By Caroline Britt, Director of Sales Development & Enablement

Between a surgical order and the OR, a specialty practice coordinates the operational requirements needed for the intended case to proceed. The exact sequence varies, but it may include insurance authorization, medical clearance, documentation, patient preparation, equipment, facility requirements, scheduling, and cross-team handoffs.

The order creates intent, not readiness

The surgeon’s decision to operate starts the process. It does not mean the case is ready. Teams still need to collect information, confirm requirements, coordinate the patient and facility, and resolve exceptions. Research bears this out. One prospective study following elective surgery cases from scheduling through the operating room found that most cancellations occurred before the day of surgery, driven by patients not yet being ready or by unresolved organizational requirements rather than anything that happened on the day itself.¹

This is why a surgical date alone is not a complete operating view. Leaders need to understand the pipeline before and behind the calendar.

A practical order-to-OR map

• Order intake: Capture the decision to operate and the information needed to start work.
• Requirements: Identify payer, clinical, patient, equipment, documentation, and facility needs.
• Scheduling and coordination: Align surgeon, patient, facility, and available resources.
• Readiness review: Confirm completed work and surface unresolved exceptions.
• Final preparation: Communicate instructions, changes, and handoffs.
• Performed case and follow-through: Record the outcome and learn from delays, reschedules, and cancellations.

Not every practice uses these exact labels. The point is to agree on a shared sequence and the evidence needed to move from one stage to the next.

Where cases commonly stall

Stalls often occur at handoffs: waiting for authorization, missing documentation, unclear clearance status, patient communication, facility-specific requirements, or an exception without a clear owner. Studies of day-of-surgery cancellations find the same two categories driving most of them: patients not being medically fit for the planned operation, and organizational constraints such as bed or theatre availability.² Both trace back to requirements that went unresolved earlier in the process. If the risk is tracked in personal notes or inboxes, it is difficult to support coverage or intervene early.

What leaders should ask

• Can we see every intended case, not only scheduled cases?
• Do ready, at risk, and stalled have agreed definitions?
• Is the reason for risk visible?
• Does every material exception have an owner and next action?
• Can we identify recurring issues across teams, locations, and facilities?

Surgimate supports a shared order-to-OR view that connects leadership visibility with coordinator workflow.

Map your surgical journey from order to OR.

References

1. Turunen E, Miettinen M, Setälä L, Vehviläinen-Julkunen K. Elective surgery cancellations during the time between scheduling and operation. J Perianesth Nurs. 2019;34(1):97-107. doi:10.1016/j.jopan.2017.09.014
2. Dimitriadis PA, Iyer S, Evgeniou E. The challenge of cancellations on the day of surgery. Int J Surg. 2013;11(10):1126-1130. doi:10.1016/j.ijsu.2013.09.002