Background: Surgical cancellations at the day of surgery present major difficulties to both health care organizations as well patients and families. In a low middle income country (LMIC), cancellations stress an already resource limited system and result in significant financial burden and loss of resources. Due to a limited number of tertiary care hospitals, most families have to travel great distances and outpatient visits for preoperative assessment are unfeasible. We describe a protocol using screening phone calls and patient’s family counseling prior to admission to reduce same-day cancellations rates. Objective: To determine whether implementation of nurse –led protocol involving screening phone call and standardized questionnaire, along with patient’s family counseling 48 hours prior to surgery results in reducing day-of-surgery cancellations. Methods and measures: Pre-intervention data to calculate rate of cancellations was collected. Patient’s families were called 48 hours prior to surgery. A standard assessment checklist was used to cover pertinent points. A brief counseling session was also carried out regarding the surgery .In case of any concerns, attending surgeon and cardiologist were informed and a follow up call made on the day before surgery. A satisfaction survey regarding the effectiveness of the phone call was carried out after discharge from the hospital. Post intervention data was then collected and cancellation rate calculated. Results: Post-intervention, data from 144 screened patients was collected. Day of surgery cancellation rate decreased from 15.2% to 1.43 %( p<0.05) (fig 3). An average cost of $540 (Pakistan Rupee 80000) was saved per cancellation. Most families reported overall satisfaction with the phone call. Conclusion: Implementation of standardized protocol for preoperative assessment has decreased day of surgery cancellations, resulting in better resource utilization and reducing overall hospital costs. It has also helped in improving communication between patient’s family and heath care providers and improved overall patient satisfaction.