Posted on May 5, 2025
Burnaby Hospital is reducing last-minute surgical cancellations and improving patient readiness through an innovative prehabilitation program. Funded by a grant from Doctors of BC, through the Specialist Services Committee (SSC) and its Perioperative Clinical Action Network (PCAN), the program aims to optimize patient health and streamline the surgical pathway. This initiative emerged from frustrations among anesthesiologists and surgeons who found that pre-admission assessments occurred too late for meaningful intervention.
Dr. Yotis Tsaparas, a surgeon and key member of the pre-admission clinic committee, highlights the need for change. “Patients were being assessed too close to their surgical dates, leaving little time for intervention and often resulting in cancellations. We needed to shift the timeline of events earlier to allow for better pre-surgical optimization.”
Recognizing the need for a more structured approach, the committee – which includes anesthesiology and surgical leads, nursing management, pre-admission clinic staff, and OR administrators – worked to refine the process and improve patient outcomes.
A crucial element of identifying areas for improvement included conducting a time study across various departments that support the patient’s journey to surgery. From September 2024 to January 2025, multiple time studies were completed as part of a gap analysis to identify workflow inefficiencies across OR booking, health records, pre-admission clinic and anesthesiology. This data-driven approach revealed different bottlenecks and inefficiencies, offering valuable insights for targeted improvements. The team observed various pieces of information and also collected qualitative information from subject matter experts within each department, who provided insights into tasks or processes that can be improved, are working well or should be evaluated further. Seemingly small issues can have significant downstream impacts, therefore the completion of multiple departmental time studies helped capture inefficiencies that could affect the likelihood of surgery cancellations or timely access to critical information. The data from these time studies will enable the Burnaby team to identify key areas for improvement and make informed, impactful changes.
“Prehabilitation is about getting patients in the best possible shape, both physically and mentally, before surgery,” says Dr. Tsaparas. “This not only improves surgical outcomes, but also reduces the likelihood of cancellations due to preventable health issues.” The current system, however, presents significant obstacles. Currently, patient charts, once received at the hospital are filed away until a patient is assigned a surgical date. This creates a critical gap in the pre-surgical window." According to Dr Tsaparas, this ‘limbo’ period is a lost opportunity to optimize patient health.
The prehab program is tackling this challenge with key strategies, including a pilot led by a team of anesthesiologists under the leadership of Dr. Tsaparas. Scheduling anesthesia consults immediately after surgical consent allows for earlier issue identification and intervention. He notes that through improved staffing and policy changes, the hospital has been able to shift pre-surgical anesthesia consults from three days pre-op to ten days. This is already a significant improvement, with a long-term goal of moving them to four to six months in advance to align with wait times and enhance prehabilitation.
Another crucial component is the push for digitalization. Moving from paper-based charts to a fully integrated digital system will enhance communication, minimize clerical errors, and support remote consultations. Dr. Tsaparas emphasizes that relying on paper records is inefficient and cumbersome, highlighting digitalization as a key step in optimizing the prehabilitation pathway. This effort also aligns with provincial initiatives, such as the development of a digital pre-admission solution.
One metric of the program’s success will be measured by its impact on day-of-surgery cancellations, with a target reduction of 40%. The team will re-evaluate progress in the coming months. This initiative is not just about reducing cancellations – it’s about creating a more patient-centered approach to surgical care. “By empowering patients to actively participate in their pre-surgical preparation,” he concludes, “we can improve their overall experience and achieve the best possible outcomes.”
