A one-year prospective audit (1989) of patient non-attendance for elective surgery in our department showed that of those summoned, five per cent defaulted on the day of admission without contacting the hospital (Hampal and Flood, 1992). Contributing factors such as lengthy waiting lists and inefficient communication with the patients were amenable to correction by the hospital. However, the current admission policy made inevitable a significant waste of theatre time.

The pre-admission clinic (PAC), an outpatient attendance shortly before planned surgery, was recommended in ENT practice by Robin (1991) and introduced into our department that year. Failure to attend the PAC allowed adequate time' for replacement on the theatre list and was recommended as a solution to the problem of unfilled theatre sessions (Dingle et al., 1993).

A subsequent four-year experience of conducting PACs has confirmed several expected advantages. However, some of the hopes for development expressed in our earlier work (Dingle et al., 1993) have failed to materialize. This study aims to review retrospectively our experience and compare it with the admission practice and desires of ENT departments in the United Kingdom as revealed by a postal survey. The findings are of relevance to all surgical specialties and to anaesthetic departments wishing, to adopt this system of admission.