# The Effectiveness of a Preoperative Check-and-Consent Clinic in Reducing Day-of-Surgery Cancellations in Elective Hand Surgery: A Retrospective Service Evaluation

## TL;DR

A pre-surgery check-and-consent clinic reduced last-minute cancellations and improved efficiency in hand surgery.

## Contribution

Introduces a low-cost, surgeon-led clinic to reduce day-of-surgery cancellations in elective hand surgery.

## Key findings

- 43.9% of patients had their management plans changed after the clinic visit.
- At least 30.3% of potential day-of-surgery cancellations were avoided.
- The clinic resulted in net financial savings for the NHS.

## Abstract

Day-of-surgery cancellations (DoSC) waste resources, increase costs, and cause patient dissatisfaction. They are common and often preventable. With growing reliance on allied healthcare professionals and virtual clinics, patients can be listed without surgeon review or a Montgomery-compliant consent process, leading to last-minute changes. A surgeon-led "check-and-consent" clinic was introduced to reduce potential DoSC in elective hand surgery.

A retrospective review was conducted of patients scheduled for elective day-case hand surgery and seen in the check-and-consent clinic (April 2022-January 2024). A consultant surgeon reassessed symptoms, reconfirmed consent, adjusted management as required, and obtained written consent. Primary outcomes were management changes and potential DoSCs avoided. Secondary outcomes included cost impact using National Health Service (NHS) tariffs.

Sixty-seven patients were scheduled; one did not attend, leaving 66 analyzed (mean age, 58.1 years). Carpal tunnel syndrome was the most common diagnosis (77.3%). Management changed in 29 patients (43.9%): 12 were converted to nonoperative care, eight declined or did not require treatment, and nine had a modified surgical plan. A minimum of 20 DoSCs (30.3%) were avoided. Cost analysis demonstrated net financial savings after accounting for clinic costs.

A dedicated check-and-consent clinic reduced avoidable DoSCs, improved theater efficiency, and reinforced the principle of shared decision-making. This low-cost intervention offers measurable clinical and economic benefits and could be adopted in other elective surgical pathways.