Only as strong as the weakest link.

Procedure cancellation on the day of surgery should be a rare occurrence. Operating theatres are an expensive resource that needs to be efficiently utilised. The practical consequences of last-minute surgery cancellation and the psychological impact on patients should be unacceptable in a modern health care system. A lot of factors can affect the smooth progress of a patient through the process from booking of a case through to discharge from the recovery room. All are important, as the system is only as strong as its weakest link, for example, a relatively inexpensive factor such as the employment of porters to bring patients to the theatre suite can impact on the ability of expensive medical and nursing teams to facilitate surgery. Much effort has been expended to address this conundrum. For example, preoperative assessment clinics can decrease the likelihood of last-minute cancellations for medical reasons. This facilitates early identification of co-morbidities, improves and allows time for dialogue between specialist teams and gives adequate time for pharmacological or nonpharmacological interventions. They can also decrease costs and morbidity, and shorten hospital stay, and not surprisingly many Hong Kong hospitals are currently developing such services. The development of patient care plans such as for those with diabetes or persons undergoing a particular type of surgery can simplify management and reduce confusion over what is appropriate preparation. Likewise teams can be issued with guidelines on preoperative investigations. None of these is particularly difficult to achieve with some local modifications, as they have been tried and tested in other countries. However, they require cooperation between surgeons, anaesthetists, and physicians, as well as support from the hospital administration.