Purpose The purpose of this project was to design, develop, implement, and manage a sustainable process for pediatric pre-operative COVD-19 testing and use the test results to determine the level of personal protective equipment and infection control required for each patient for optimal surgical scheduling and preservation of resources. Design This quality improvement project used the Plan-Do-Study-Act methodology Multiple cycles of re-evaluation refined this process which was standardized across the enterprise. Methods A process for pre-operative testing for all patients undergoing procedures requiring anesthesia was developed and implemented. Findings A safe, feasible, timely process was developed and piloted to obtain COVID-19 test results to guide individualized interventions. During the pilot, 1707 patients were screened, and five tested positive for COVID-19, eliminating the need to manage 1702 patients as COVID-19 positive. Conclusion To continue to safely re-open, knowledge of the patient's COVID-19 status is imperative to ensure a safe journey through the perioperative area.