Issue 001 · Tuesday, March 3, 2026 | OR Edge Morning Report

Good Morning,

Welcome to the first issue of OR Edge Morning Report.

Every Tuesday at 0700, this briefing delivers one thing: clinical intelligence that actually reflects what happens inside the OR. Not press releases. Not generic healthcare content. The kind of insight that comes from 10+ years of perioperative nursing — filtered through the lens of someone building a solution to the problems I watched repeat themselves every single week.

Let's get into it.

The $47,000 Question Every ASC Administrator Should Be Asking

Here is a number worth sitting with: the average ambulatory surgery center running 2,400 cases per year with an 8% cancellation rate is losing approximately $47,000 annually in direct revenue [1] — before you account for a single hour of wasted OR time.

Add the OR time cost, and that number climbs past $90,000.

That figure comes from running the math that most ASC administrators have never formally done. Not because they don't care — but because no one handed them the formula.

The problem is not that ASCs are poorly run. Most are not. The problem is that pre-op failure has been normalized. It gets logged as a "cancellation" in the scheduling system, the slot gets filled or doesn't, and the day moves on. The cost never appears on a single line item. It hides in the aggregate.

Here is what makes this particularly expensive: the majority of those cancellations are preventable.

Published data consistently shows that 20–40% of surgical case cancellations are directly attributable to pre-operative factors [2] — NPO non-compliance, incomplete clearances, unresolved medication conflicts, and missing labs. Every one of those is a systems failure, not a patient failure. Patients do not arrive unprepared because they are careless. They arrive unprepared because the pre-op process failed to close the loop before procedure day.

The distinction matters enormously. A patient failure is unpredictable. A system failure is fixable.

The ASCs achieving cancellation rates below 3% – and they do exist – are not operating with better patients. They are operating with better pre-op systems. Systematic NPO verification. Structured clearance tracking. Pre-op communication that functions as a clinical intervention rather than a courtesy call.

The difference between a 3% and an 8% cancellation rate, with 2,400 cases annually, results in a loss of approximately $47,000 in direct revenue each year. And this loss is recurring and entirely preventable.

That is not a scheduling problem. That is a clinical operations problem with a clinical operations solution.

→ Want to calculate your ASC's specific number? The free Pre-Op Cancellation Cost Calculator runs your real figures in under 60 seconds: Pre-op Cancellation Cost-Calculator

The Pre-Op Call Restructure: One Change, Measurable Impact

Most ASCs treat the pre-op phone call as a reminder. Confirm the appointment. Review NPO instructions. Answer questions. Scripted, transactional, and completed in under three minutes.

That call, reframed as a clinical intervention, is where the majority of preventable cancellations are caught.

Here is the framework used in high-performing ASCs:

The 5-Point Pre-Op Verification Protocol

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

Point 1 — NPO Verification (not reminder) Do not say: "Remember, nothing to eat or drink after midnight." Say: "Walk me through what you've had to eat and drink today and what your plan is for tomorrow morning." Active verbal commitment dramatically improves compliance over passive instruction.

Point 2 — Medication Reconciliation: Ask specifically about GLP-1 agonists (Ozempic, Wegovy, Mounjaro), blood thinners, and insulin. These three categories cause the most day-of surprises. Do not rely on the intake form alone.

Point 3 — Clearance Confirmation: Do not assume clearance came through. Confirm it in the system before the call ends. If it is not there, initiate the follow-up during the call — not the morning of surgery.

Point 4 — Transportation Verification: Confirm the driver. Not just that, they have one — confirm the driver knows the procedure time and location. Lack of a confirmed driver is a top-five reason for same-day cancellations.

Point 5 — Anxiety Screen: Ask one question: "How are you feeling about the procedure?" Elevated pre-op anxiety correlates with day-of no-shows and last-minute refusals. A 60-second reassurance conversation here prevents a 4-hour disruption to the schedule later.

This protocol adds approximately 4 minutes to the pre-op call. The return on those 4 minutes, in cancellations prevented, is not close.

GLP-1 medications and surgical risk [4] remains the conversation no ASC has fully solved. Anesthesiologists continue to raise concerns about aspiration risk in patients on semaglutide and similar medications, particularly given the delayed gastric emptying effects that can persist beyond standard NPO windows. The American Society of Anesthesiologists has issued guidance, but implementation varies widely across ASCs. If your pre-op protocol does not include a specific GLP-1 screening question, this is the week to add it.

ASC volume growth is outpacing pre-op infrastructure [3]. Industry data continues to show that case volume migration from hospital ORs to ASCs is accelerating — driven by payer incentives and patient preferences. The operational implication: pre-op systems designed for lower volume are being asked to manage higher complexity and higher throughput simultaneously. The centers that scale their readiness infrastructure now will absorb this growth. The ones that don't will see their cancellation rates climb.

Workforce retention in perioperative nursing remains a pressure point [5]. Burnout among OR and pre-op nurses continues to rank among the top reasons for departure. One underreported driver: the chronic stress of day-of cancellation scrambles. When pre-op systems fail repeatedly, the staff absorbing that failure burn out faster. Readiness systems are not just a revenue protection tool — they are a retention tool.

I remember the shift where I finally stopped being surprised by last-minute cancellations.

Not because they stopped happening. Because I understood why they kept happening.

A patient arrived for a knee scope. NPO non-compliant — she had taken her morning medications with a full glass of water and a small breakfast because, as she explained calmly, "No one told me not to."

The pre-op call had happened. The instructions had been given. The box had been checked.

But no one had verified. No one had asked her to repeat back what she understood. No one had caught that her morning routine was so automatic she hadn't connected the instruction to her actual behavior.

That case was canceled. The surgeon was frustrated. The slot sat empty for two hours. And the patient — who had taken time off work, arranged childcare, and mentally prepared for a procedure she was anxious about — went home feeling like she had failed.

She hadn't failed. The system had.

That is the moment I started thinking about pre-op differently. Not as documentation. Not as instruction delivery. As a clinical intervention with a measurable outcome: a prepared patient arriving on a scheduled day.

Everything I write in this newsletter comes back to that framing.

Sources & Methodology

_{All data cited in OR Edge Morning Report is drawn from peer-reviewed literature, government reports, or professional association guidance. Calculations apply published ranges to illustrative ASC baseline figures.}

_{[1] Case cancellation revenue loss: Shippert RD. American Journal of Cosmetic Surgery, 2005; Tzong KY et al. Anesthesia & Analgesia, 2012.}

_{[2] Preventable cancellation rate: Dimitriadis PA et al. British Journal of Anaesthesia, 2013; Ferschl MB et al. Anesthesiology, 2005.}

_{[3] ASC volume growth: Medicare Payment Advisory Commission (MedPAC). Report to Congress: Medicare Payment Policy, March 2023. medpac.gov}

_{[4] GLP-1 perioperative risk: American Society of Anesthesiologists. Consensus-Based Guidance on Preoperative Management of Patients on GLP-1 Receptor Agonists, June 2023. asahq.org}

_{[5] Perioperative nursing workforce: AMN Healthcare 2023 Survey of Registered Nurses; AORN Perioperative Nursing Workforce Survey, 2022. aorn.org}

If this was valuable, forward it to one colleague in your ASC or hospital who would benefit. Every perioperative professional who gets better information makes the system work better for patients.

Reply to this email oredgemorningreport.com with your biggest pre-op challenge. I read every response.

See you next Tuesday at 0700

Yetsenia Tyson, RN, Founder

Haleris Publisher, OR Edge Morning Report