Date of Graduation

Summer 8-4-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Liesel Buchner

Second Advisor

Sara Horton-Deutsch

Third Advisor

Dave Ainsworth

Abstract

Problem: Same-day surgical cancellations in the outpatient surgery setting remain a significant operational and patient care challenge. Preventable cancellations negatively affect patient experience, operating room efficiency, staff productivity, and healthcare costs. 

Context: A microsystem and organizational culture assessment identified several factors contributing to same-day cancellations, including unclear preoperative instructions, incomplete medical clearance, inconsistent patient education, lack of standardized workflows, unclear staff responsibilities, and communication gaps among interdisciplinary teams. SWOT and gap analyses were used to identify opportunities for improvement and guide intervention planning.

Interventions: Quality improvement interventions were implemented through iterative Plan-Do-Study-Act (PDSA) cycles. Strategies included revising preoperative patient instructions, implementing a standardized preoperative checklist, enhancing day-before-surgery confirmation calls, conducting 48-hour preoperative chart reviews, and strengthening interdepartmental communication through structured communication processes. Interventions focused on improving patient preparedness, workflow standardization, and interdisciplinary collaboration.

Measures: Primary outcome measures included the same-day surgical cancellation rate. Process measures assessed adherence to the standardized preoperative workflow, completion of preoperative chart reviews, and confirmation call compliance. Balancing measures evaluated workflow feasibility, overtime hours, and operational impact on staff.

Results: Over a three-month implementation period, the same-day cancellation rate decreased from 11.9% to 10.1%, demonstrating measurable improvement toward the organizational goal.  Improved adherence to standardized workflows enabled earlier identification of patient readiness concerns and strengthened communication among care team members.

Conclusions: This project demonstrated significant implications for both clinical and operational practice in the outpatient surgery setting. Findings indicate that reducing same-day surgical cancellations requires a coordinated, standardized, and patient-centered approach supported by early intervention, clear communication, interdisciplinary collaboration, and continuous quality improvement methodologies.

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