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The management of unscheduled patients presenting to an operating theatre poses a major obstacle for service planning and provision. The very nature of a case being unscheduled undermines one's ability to plan for their presentation. However, the ability to schedule these cases during rostered working hours, where possible, is safer for the patient and a more efficient use of theatre, staff & hospital resources. The change initiative focused on the booking of unscheduled patients. The author introduced a structured booking form with a view to enhancing workflow patterns from point of booking until transition to the operating theatre. The Productive Operating Theatre (TPOT) acted as a framework with which to devise & develop the change idea. An adapted version of Kotters model for changed was used. This study found that unscheduled patients can be scheduled in an efficient & effective manner. Equally a structured booking process can translate into considerable cost savings where this results in increased resource utilization. This book would interest those working in health care management, particularly those involved in theatre services & theatre scheduling.