Date of Award
Spring 5-14-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Dr. Joseph Burkard, DNSc, CRNA, EBP-C
Abstract
Background: Same-day surgical cancellations are a persistent and costly issue within outpatient surgery centers, accounting for approximately 5% of elective cases. These disruptions result in inefficient utilization of operating room (OR) time, increased staffing burdens, lost reimbursement, and diminished patient satisfaction. Unanticipated cancellations undermine scheduling reliability and workflow efficiency, contributing to care fragmentation and increased financial strain on health systems. A growing body of evidence suggests that nurse-led, structured preoperative screening has the potential to mitigate these challenges by identifying risk factors in advance and facilitating timely interventions. Nurses' clinical acumen and communication expertise uniquely position them to lead such efforts.
Purpose: This policy-focused initiative aimed to evaluate the projected impact of implementing a nurse-driven, standardized preoperative screening 72 hours prior to scheduled elective procedures at an academic outpatient surgical center. The primary objectives were to reduce same-day cancellations, enhance surgical block utilization, improve patient readiness, and advance the quality and consistency of preoperative workflows. Leveraging the Epic electronic health record (EHR) platform, the policy integrates clinical documentation with standardized assessment criteria to support early identification of logistical, medical, or educational barriers that may delay or disrupt surgery.
Methods: The project was guided by the Iowa Model for Evidence-Based Practice, emphasizing problem identification, critical appraisal of evidence, stakeholder engagement, and sustainable implementation. A structured preoperative telephone screening protocol was developed for use by registered nurses and integrated into Epic as a standardized documentation template. Retrospective and prospective Epic data were analyzed to compare same-day cancellation rates over two six-month periods—before and after the intervention. In addition to outcome analysis, a cost-benefit evaluation was conducted to assess financial feasibility and return on investment (ROI).
Evaluation of Outcomes/Results: Preliminary findings demonstrated significant clinical and economic value of the nurse-driven screening process. The projected annual cost of implementation, including nurse training and administrative support, was estimated at $35,970. Anticipated savings associated with a 50% reduction in same-day cancellations were estimated at $57,752, resulting in a cost-benefit ratio of $1.61 per dollar invested and an ROI of 61%. Operational benefits included improved OR efficiency, decreased staffing inefficiencies, and increased patient throughput. Qualitative feedback from staff highlighted the value of early patient engagement and structured documentation in reducing last-minute disruptions.
Conclusion: The implementation of a nurse-led, standardized preoperative screening policy represents a pragmatic, evidence-based solution to a well-documented operational problem. By aligning nursing leadership with institutional quality goals, this initiative strengthens perioperative processes, enhances patient outcomes, and demonstrates measurable financial return. The standardized Epic template enhances documentation consistency, interprofessional communication, and facilitates real-time risk mitigation. As a scalable and sustainable model, this policy has strong potential for broader adoption across outpatient surgical services seeking to improve efficiency, safety, and patient-centered care.
Digital USD Citation
Kuelz, Amanda, "Strategic Policy Development to Reduce Same-Day Cancellations: A Nurse-Led Preoperative Approach" (2025). Doctor of Nursing Practice Final Manuscripts. 311.
https://digital.sandiego.edu/dnp/311
Copyright
Copyright held by the author
