based, electronic nurse handoff, which is an evidence-based, research-supported practice improvement. Methods: A multidisciplinary team was formed to identify possible root causes to OR delays, followed by an extensive evidence search and collection of pre-implementation data. Modified to fit the unit needs, an evidenced- based SBAR handoff tool was built into the EMR. Once finalized, forty-eight pre-operative RN’s were trained in small groups, using return demonstration. Daily in-person rounding by leaders, weekly emails, and monthly recaps, were used to remind and support RN’s. In addition to tracking FCOTS, completed handoff tool, and random observations were completed weekly. Results: Post-implementation, 46% (n=548) of OR cases observed (n= 1,190) were late to the OR. Of the late cases, 17% (n=93) were late due to pre-operative nurse handoff and tasks. This is a significant decrease from 31% (n=113), pre-implementation. Handoff documentation over-all stayed the same, pre and post implementation, at 75% (n=120). Random observation showed that SBAR Handoff was used 82% (n=317) of the time. Conclusions: Findings suggest that the standardization of perioperative handoff decreases delays in first cases to the OR. Although documentation compliance was not significantly affected, when further measures were added to promote documentation by unit leadership, compliance increased. Hospital revenue, provider reimbursement, and patient safety & satisfaction, are positively impacted