Ontario’s healthcare system is complex and historically patients going for surgery were all seen in the clinic with standard bloodwork and tests. In 2015, following Choosing Wisely Canada’s initiative “Drop the Preop”, the surgical team developed and implemented a patient-centered experience in the Pre-operative Assessment Clinic (PAC) with a reduction of unnecessary visits/investigations that ultimately resulted in shorter PAC appointments and minimize costs. An inter-professional quality improvement (QI) initiative was undertaken to reorganize a high-volume PAC. The goal was to create a PAC that efficiently optimizes patients for surgery using-medically and fiscally responsible practice guidelines for care while minimizing day of surgery cancellations. 

 The Surgical Program Services: 

  • 13 ORs’ 
  • 1 Block Room 
  • 1 Cystoscopy suite 
  • 4 Endoscopy rooms 
  • 1 Bronchoscopy room 
  • Orthopaedic Unit 36 beds 
  • Surgical & Short Stay Unit (SSU) 39 beds + 11 Short Stay Unit (SSU) beds 
  • 2 ORs: Ophthalmology 
  • 1 Cystoscopy room 


  • 5,870 inpatients 
  • 16929 outpatients 

Using a quality improvement methodology, and inter-professional approach was taken to create processes that: 

  1. Increase completeness of charts 
  2. Improve efficacy with booking appointments 
  3. Decrease medically unnecessary investigations/consultations 
  4. Implement a patient grid that provides a guideline based on patient and surgical criteria 
  5. Create a patient prompt appointment reminder process to decrease no-shows for clinic appointment 

After implementation in February 2015, we have sustained a consistent improvement of all processes and in addition increased access to urgent and emergent preoperative request. The preoperative grids developed by NYGH is now available on the Choosing Wisely Canada website. 

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