Saved by the Phone: Enhancing the Pre-admission Process

Staff at Blue Mountains District ANZAC Memorial Hospital (BMDAMH) implemented a standardised phone screening tool with fasting instructions, to prepare patients for their surgical procedure.


To ensure 100 per cent of patients arriving at BMDAMH are fully informed and prepared for their surgical procedure, by December 2017.


  • Improves patient safety and health outcomes following surgery.
  • Reduces the risk of cancellations on the day of surgery.
  • Enhances the productivity and efficiency of surgical theatres.
  • Streamlines the pre-admission process before surgery.
  • Improves staff satisfaction and efficiency in the workplace.
  • Increases patient compliance and understanding of fasting and surgical instructions before arriving at the operating theatre.
  • Improves the patient experience and health care journey.


When patients are booked for a surgical procedure, they either attend a pre-admission clinic (if they have more than one condition) or ring the bookings clerk to confirm their arrival time at the hospital, before they are admitted on the day of their surgery. The clinic provides the patient with information about the procedure, reviews their medical history, performs any tests required and identifies any risk factors that may cause complications. This process aims to increase patient safety and reduce the risk of cancellations on the day of surgery.

In March 2017, surveys were conducted with patients and staff in the Day Unit, to measure the performance of the booking process and identify areas for improvement. Results showed that patients, families and carers often received incorrect or inconsistent information from the bookings clerk, or did not hear or understand the information provided. Inconsistencies were mostly associated with incorrect fasting before surgery, and a lack of understanding about how to use regular medications before and on the day of surgery. These inconsistencies led to an increased number of surgical cancellations, reduced productivity and an ineffective use of hospital resources.

Following consultation with anaesthetists and nursing staff, it was determined that standardising materials for patients and streamlining the pre-admission process would help patients understand the importance of fasting correctly before surgery and clarify their concerns, as well as help them understand what to expect before and on the day of surgery. It was expected that this would reduce the number of cancellations and improve the patient’s health care experience.


  • Consultation was undertaken with anaesthetists and other clinicians involved in the pre-admission clinic, to identify the challenges with the pre-admission process and areas for improvement.
  • Feedback from nursing staff showed that information provided to patients could be improved and would be more appropriate and consistent if presented by a clinician from the Day Unit.
  • A standardised question sheet was developed, to help staff convey the correct information and cover off all aspects of the pre-admission process. View the question sheet
  • Nursing staff contacted patients by phone the night before surgery, to go through the question sheet and address any concerns they may have.


Sustained – The project has been implemented and is sustained in standard business.


  • Project start: March 2017
  • Solution developed: April 2017
  • Solution trial period: November - December 2017
  • Solution implemented: January 2018
  • Project evaluation: April 2018

Implementation site

Blue Mountains District ANZAC Memorial Hospital, NBMLHD


Clinical Excellence Commission Clinical Leadership Program


A full evaluation of the standardised document will be conducted in 2018, to determine whether it informed patients and prepared them for their surgical procedure. The following outcomes will be measured during the evaluation:

  • the number of surgical cancellations and reasons for the cancellation
  • staff surveys to measure satisfaction and feedback on the new process
  • patient surveys to measure their understanding of pre-admission instructions, and clarify their understanding of and satisfaction with their health care journey
  • cost savings achieved during a three month period, taking the type of surgical procedure and total cancellation rate into consideration.

Lessons learnt

  • The time constraints associated with leading a project and undertaking a full workload can be challenging.
  • There were significant challenges with engaging nursing staff to complete the surveys, provide feedback on initial suggestions and understand the benefits that a change in clinical practice can bring to the unit.
  • There were time constraints associated with helping patients complete their surveys.
  • Completing the Ethics Committee application was an essential yet complex process and demonstrated the importance of documenting the project clearly.
  • The project highlighted the importance of persistence and belief in change. While it can be hard work, the efforts made to advocate for patients and improve clinical practice are worth it.

Further reading

NSW Agency for Clinical Innovation. Operating Theatre Efficiency Guidelines: A guide to the efficient management of operating theatres in New South Wales hospitals. Chatswood, NSW: ACI; 2014.


Louise Mackie
Clinical Nurse Specialist
Blue Mountains District ANZAC Memorial Hospital
Nepean Blue Mountains Local Health District
Phone: 02 4784 6540


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EfficiencyPatient safetySurgeryNepean Blue MountainsMetropolitanClinical Leadership Program
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