BackgroundUrgent surgical cases have worse outcomes and are responsible for most case cancellations and delays. Improving preoperative care of urgent cases is cost saving and can potentially improve patient outcomes. We describe the design and implementation of a Rapid OR Decision Evaluation and Optimization (RODEO) service to assess patients requiring urgent surgery during their admission (“inpatients"). We hypothesized that the RODEO service will reduce Operating Room (OR) delays and cancellations. MethodsA multidisciplinary steering committee designed RODEO to be staffed by Advanced Practice Providers (APPs) with attending physician support. The attendings were available on the phone with the level of support changing as the APPs became more experienced. Initially the service focused on orthopedic trauma patients but expanded to other surgical specialties. RODEO assessment included evaluating chronic medical conditions, ordering testing and consults, medication management and communication with the patient care teams. Monthly meetings of the steering committee using standard data reports were used to identify areas for improvement. The primary outcome was the ratio of OR delays and cancellations due to incomplete workup to all OR delays and cancellations. ResultsBetween April 2020 and March 2021, 730 patients were assessed by the RODEO service. When RODEO needed to prioritize within the trauma patient population, the service focused on medically complex patients, (54% of patients had at least one chronic medical diagnosis), 20% of patients had respiratory disease, 19% cardiovascular disease, 18% diabetes, 16% renal disease, and 10% chronic pain. Optimization included ordering guidelines directed testing (48% of patients), managing chronic medications (46% of patients), requesting consults from other services (28% of patients), and placing orders (17% of patients). A significant portion of RODEO work involved multidisciplinary communication. We found that OR delays due to incomplete workup were reduced from 19% of total OR delays to 0%. Surgery cancellations due to incomplete workup were reduced from 50% of all cancellations to 0%. Expansion of RODEO services to other surgical specialties is achievable. DiscussionA service providing preoperative evaluation and optimization to surgical inpatients is feasible and may reduce delays and cancellation due to incomplete workup. Potential limitations to our findings are that RODEO was designed for a specific setting; and that the implementation coincided with the COVID-19 pandemic. Future research will need to assess the effect of RODEO on postoperative outcomes. ConclusionA specialized preoperative team optimizing surgical inpatients can reduce OR delays and cancellations