title: Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit.
abstract: BACKGROUND
  Structured preoperative assessment has been reported to improve operating room efficiency as measured by metrics such as day of surgery cancellations (DOSCs). However, not all patients require comprehensive assessment; routine full assessments can result in unnecessary duplication of tests and investigations. Selective nurse screening under the supervision of anesthesiology may provide adequate information gathering in lower risk patients. This study is undertaken to assess if DOSC rates vary with different assessment processes.
  
  
  METHODS
  At a single academic tertiary care hospital, from Jan 2 to May 31, 2013, the consecutive patients undergoing comprehensive preoperative assessment (CPA) and nurse screening (NS), as well as the patients not assessed by the anesthesiology-supervised preoperative process, were followed for the occurrence and reason for DOSC. The operating room schedule of all elective surgery patients was analyzed to allow calculation of rates of DOSCs. Reasons for cancellations were documented as one of ten structured reasons by preoperative holding area clerical staff.
  
  
  RESULTS
  Overall, there were 14,893 elective surgery patients in this time period, with 183 DOSCs, giving a rate of 1.23 % (95 % CI 1.06, 1.42). Patients who received CPA numbered 5980; 29 of them had a DOSC, giving a rate of 0.48 % (95 % CI 0.33-0.70) (P < 0.0001 vs. no assessment). Patients receiving NS numbered 1840; 11 of them had a DOSC, giving a rate of 0.60 % (95 % CI 0.30-1.10) (P < 0.0001 vs. no assessment). The most common reason for cancellation was new medical condition.
  
  
  CONCLUSIONS
  A very low DOSC rate can be achieved with a comprehensive preoperative process where some patients are selectively telephone screened by nurses, with complete assessment deferred to the anesthesiologist on the day of surgery.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Box 3094, 40 Duke Medicine Circle Dr, Durham, NC 27710 USA.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Olson
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Box 3094, 40 Duke Medicine Circle Dr, Durham, NC 27710 USA.
authors.forename: Ishwori B
authors.initials: IB
authors.lastname: Dhakal
keywords: Day of surgery cancellation; Nurse screening; Preoperative assessment