ASC Pre-Op Calls: How AI Handles Day-of-Surgery Patient Communication

At 6:45 AM your first case is scheduled for 7:30. The patient isn’t in the waiting room. Your OR coordinator calls the cell phone on file. Voicemail. She calls again at 7:05. The patient picks up, groggy: “I didn’t think I had to be there until 9.”

That case is done. Your surgeon’s block just lost its opening slot.

Patient no-shows are the single largest driver of same-day cancellations in ambulatory surgery centers. Research published in PMC found that in ASC settings, patient no-show accounted for 75.8% of same-day case cancellations, with the overall cancellation rate running at 5.1%. In a center running 25 cases per day, that’s more than one case per day going sideways before the OR team finishes setting up.

The pre-op communication gap is what drives this. Patients schedule a surgery weeks in advance, receive a printed instruction sheet at their pre-op appointment, and then hear nothing from your facility until the day before at best. Over those weeks, they forget details. They get confused about NPO instructions. They lose track of what time to arrive. And some simply forget the surgery is happening at all.

AI voice agents solve this with proactive, automated pre-op calling that delivers the right information at the right time, without adding to your nursing or coordinator workload.

What patients actually need before surgery

The standard approach to pre-op patient communication was designed for a world where patients had one source of information and paid close attention to written instructions. Neither is true anymore.

Your patients are managing multiple medical appointments, medications, and family obligations. The folder of pre-op instructions they got three weeks ago is somewhere. They think. The NPO cutoff was midnight, or was it 8 PM for liquids? They’re not sure.

What patients need is not a more detailed instruction packet. They need the right information delivered at the right time, in a format they can respond to. Specifically:

Confirmation of surgery time and location. Patients should hear the exact report time, address, where to park, and where to check in, not at their pre-op appointment three weeks earlier, but two to three days before surgery when it’s actually relevant.

NPO instructions timed to their procedure. “Nothing after midnight” is outdated and often wrong. Current anesthesia guidelines typically allow clear liquids until two to four hours before surgery depending on the procedure. Patients need the specific cutoffs for their case, delivered within 48 hours of surgery so they don’t forget.

What to bring and what to leave home. Insurance cards, ID, a driver, no jewelry, leave contact lenses at home. This is the content of a hundred patient calls that happen the morning of surgery because nobody confirmed it beforehand.

A chance to ask questions. Some patients have questions they didn’t ask at their pre-op appointment. “Can I take my blood pressure medication this morning?” “What happens if I feel sick when I wake up?” Giving them a voice-response pathway before they arrive is better than getting those questions at check-in while your OR is waiting.

The phone call problem in ASC settings

Every ASC has some version of a pre-op call program. Typically, a nurse or coordinator calls patients 24 to 48 hours before surgery to confirm they’re coming, review NPO instructions, and answer questions.

The problem is that this program depends entirely on staff time, and staff time is finite. In a center running 20 to 30 cases per day, making 20 to 30 confirmation calls per day, plus handling callbacks from patients who didn’t answer the first time, plus managing the cases that actually need clinical follow-up, is a significant workload. Many centers cut corners by only calling the day before, which reduces the window to catch problems.

The other problem is consistency. When a pre-op call is made by a different staff member each time, patients get slightly different instructions. One coordinator explains the NPO rule one way. Another explains it differently. The inconsistency creates confusion, and confused patients cancel or show up wrong.

AI voice agents solve both problems. They make the calls on a consistent schedule, deliver standardized instructions, and scale infinitely regardless of how many cases are on the board that day.

How AI-driven pre-op calling works

The workflow starts when a case is scheduled. Once a case is booked in your surgical scheduling system, the AI agent is assigned the case and follows a defined pre-op communication protocol based on procedure type and case date.

48-72 hours before surgery: The AI places a call to the patient. It confirms the surgery date, time, and location. It delivers NPO instructions specific to that case. It asks the patient to confirm they have a driver arranged. It offers the patient the opportunity to ask questions or speak to a staff member.

24 hours before surgery: A second call confirms the patient is still planning to come. It repeats the report time. It runs through the “what to bring” checklist. If the patient doesn’t answer, the AI leaves a voicemail with a callback number and flags the case for your coordinator’s attention.

Day-of morning: A brief same-morning confirmation call for patients scheduled in the afternoon block, confirming they’ve maintained NPO status and confirming the report time.

Each call is logged with a timestamp and outcome. If a patient says they’re not coming, the cancellation is flagged immediately so you can fill the slot rather than discovering it when they don’t show up.

What happens to NPO violations

NPO violations are the specific pre-op problem that creates the most OR disruption. A patient who ate breakfast before their 7:30 case doesn’t just lose their slot. They create a cascade: your anesthesiologist now has to reschedule, the surgeon has a gap, and your OR team has downtime they can’t fill without scrambling.

Proactive NPO confirmation calls reduce violations by catching patient confusion before it becomes an OR problem. When the AI calls the evening before and walks through NPO instructions, patients who were confused about the rules get clarified. Patients who didn’t realize their blood pressure medication counted ask the question while there’s still time to get an answer from your anesthesiologist.

The key is timing. A pre-op instruction sheet given at a pre-op appointment three weeks ago is not the same as a conversation the night before surgery. Patients retain and act on information when it’s timely.

Catching the cases that need clinical intervention

Not every pre-op problem can be handled by an AI agent. A patient who developed a fever the night before surgery needs to speak to a nurse, not complete an automated call flow.

The AI handles the routine cases autonomously and flags the exceptions. When a patient reports a new symptom, expresses significant concern, or answers a clinical screening question in a way that warrants follow-up, the call is immediately escalated to your pre-op nursing staff.

This lets nurses focus on the cases that actually need their clinical judgment, instead of spending their mornings confirming that 20 patients know what time to arrive and haven’t had breakfast.

The block utilization math

For an ASC running 500 cases per month with a 5% cancellation rate, 25 cases per month are canceling. Research shows roughly three-quarters of those are patient no-shows driven by inadequate pre-op communication. That’s roughly 18 to 19 cases per month that proactive pre-op calling can potentially recover.

The revenue impact depends on your average case value. For a center with an average case contribution of $1,200, recovering 10 of those 19 cases per month is $12,000 in additional monthly contribution. The cases that still cancel with notice (48+ hours) can be backfilled with patients from your wait list.

The more immediate operational benefit is OR utilization. Predictable starts, fewer scrambles, and nursing staff who aren’t spending the first two hours of the day making frantic confirmation calls. That has value even before you count the recovered cases.

Integration with athenahealth

For ASCs using athenahealth for practice management, PGA’s AI voice agents integrate with athenaOne patient records. Pre-op call outcomes are logged against the patient chart, and anesthesia and nursing staff can see the complete communication history before a patient arrives. Instructions were delivered, confirmed, and the patient acknowledged NPO compliance at 8:47 PM the night before surgery.

That documentation also creates a record if a patient later claims they didn’t receive instructions, which matters in the rare cases where an NPO violation leads to a procedure complication.

What to measure

Track these numbers before and after deploying AI pre-op calling:

• Same-day cancellation rate, specifically patient no-shows
• NPO violation rate per month
• OR start delay rate attributed to late patient arrivals
• Staff time spent on pre-op confirmation calls per week

For most ASCs, the same-day no-show rate drops meaningfully within the first 30 days. The NPO violation rate, which is harder to measure precisely, typically drops because patients are getting better-timed, more consistent instructions than they were getting before.

Pre-op patient communication is not a glamorous problem. But it is a preventable one. When a patient no-shows your first case of the day, the entire morning OR schedule shifts. Your surgeon is unhappy. Your nursing team is scrambling. And somewhere, a patient is at home realizing they mixed up the date, or figured surgery wasn’t important enough to rearrange their morning.

AI handles the calls that catch those situations before 6:45 AM.

Sources:

• Dynamics of Elective Case Cancellation in Ambulatory Surgery Centers
• Day of Surgery Cancellation Rate after Preoperative Telephone Nurse Screening