By Sarah Miracle, BSN, RN
A patient’s surgical journey does not begin when the stretcher reaches the operating room. For hospitalized patients scheduled for surgery, much of the preparation occurs hours before that transition on the inpatient nursing unit.
Yet the transition from the floor to perioperative services can involve multiple handoffs, competing priorities, time-sensitive requirements and information documented in different places. When preparation is incomplete or responsibilities are unclear, concerns may not be identified until the patient arrives in the preoperative or holding area.
A standardized preoperative readiness process can help change that.
The goal is not to create another burdensome checklist. Instead, the goal is to give nurses a concise cognitive aid that answers a simple question:
“Is this patient appropriately prepared for the next step in their surgical journey, and if not, who needs to know?”
What Does “Ready” Mean?
Preoperative readiness should be individualized to the patient, procedure, anesthesia plan and organizational policy. A readiness checklist could prompt the inpatient nurse to verify or address:
- Patient identification and planned procedure
- Required consent and documentation
- Allergies
- NPO/fasting requirements
- Medication considerations
- Relevant laboratory and diagnostic information
- IV access and site assessment
- Procedure-specific preparation
- Changes in the patient’s clinical condition
- Outstanding concerns requiring communication or escalation
The checklist would complement and not replace clinical judgment, organizational policy, procedural verification, site marking or the surgical time-out.
Why Standardize?
Nurses work in complex environments where variation is inevitable. Standardization can reduce reliance on memory and make important steps more visible.
The World Health Organization’s Surgical Safety Checklist emphasizes structured communication, multidisciplinary participation, local adaptation, leadership support and ongoing feedback.¹ These principles can be extended upstream to the inpatient unit.
The key is to design the process with the nurses who will actually use it.
Make It a Team Process
Preoperative readiness crosses professional boundaries.
Inpatient nurses understand the patient’s current condition and bedside workflow. Perioperative nurses understand the requirements of the surgical pathway and the gaps that can create delays once a patient arrives in holding. Anesthesia professionals and proceduralists provide procedure-specific requirements and escalation pathways.
Together, these groups can define:
What must be completed?
Who owns each item?
What requires escalation?
When is the patient ready for transport?
Clear ownership is just as important as the checklist itself.
Start Small
A readiness initiative does not need to begin with an organization-wide rollout.
A small pilot can test the process on one inpatient unit or with a defined surgical population. Using Plan-Do-Check-Act cycles allows frontline staff to identify what works, what creates unnecessary duplication, and what needs to change.
Measures could include:
- Checklist completion
- Readiness-related delays
- Outstanding issues identified before transport
- Staff usability
- Time required to complete the process
- Unintended documentation burden
The objective is not simply to achieve 100% checklist completion. The objective is to determine whether the process actually improves communication and reliability.
Leadership Beyond a Job Title
Nurses do not need a formal leadership position to improve a system.
Recognizing a recurring problem, bringing the concern forward, collaborating across departments, developing a practical solution, testing the change and learning from the results are all forms of nursing leadership.
Preoperative readiness is an opportunity for perioperative nurses to extend patient-safety thinking beyond the walls of the OR.
The ultimate goal is simple: Patients should arrive for surgery prepared, appropriately assessed and supported by clear communication.
When the inpatient unit and perioperative team share that expectation, the handoff becomes more than a transfer of a patient it becomes a coordinated transition in care.
References
1. World Health Organization. Implementation Manual WHO Surgical Safety Checklist 2009: Safe Surgery Saves Lives. World Health Organization; 2009.
2. The Joint Commission. National Performance Goal #1: Right Patient, Right Care. Updated January 9, 2026.
