Advances in technology and surgical methods have allowed an increasing number of surgical procedures to be performed on an ambulatory basis, which has improved patient outcomes and decreased the costs associated with many of these procedures. Unfortunately, an area that continues to exhibit negative clinical and economic consequences is post-operative nausea and vomiting (PONV). The prevalence of PONV after general anesthesia, even for those surgeries performed on an ambulatory basis, remains quite high and is a leading cause of delayed discharge and unanticipated hospitalization in these patients. OBJECTIVE: To test the efficacy, safety, and economic impact of an algorithm for PONV prophylaxis. METHODS: From October to December 1999, baseline data were collected on 473 consecutive patients undergoing surgical procedures of any kind, including demographic data, risk factors for PONV, medication utilization, occurrence of PONV, time in PACU, unanticipated hospitalization, and patient satisfaction. Following implementation of a PONV prophylaxis algorithm, data will be collected for consecutive patients undergoing surgical procedures and compared to the data from the baseline period. RESULTS: Preliminary analysis of the baseline data found that 34 of 473 patients (7.2%) had at least one episode of emesis in the PACU. Thirteen of these patients (38.2%) were delayed from being discharged secondary to PONV; average time spent in the PACU was 41 minutes for patients without PONV and 130 minutes for patients with PONV. Three patients were hospitalized for PONV. CONCLUSION: Comparison of data before and after implementation of the dolasetron-based algorithm will allow us to determine the efficacy, safety, and economic impact.