Date of Graduation

Spring 5-18-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. Juli Maxworthy, DNP, PhD (c), MSN, MBA, RN, CNL, CPHQ, CPPS

Second Advisor

Dr. Cathy Coleman, DNP, RN, CPHQ, CNL


Problem: Medical clearance is required for patients scheduled for surgery, also known as “patient optimization.” Ineffective and inefficient patient optimization is a major contributor to surgery postponements, procedure cancellations, and patient dissatisfaction.

Context: Ambulatory care clinics often lack resources to medically clear patients prior to scheduled surgery. Poor surgical optimization continues to occur on the same day of surgery, resulting in case cancellation or delay in a suburban, 169 bed community hospital with 9 operating rooms and approximately 500 surgical procedures per month.

Interventions: A nurse-led PreOp One Stop Shop (POSS) utilized a standardized checklist to perform preoperative surgical assessment.

Measures: System-generated reports assisted in ranking contributing factors that impacted day of surgery cancellations rates, outpatient care experience scores, and staff engagement metrics were reviewed and analyzed weekly between August 2021 to July 2022.

Results: A nurse-led POSS decreased the number of same-day surgical cancellations from 10% to 3%, improved the standardized patient care experience measures from 78% to 79%, and increased internal staff engagement scores from 72% to 77% by July 2022.

Conclusion: A standardized checklist and associated workflows are recommended for routine presurgical assessment to expedite medical clearance and promote reliable patient optimization.

The implementation of a nurse-led PreOp One Stop Shop (POSS) can lead to improved patient safety outcomes and add value for organizational metrics such as patient centered care and staff engagement.

Keywords: surgical cancellations; patient optimization; workflows; care experience; medical clearance; safety


Included in

Nursing Commons