Good Morning,

Last week, we examined the revenue crisis lurking in your pre-op suite – the aggregate cost of preventable cancellations that often goes unnoticed. This week, we're getting practical. Specifically, we'll focus on the one clinical interaction that differentiates high-performing ASCs from the average, and the 4-minute framework that makes it effective.

Most ambulatory surgery centers make a pre-op phone call. Very few make it well.

The standard pre-op call runs under three minutes. It confirms the appointment, reviews NPO instructions, and answers questions. It is scripted, transactional, and completed by whoever has time. The box gets checked. The call gets documented. The patient hangs up.

And then they arrive on procedure day without having followed the instructions.

Not because they're careless. Because the call didn't function as a clinical intervention. It functioned as a notification, and notifications are easy to ignore.

The research consistently demonstrates that passive instruction delivery leads to significantly lower compliance compared to active verbal commitment. [1] Asking patients to verbally confirm their actions yields measurable differences in outcomes compared to simply telling them what to do. This principle is well-established in behavioral health, where stating an intention aloud has been shown to increase the likelihood of follow-through. [2]

This is not a communication problem. It is a clinical design problem. And it has a clinical design solution.

The 4-Minute Pre-Op Verification Framework

The following protocol adds approximately 4 minutes to a standard pre-op call. In outcome terms — cancellations prevented, OR time protected, surgeon trust maintained — the return on those 4 minutes is not close.

Call timing: 48–72 hours before procedure. Not the night before.

Night-before calls catch problems too late to resolve them. A missing clearance discovered at 6 PM the evening before a 7 AM procedure is essentially unresolvable. The same problem discovered 48 hours prior has multiple resolution pathways. Timing is not a logistical preference — it is a clinical variable.

Minute 1 — NPO Active Commitment

Do not say: "Remember, nothing to eat or drink after midnight."

Say: "Walk me through what you've eaten today and what your plan is for tomorrow morning before you come in."

The difference isn't just superficial. The first statement provides information, while the second prompts the patient to create and verbalize a plan, which research consistently demonstrates leads to greater compliance than simply receiving instructions passively. [1]

If they describe a morning routine that includes coffee or breakfast, you catch the problem during this call. Not at 0630 in your pre-op holding area.

Minute 2 — Medication Reconciliation (Three Priority Categories)

Do not rely on the intake form alone. Ask specifically about three categories that intake forms consistently miss or underreport:

GLP-1 receptor agonists: Ozempic, Wegovy, Mounjaro, Rybelsus, Trulicity. Patients often don't recognize these as surgery-affecting medications. The ASA's 2023 guidance recommends holding weekly GLP-1 medications one week before elective procedures due to the risk of delayed gastric emptying [3]. Your pre-op call is often the last chance to identify this.

Blood thinners and anticoagulants: Including newer agents like apixaban (Eliquis) and rivaroxaban (Xarelto) that patients may not associate with "blood thinners."

Insulin and diabetes medications: Dose adjustment protocols vary by procedure and anesthesia type. Confirm the patient has received specific guidance from their PCP or endocrinologist — do not assume the surgeon's office communicated this.

Minute 3 — Clearance and Transportation Confirmation

Check your system before the call ends. Do not assume clearance came through.

If it is not in your system, initiate the follow-up during the call: "I'm showing we're still waiting on your clearance from Dr. [name]. I'm going to follow up with their office today — is this the best number to reach you if we need anything?"

This converts a passive documentation gap into an active resolution workflow — during the call, not the morning of surgery.

Transportation: Don't just confirm they have a driver; verify the driver knows the exact procedure time, the correct facility address, and is available on the day. Lack of confirmed transportation is a leading cause of same-day no-shows. [4]

Minute 4 — Anxiety Screen

Ask one question: "How are you feeling about the procedure?"

This is not small talk. Elevated pre-operative anxiety is a documented predictor of day-of refusals, last-minute cancellations, and post-operative complications. [5] A 60-second acknowledgment and reassurance conversation—validating that their feelings are normal, confirming the team is prepared, and providing a direct callback number—prevents outcomes that no amount of day-of intervention can reverse.

Patients who feel heard before procedure day arrive. Patients who feel like a scheduled unit sometimes don't.

→ Download the free Pre-Op Cancellation Cost Calculator to see how much your current cancellation rate is costing your ASC annually: Pre-op Cancellation Cost Calculator

For charge nurses and pre-op coordinators. Each point requires active patient response, not passive confirmation.

☐ NPO — Patient verbalizes tomorrow morning plan. Not just "yes, I understand."

☐ Medications — GLP-1, anticoagulants, and insulin specifically asked about by name.

☐ Clearance — Confirmed in system before call ends. Follow-up initiated if missing.

☐ Transportation — Driver name confirmed. The driver knows the time and location, and has the day available.

☐ Anxiety — "How are you feeling?" asked and answered. Callback number provided.

Call timing: 48–72 hours pre-procedure. Document all five points.

Curated intelligence from the perioperative space this week.

The Joint Commission's focus on pre-operative documentation gaps is intensifying. Recent survey findings continue to cite pre-operative assessment deficiencies as a leading contributor to adverse events and near-misses in ambulatory surgical settings. ASCs preparing for accreditation review should audit their pre-op call documentation protocols now—the standard is not simply that calls are made, but that they are structured, documented, and clinically defensible.

Anesthesia staffing shortages are putting pressure on pre-op workflows. The post-pandemic CRNA shortage persists, and many ASCs are absorbing the operational strain of reduced anesthesia coverage directly into pre-op processes. When pre-op workflows are rushed or compressed, verification steps get skipped, leading to higher cancellation rates. Systematizing the pre-op call protects quality, regardless of staffing pressures.

Medicare's ambulatory surgery center quality reporting requirements are expanding. CMS continues to add patient safety and outcome metrics to the ASC Quality Reporting Program. Pre-operative complication rates and case cancellation data are increasingly visible to payers and referring physicians. ASCs with documented readiness protocols are better positioned as quality reporting requirements tighten.

The patient paused when I asked her to walk me through her morning plan. Then she said, "Actually, I was going to take my morning pills with a small glass of water. Is that okay?"

It was not okay. She was on an anticoagulant that required holding before her procedure. No one had specifically confirmed this with her. She had been told at intake, but the instruction had not registered as applying to her morning routine.

That conversation took 90 additional seconds. It prevented a same-day cancellation, a rescheduling headache, and a potential adverse event.

The pre-op call is not paperwork. It is the last clinical gate before a patient enters your facility. Design it accordingly.

Sources & Methodology

^{All data cited in OR Edge Morning Report is drawn from peer-reviewed literature, government reports, or professional association guidance.}

^{[1] Patient instruction compliance and active verbal commitment: Ley P. Communicating with Patients: Improving Communication, Satisfaction and Compliance. Chapman & Hall, 1988. Updated evidence in: Zolnierek KB, Dimatteo MR. "Physician communication and patient adherence to treatment." Medical Care, 2009.}

^{[2] Behavioral intention and follow-through: Gollwitzer PM. "Implementation intentions: Strong effects of simple plans." American Psychologist, 1999.}

^{[3] GLP-1 receptor agonists perioperative management: American Society of Anesthesiologists. Consensus-Based Guidance on Preoperative Management of Patients on GLP-1 Receptor Agonists, June 2023. asahq.org}

^{[4] Transportation as a cancellation cause: Tait AR, et al. "Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families." Journal of Clinical Anesthesia, 1997. (Transportation cited among top causes across ambulatory surgery populations.)}

^{[5] Pre-operative anxiety and outcomes: Caumo W, et al. "Risk factors for preoperative anxiety in adults." Acta Anaesthesiologica Scandinavica, 2001.}

That is Issue 002!

Forward this to one pre-op nurse or ASC administrator who runs the pre-op call process at their center. This protocol is most valuable in the hands of the person making the calls.

Reply with how your center currently structures the pre-op call — I read every response and it directly shapes what comes next.

See you next Tuesday at 0700.

Yetsenia Tyson, RN, Founder,

Haleris Publisher, OR Edge Morning Report