Date of Graduation

Spring 5-22-2026

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Family Nurse Practitioner

First Advisor

Dr. Victoria Chaudhary

Second Advisor

Dr. Jo Loomis

Abstract

Abstract

Background: Ambulatory surgery centers (ASCs) require effective preoperative screening to ensure appropriate patient selection and minimize day-of-surgery (DOS) cancellations, which affect patient safety, operational efficiency, and financial performance.

Local Problem: In a Northern California ASC serving a racially diverse, predominantly older-adult population with a high burden of chronic diseases, the DOS cancellation rate was 3.84%, exceeding the 2.3% institutional benchmark. Inconsistent preoperative screening contributed to avoidable cancellations.

Methods: A pre- and post-intervention quality improvement design evaluated the effect of a standardized screening tool and staff education on DOS cancellations.

Interventions: The Preoperative Stoplight Tool, a color-coded triage system classifying patients as Green (ASC-appropriate), Yellow (optimization or anesthesia consult required), or Red (hospital-level care required), was implemented with staff education on risk stratification.

Results: Among 1,879 cases (pre n = 966; post n = 913), medically caused cancellations decreased from 27.0% to 8.3% of all cancellations (OR = 0.25, 95% CI [0.08, 0.74], p = .019). The overall DOS cancellation rate rose from 3.84% to 7.89% (p < .001), driven by a facility-level HVAC disruption accounting for 30.3% of post-implementation non-medical cancellations.

Conclusions: Standardized preoperative triage with staff education significantly reduced medically caused cancellations, supporting patient safety and patient-facility match. The rise in overall cancellations from a facility event illustrates the need to address non-clinical operational factors alongside clinical screening.

            Keywords: ambulatory surgery center; preoperative screening; triage; day-of-surgery cancellations; quality improvement

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