With more than 7.1 million people waiting for treatment in England, tackling the elective care backlog remains one of the NHS’s most pressing challenges. Improving perioperative care — how patients are prepared for surgery — offers a key opportunity to increase capacity, reduce delays, and improve outcomes. In this blog, Pearl Okeke (Senior Project Manager at the Health Innovation Network South London) and Ramai Santhirapala (Consultant Anaesthetist and Perioperative Physician at Guy’s and St Thomas’ NHS Foundation Trust) reflect on lessons from a new health economics evaluation into an innovative tool and process for early digital screening.
The challenge with traditional pathways
Traditional perioperative pathways often identify patient complexity too late in the journey. This timing results in inefficient scheduling, wasted resources, and avoidable last-minute cancellations.
To address this, teams at Guy’s and St Thomas’ NHS Foundation Trust introduced a digitally enabled Early Screening Tool (EST) within the Upper Gastrointestinal (GI) surgical pathway. Co-designed with patients and clinical staff, the EST aims to identify patient complexity earlier and support more efficient, personalised care.
The timing coincides with the recent publication of the national Postponement and Cancellations in Elective Care (PACE) audit, which found that 10% of elective surgery cancellations occur within 24 hours of the planned procedure, with a further 9% resulting in short-notice postponements. Significantly, 40% of these were attributed to suboptimal preoperative preparation, such as acute medical condition management and theatre list overruns.
This reinforces the opportunity to transform waiting lists into preparation lists. By identifying a patient’s holistic needs early in the perioperative pathway, we can fast-track those with lower complexity while ensuring earlier optimisation for patients with medium and higher complexity needs. The result is a more proactive, patient-centred approach that supports better outcomes while reducing avoidable delays and cancellations.
How the early screening tool and process works
- Digital questionnaire: Patients complete a digital questionnaire early in their perioperative journey of which the tool classifies the patient as low or medium/high complexity
- Clinical validation: Submissions are reviewed and initial complexity scores are validated by a Clinical Nurse Specialist (CNS) to inform triage decisions.
- Targeted pathways: Patients assessed as low complexity are fast-tracked to elective hubs or day-case pathways. Patients with more complex needs or assessed as medium/high complexity are directed immediately toward early clinical optimisation.
What the evaluation tells us
The evaluation from the Health Innovation Network (South London) was funded by Guy’s & St Thomas’ Charity, which supports the remarkable NHS staff and exceptional healthcare provided by Guy’s and St Thomas’ NHS Foundation Trust.
The evaluation found the EST and process to be both clinically safe and effective.
Key clinical and operational findings include:
- Zero cancellations on the day of surgery: one postponement of surgery
- Zero patient safety incidents
- High clinical alignment: 86% of EST screening scores remained unchanged after CNS validation, indicating strong alignment with clinical judgement.
- Strong patient uptake: 71% of patients completed the tool independently, with the majority finding it easy to use.
- The inclusion challenge: Lower uptake among patients from more deprived communities and global majority backgrounds highlights a critical, ongoing need to focus on digital inclusion.
Operational and financial benefits
- Fewer appointments required across the pathway.
- Faster progression to surgery, reducing overall time to treatment by approximately two weeks.
- Shorter outpatient consultations and improved clinic flow.
- Better administrative efficiency regarding booking and scheduling.
- Improved theatre planning, resulting in more accurate patient allocation and fewer last-minute changes.
- Cost savings of around £19 per patient
Scaling what works: Insights from national clinical leaders
National perioperative and preoperative leads across NHS England and GIRFT reviewed these findings and identified four key pillars for successfully scaling early screening pathways across other NHS Trusts:
- Prioritise high-volume, low-complexity (HVLC) pathways first
Focus first on specialties where large numbers of patients progress directly to surgery (e.g., hip and knee replacements or minor orthopaedics). Specialties with complex diagnostic pathways and lower surgical conversion rates are less likely to see immediate benefits from earlier screening. - Ensure digital readiness
Successful implementation depends on robust digital infrastructure and standardising processes at the trust, including maintaining consistent approaches to triage and pre-assessment. - Invest in implementation and clear protocols
Trusts should allocate additional upfront staff time at the early implementation stage to ensure safe adoption of new digital pathways and establish explicit protocols. This includes guidance for managing patients who do not ultimately proceed to surgery, and clear criteria for identifying low-complexity patients who may be suitable for expedited elective surgical pathways. - Optimise appointment models
Adapt the workforce model so that shorter appointments are utilised for low complexity patients, allowing higher complexity individuals to receive the comprehensive, dedicated assessment they need.
Moving forward
The findings from this evaluation demonstrates how the EST supports early, digitally enabled screening which can reshape perioperative care to support faster treatment, better planning, and a more patient-centred experience. By focusing on the right pathways, ensuring digital readiness, and investing in clear processes, Trusts can unlock meaningful gains in elective recovery and system efficiency.
Read the full report
The complete report including health economic evaluation by the Health Innovation Network (South London) can be accessed here