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We describe a nurse‐led pre‐assessment system at an elective surgical centre. A targeted referral system was used by trained nurses to direct referrals to a supervising consultant anaesthetist or to the surgical team. Of 2726 patients pre‐assessed in the first 2 years, 105 patients (3.9%) were cancelled or postponed for medical optimisation after pre‐assessment. There were 137 cancellations (5.0%) on the day of surgery, despite pre‐assessment, but only 36 were for anaesthetic or medical reasons. Only eight of these 36 were considered a ‘failure’ of the pre‐assessment system. These results are much better than the cancellation rate of about 11% in the Trust as a whole. There were 18 transfers of patients postoperatively from the elective centre to another hospital. A review suggested that four of these transfers could have been reasonably predictable from the patients' medical history. We conclude that a pre …