This study aims to explore how often the operating list is changed on the day of surgery, and the reasons why this may occur. The purpose being to analyse the wider potential impact of changing the list on the day of surgery has on patient safety, patient satisfaction and theatre efficiency. Survey data was collected across a multi-specialty elective operating department. The findings demonstrated a significant (P <0.001) change in operating lists occurred in 37.3% of sessions with a variety of potentially avoidable reasons. We concluded that improved organisation and communication before the planned session could reduce the occurrence of changes, increasing patient safety, theatre efficiency and potentially reducing incidents.