Patient Safety Topics
Screening/Assessment, ASF

The tools contained in this Patient Safety Topic provide ambulatory surgical facilities (ASFs) the ability to track cancellation and transfer rates, collect event information, and evaluate the costs of cancellations.

There are opportunities to use the data to identify and incorporate enhancements to nurse-driven preoperative screening and assessment processes, including the use of health literacy strategies and additional preoperative phone calls. As enhancements are implemented, continual tracking of these events offers facilities ongoing feedback to evaluate the value of changes made to the nurse-driven preoperative screening and assessment process.

Key Data and Statistics

In 2010, Pennsylvania ambulatory surgical facilities (ASFs) reported 3,648 events to the Pennsylvania Patient Safety Authority; 66% (n = 2,403) of these events were reported as “Incidents” and 34% (n = 1,245) of these events were reported as “Serious Events.” Of the reported serious events, 34% (n = 423 out of 1,245) indicated that the patient was transferred from the ASF to an acute care hospital. ASFs also reported 335 cancellations of procedures on the day of surgery.

The Authority initiated a regional ASF collaboration to examine presurgical screening and assessment processes and the frequency of ASF transfers and cancellations. Observations from during the collaboration include those below.

Figure. Transfer Rates: Participating Pennsylvania Ambulatory Surgical Facilities and National Ambulatory Surgical Center Quality Collaboration Facilities

Excerpted from: Gardner LA, Bomboy J. Preoperative screening and the influence on cancellations and transfers: an ambulatory surgical facility collaboration. 2014 Mar.


Table. Reasons for Ambulatory Surgical Facility Day-of-Surgery Cancellations from December 2012 through June 2013 (N = 824), as Reported by Collaboration Participants ​ ​
Reason for CancellationNo. of
% of
Change in medical status*237 28.8
Preoperative instructions not followed10312.5
Procedure not rescheduled779.3
Rescheduled procedure526.3
Protocol issues516.2
Weather related*435.2
Financial issues303.6
Family issues/emergencies*192.3
Surgeon illness*192.3
Work related 40.5
Language barrier20.2 ​ ​
* These cancellation reasons collected during the collaboration are rarely amenable to a nurse-driven preoperative screening and assessment. ​ ​ ​

Excerpted from: Gardner LA. Tracking ambulatory surgical facility cancellations and transfers: lessons learned from an 18-month collaboration. 2014 Sep.    

Educational Tools

Ambulatory Surgical Facility Falls Risk Assessment Tool
Ambulatory surgical facilities can use this tool to screen patients for falls risk at three intervals: pre-admission, pre-operatively, and post-operatively.

Ambulatory Surgical Facility Preoperative Screening and Assessment Checklist
The components of this sample checklist are intended as a cue for ambulatory surgical facilities to confirm that the essential items needed for screening patients preoperatively are included on an existing nursing-based preoperative screening form.

Nursing Preoperative Screening
This sample form may be used for nursing preadmission before the day of surgery. This form may be used for telephone or in-person screening and modified per facility policy and procedure.

Health History
This sample form may be sent to the primary care physician or the referring physician for completion before the day of surgery. This form may be reviewed by anesthesia and nursing staff before the day of surgery, according to facility policy and procedures.

ASF Cancellation and Transfer Tracking Tool
Ambulatory surgical facilities can use this tool in tracking and trending day-of-surgery (DOS) cancellation and transfer rates, as well as event information and costs associated with DOS cancellations.


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