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Preop to Theatre: Ready and On Time

Project Added:
5 December 2016
Last updated:
16 December 2016

Preop to Theatre: Ready and On Time


This project redesigned the preoperative screening and triage process, as well as operating theatre (OT) and pre-admission clinic staff work schedules. Patient information brochures were revised and new systems introduced, including text message reminders, operating theatre forecast planning meetings and team communication huddles.

View a poster from the Centre for Healthcare Redesign graduation, December 2016.


To improve first case on time performance by 40%, reduce monthly patient related day of surgery cancellations to 1.5%, improve the elective surgery patient experience by 20% and improve coordination and integration of preoperative care by 30%, by December 2016.


  • Reduces patient related day of surgery cancellations.
  • Improves first case on time performance.
  • Improves staff work scheduling, teamwork and communication.
  • Enhances patient satisfaction with the service.
  • Reduces financial pressure, emotional stress and distrust experienced by patients and carers, due to surgical delays or cancellations.
  • Improves preoperative screening and triage processes.


A review of all elective OT cancellations at Shoalhaven Hospital in 2015 found that the leading causes of cancellations were patient related (34%). Either patients were not adequately prepared, failed to arrive or had their surgery cancelled.

In NSW, hospitals are required to report on perioperative efficiency each month. One of these measures is ‘first case on time’. It is acknowledged that starting the first surgical case of the day on time will allow facilities to maintain an efficient OT and reduce the number of hospital related delays or cancellations.

The Ministry of Health target for first case on time performance is 95%. However, in 2015 Shoalhaven Hospital experienced a significantly below average performance. The increasing number of delays often resulted in cancellations, with patients and carers having to take additional time off work, resulting in financial stress. They also experienced emotional stress and distrust in the service, with one elective surgery patient stating: “My surgery has been cancelled three times, I can’t trust you guys (Shoalhaven Hospital) anymore.”


  • The preadmission clinic was redesigned, with new work schedules to ensure there is dedicated time for nurses to screen patients prior to surgery.
  • New clinical guidelines for preoperative screening and triage were developed.
  • Patient information on bowel preparation and preoperative instructions were revised.
  • A text messaging system was implemented for elective surgery patients, to remind them of their upcoming surgery.
  • Phone calls to patients on the day before surgery were made earlier in the day and included a wellness screening tool.
  • A policy was developed to help staff manage patients who were scheduled for day surgery and did not have a carer.
  • The start time for OT nurses was changed to 7am, leaving more time for OT setup, which reduced the risk of delays.
  • A daily OT forecast meeting was introduced during weekdays, to review equipment, staffing and anaesthetic requirements for the next day.
  • A morning team communication huddle was introduced during weekdays, to enhance collaboration among clinicians and improve first case on time performance.

Project status

Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.

Key dates

February 2016 – December 2016

Implementation site

Shoalhaven Hospital, Illawarra Shoalhaven Local Health District


Centre for Healthcare Redesign


  • First case on time performance increased to an average of 62% in November 2016.
  • Patient related day of surgery cancellations were reduced by 65% between August and October 2016, with a median cancellation rate of 1% (target 1.5%).
  • The patient experience with preoperative information improved from 60% to 90% (n=10).
  • Patients reporting a positive experience with coordination and integration of care increased from 50% to 100% (n=10).
  • 86% of patients were triaged to the appropriate pre-admission process (n=22).
  • Number of request for admission forms screened within two days of receipt increased from 0% in August 2016 to 17% in October 2016 (n=22).
  • The number of patients with no documented screening on their request for admission form reduced from 22% in August 2016 to 0% in October 2016 (n=22).
  • Team huddles have identified additional opportunities to improve OT efficiency, as well as patient and staff safety.
  • Staff have reported improvements in OT teamwork, communication and efficiency.

Lessons learnt

  • Good project management tools such as Gantt charts are essential.
  • The Accelerating Implementation Methodology change management framework works and is now used on a daily basis.

Related project

Operating Theatre Efficiency

Further reading

  • Jain AL, Jones KC, Simon J et al. The impact of a daily pre-operative surgical huddle on interruptions, delays, and surgeon satisfaction in an orthopedic operating room: a prospective study. Patient Safety in Surgery 2015; 9: 8.


Leanne Davey
Nurse Manager Perioperative Services
Shoalhaven Hospital
Illawarra Shoalhaven Local Health District
Phone: 02 4423 9419

Raeline Phillips
Registered Nurse
Shoalhaven Hospital
Illawarra Shoalhaven Local Health District
Phone: 02 4423 9298

Kerrie O’Leary
Clinical Redesign Coordinator
Illawarra Shoalhaven Local Health District
Phone: 0476 821 727

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