Improving operating room efficiency is a high priority as health care cost become more challenging. In order to reduce surgical cancellation rates, a process improvement plan was implemented using a preoperative surgical pathway to optimize a patient's health prior to scheduling the surgical procedure. The surgical risk assessment tool risk stratifies the patient based on the urgency of the procedure, the type of procedure, and the patients overall medical disease state. The Surgical Risk Tool determines patients with surgical risk scores of 9 or greater require medical and/or cardiac clearance in addition to hemoglobin A1C of 8 or less and hypertension controlled with 160/90 or less in order to proceed with surgery. Following pre and post intervention, a total of 6,867 charts were reviewed for comparison. Data demonstrated that surgical cancellations were reduced from 22.9% to less than 15% after implementation of the surgical pathway at one-year post-implementation. The cost savings at one-year post-implementation was estimated to be $1,156,000 and completion surgical rates increased from 80% to 90%. Implications for practice, policy, and research include a full system implementation of the Surgical Risk Tool, policies and procedures for process implementation, and continued data assessment to determine refinement of the intervention.