Ready on Arrival: Earlier Preoperative Readiness, Fewer Late Cancellations

Getting a patient ready for surgery is a highly coordinated effort that can be easily disrupted. Between the clinic visit and the day of surgery, dozens of things have to come together: lab work and clearances, medication reconciliation and adjustments, fasting and skin-prep instructions, transportation and caregiver plans, and clear communication with a patient who may be anxious and hearing it all for the first time.

Each of those steps creates an opportunity for something to fall through the cracks. Without a coordinated way to manage requirements, ownership, follow-up, and escalation, preoperative readiness gaps can remain hidden until the surgical schedule is already at risk. One systematic review and meta-analysis found that intended-day-of-surgery cancellations occur globally at an estimated rate of 18% (95% CI: 16% to 20%), underscoring how often readiness issues are identified too late.¹ 

When preoperative readiness actions are missed, the impact shows up operationally. A missed instruction, unmanaged medication, incomplete record, or unconfirmed ride can lead to a late cancellation, a delayed case, or a fully staffed room sitting idle.

Leading health systems are starting to treat case planning as a connected workflow, not a series of disconnected tasks. That means bringing together patient information, documentation, clinical readiness needs, patient and procedure risk, preparation pathways, outreach, ownership, and escalation so teams can identify gaps earlier and keep cases moving predictably.

The gap between visibility and execution

Over the past decade, perioperative teams have gained more dashboards, reports, task trackers, and reminders than ever. Yet many still struggle to:

• Identify which patients can move through a streamlined pathway and which require more hands-on coordination;
• Confirm that required documentation, clinical review, and patient instructions are complete before the schedule is at risk;
• Surface unresolved readiness gaps while there is still time to act;
• Know who owns the next step when an issue requires follow-up or escalation.

More information has not closed the gap because preoperative readiness still depends on timely action across multiple roles. A dashboard can show that a case needs attention, but it does not always make clear what action should happen next, who owns it, or whether the patient has what they need to arrive ready. 

When case review, risk identification, and patient follow-up rely on manual work, small inconsistencies can move downstream quickly. By the day of surgery, those inconsistencies may show up as avoidable delays, reschedules, cancellations, or staffed OR time that cannot be used as planned.

OR time is among a hospital’s most expensive resources. A 2022 literature review estimated a mean cost of $46.04 per minute,³ while other studies report costs ranging from $22 to $133 per minute—making even brief delays costly across rooms and service lines.^2,3

What proactive teams do differently

High-performing perioperative teams treat readiness as a coordinated case planning workflow, not a series of last-minute tasks. Proactive teams consistently:

1. Surface clinical readiness needs early. Patient information, patient and procedure risk, documentation gaps, and preparation needs are brought together while there is still time to review and act. 
2. Route every patient to the right pathway. Lower-risk patients can move through a streamlined outreach workflow, while higher-risk patients are prioritized for the right visit type, timing, provider level, and follow-up.
3. Deliver clinically complete instructions. Every patient receives accurate, evidence-based guidance that reflects the case, facility requirements, and preparation pathway.

Evidence supports this more systematic approach. In a study of 14,893 elective surgery patients at an academic tertiary hospital, the overall day-of-surgery cancellation rate was 1.23%. Patients who received comprehensive preoperative assessment had a cancellation rate of 0.48%, and patients who received nurse telephone screening had a rate of 0.60%, compared with 2.02% among patients without structured preoperative assessment.⁴ 

The American College of Surgeons’ Strong for Surgery program similarly emphasizes preoperative screening for risk factors that can lead to surgical complications, paired with targeted interventions before elective operations.⁵

The takeaway is simple: preoperative readiness does not start with a phone call. It starts with knowing which patients need which pathway, and then executing that pathway reliably.

Clinical readiness and patient outreach work better together

iQueue for Operating Rooms supports case planning by helping teams coordinate preoperative readiness activities that are often managed manually or across disconnected processes. 

LeanTaaS has two new Workflow Assistants within iQueue that help teams assess clinical readiness needs, guide preparation pathways, automate patient outreach, and make follow-up more consistent before the day of surgery:

• Clinical Readiness Assistant brings together patient context, patient risk, procedure risk, and pathway guidance to help clinicians understand which patients may need additional review, preparation, or follow-up. The goal is to give clinicians a consistent, explainable starting point for determining the right preparation pathway.
• Patient Outreach Assistant then helps carry that plan forward by automating repetitive outreach at scale, delivering consistent, facility-specific pre-op instructions, documenting outcomes, and escalating clinical concerns for review. Teams have saved an average of 52.8 nursing hours per month while completing thousands of calls with high patient satisfaction. Together, these capabilities help teams focus time where it is needed most and reduce preventable late-stage cancellations.

Preoperative excellence requires every detail to be confirmed

Pre-op instructions are more than reminders. They are a clinical handoff to the patient, and each element can influence whether the case proceeds as planned:

• Fasting (NPO): Clear, standardized guidance, such as no solid food after midnight and clear liquids up to the facility’s cutoff.
• Medication management: Which medications to continue, hold, or adjust, including high-risk classes like anticoagulants, diabetes medications, and GLP-1 agents.
• Skin preparation: How and when to use chlorhexidine, plain soap, or the facility’s prescribed surgical wash, consistent with local infection-prevention protocols.
• Illness screening: Checking for fever, cough, rash, or wounds near the surgical site, and flagging symptoms that need a clinician before surgery day.
• Arrival and support: Confirming check-in time and location, a driver, and an overnight caregiver when needed.

When these details are confirmed days in advance, teams still have time to intervene. In one ambulatory surgery center study, scripted nurse-to-patient calls three business days before surgery; focused on no-shows, NPO noncompliance, and confirming transportation; reduced daily cancellations by 53%.⁶ When issues are discovered only at check-in, even one unresolved detail can delay the first case, force a cancellation, or leave staffed OR time underused.

Patient comprehension should be treated as part of readiness, too. A 2024 survey of elective surgery patients found that only 62% had adequate health literacy, and the top reported challenge was understanding preparation and recovery instructions.⁷ Half of patients sought additional preparation information, and 60% of those patients used the internet, creating a clear opportunity for health systems to deliver consistent, trusted guidance before patients search elsewhere.⁷

Case planning is where surgical orchestration starts

Leading organizations are increasingly treating preoperative readiness as part of a broader operating model for the OR, one that helps teams identify risks earlier, coordinate action across roles, and keep cases moving predictably. 

Coordinated Case Planning within iQueue is becoming the new standard for how leading perioperative teams reduce manual review, inconsistent outreach, and late-stage cancellation. That is why LeanTaaS is investing in capabilities that make Case Planning more reliable. The goal is not to add another dashboard or another layer of work, but to reduce the friction and manual effort in the processes teams already manage every day. 

Clinical Readiness Assistant and Patient Outreach Assistant are proof points within the broader iQueue for Operating Rooms story: a surgical orchestration suite that helps teams act earlier across access, preoperative readiness, staffing, and execution so more scheduled OR time becomes prepared, staffed and completed surgical care.

Are you a customer interested in the new workflow assistants or features mentioned in this blog? Contact your Customer Success liaison!

Interested in iQueue for Operating Rooms? Click here to schedule a demo.

References

1. Abate, S. M.; Chekole, Y. A.; Minaye, S. Y.; Basu, B. Global Prevalence and Reasons for Case Cancellation on the Intended Day of Surgery: A Systematic Review and Meta-Analysis. Int J Surg Open 2020, 26, 55-63. doi:10.1016/j.ijso.2020.08.006.
2. Saul, B.; Ketelaar, E.; Yaish, A.; Wagner, M.; Comrie, R.; Brannan, G. D.; Restini, C.; Balancio, M. Assessing Root Causes of First Case On-Time Start (FCOTS) Delay in the Orthopedic Department at a Busy Level II Community Teaching Hospital. Spartan Med Res J 2022, 7 (2), 36719. doi:10.51894/001c.36719.
3. Smith, T.; Evans, J.; Moriel, K.; Tihista, M.; Bacak, C.; Dunn, J.; Rajani, R.; Childs, B. The Cost of OR Time Is $46.04 per Minute. JOrthoBusiness 2022, 2 (4), 10-13. doi:10.55576/job.v2i4.23.
4. Olson, R. P.; Dhakal, I. B. Day of Surgery Cancellation Rate after Preoperative Telephone Nurse Screening or Comprehensive Optimization Visit. Perioperative Medicine 2015, 4 (1), 12. doi:10.1186/s13741-015-0022-z.
5. American College of Surgeons. Strong for Surgery. ACS Quality Programs.
6. Haufler, K.; Harrington, M. Using Nurse-to-Patient Telephone Calls to Reduce Day-of-Surgery Cancellations. AORN J 2011, 94 (1), 19-26. doi:10.1016/j.aorn.2010.12.024.
7. Williams, C.; Duff, J.; Tanagan, C. Australian Elective Surgery Patients’ Pre-Operative Preparation, Health Literacy, Learning Preferences and Knowledge Resource Needs: A Cross-Sectional Survey. Journal of Perioperative Nursing 2024, 37, 3-11. doi:10.26550/2209-1092.1283.