Date of Award

Spring 4-28-2016

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Dr. Joseph Burkard, DNSc, CRNA, Faculty Chairperson

Second Advisor

Dr. Scott Nolan, DNP, RN, CNS, PHN, CCRN, CNRN, Seminar Faculty


The purpose of this evidence-based project was to reduce the rate of elective total joint arthroplasty case cancellations by implementing a nurse practitioner-led Preoperative Assessment Clinic (POAC), in the orthopedic department of a major southern California Veterans Affairs (VA) hospital. Retrospective data collected in a 12-month time period showed a surgical cancellation rate of 22%. Reasons for delays or cancellations included: medical instability, abnormal labs and/or studies, patients requiring referral to specialists, dental clearance, patient-initiated cancellations, and active infections. The POAC reduced the rate of case cancellations at 1 year to 17% and at 2 years to 9%. Lost revenue for 12 case cancellations 2 years post-implementation was $62,940, whereas lost from 31 case cancellations prior to implementation was $162,595. A chi-squared test was performed to determine the relationship between the POAC and case cancellation rates. The relationship between these variables was statistically significant (chi-squared= 8.541, p = .003).

The results demonstrate that a nurse practitioner-led POAC reduces surgical case cancellation rates, improving patient outcome, reducing wasted resources, and increasing patient satisfaction.