Digital preoperative assessment triage at Trust published as exemplary case study by NHS England

Preoperative Assessment (POA) is an important step on the patients’ pathway to a surgery, but not all patients are required to attend an appointment for assessment.

Best practice dictates that patients who are at higher risk of anaesthetic complications should be assessed thoroughly a few weeks ahead of their surgery. This allows for sufficient time to prepare the patient and to reduce the risk of the procedure being cancelled on the day.

However, patients with no relevant past medical history, having less complex procedures can safely bypass this step. This saves unnecessary appointments for patients who are fit and healthy, freeing up resources at our hospitals for patients requiring more extensive preoperative assessments.

The POA team at our Trust developed a digital questionnaire to identify patients who are at low anaesthetic risk and do not need to attend assessment appointments prior to their surgery. NHS England has published our innovation as a case study to highlight the transformative impact of this work and to inform similar processes at other Trusts.

Working with external technical partners Palantir and Isla Care, the Trust designed and deployed the Digital Health Questionnaire (DHQ) which is sent to all adult patients on the waiting list via a text message.

This questionnaire allows patients to answer the questions at a time suitable for them without having to attend an appointment at the hospital. The hospitals POA team can then determine which patients needs to attend a face-to-face appointment and who is fit to proceed without a preoperative assessment.

Improvements to POA:

• Patients on average booked in 30 days in advance of surgery (previously 17 days)
• POA appointments held on average 15 days in advance of surgery (previously 10 days)
• 180 patients per month do not require POA and free up spaces for patients on the waiting list
• 407 patients reported they no longer want or need surgery and free up spaces for patients on the waiting list
• 7,897 patients reported that they are available at short notice (10 working days' notice) and could therefore be receiving their surgery earlier as initially expected if places become available
• 222 patients without NHS numbers identified to speed up administrative processes ahead of the surgery
• First 100 patients monitored end-to-end and no cancellations
• On-the-day theatre cancellations related to POA reduced to 1.2% (57% improvement)