The Royal Surrey NHS Foundation Trust, in partnership with Definition Health and the Kent Surrey Sussex Academic Health Science Network (KSS AHSN), has transformed its pre-operative assessment (POA) process using LifeBox, Definition Health’s electronic pre-operative assessment (ePOA) solution.
By moving away from a paper-based legacy system that met the needs of just 30% of patients, the Trust streamlined patient pathways, significantly reduced DNA rates, and achieved substantial cost and carbon savings. This collaboration demonstrates how digital innovation can tackle surgical backlogs and build more resilient healthcare systems.
Challenge
With approximately 7.6 million patients in the UK waiting for surgery following COVID-19, traditional pre-assessment pathways were no longer sustainable.
At Royal Surrey, the existing POA process only met the needs of 30% of patients, creating bottlenecks in patient flow and administrative inefficiencies. DNA rates were high at 6.3%, in-person appointments required significant patient and staff time, and travel demands contributed to increased carbon emissions.
Furthermore, shortly after the implementation of LifeBox, the Trust faced additional challenges with the introduction of a new Electronic Patient Record (EPR) system, which caused disruptions to patient management. However, the LifeBox system remained fully operational and accessible during this time, becoming an essential tool for continuity of care.
Solution
Definition Health worked closely with Royal Surrey to understand the legacy processes and re-engineer a new, optimised digital pathway. The LifeBox solution was successfully deployed within just four weeks of contract signature. Comprehensive training was delivered to administrative staff, nurses, anaesthetists, and surgeons, with on-site support provided during build-up and go-live phases.
The digital platform enabled patients to complete pre-operative assessments remotely, supported by educational resources and clinical oversight. High-risk patients could be triaged effectively, with anaesthetists accessing profiles electronically to provide early input and recommendations.
An independent, blinded real-world validation study, evaluated by Unity Insights on behalf of KSS AHSN, compared LifeBox against the legacy system with identical volumes of pre-assessments, ensuring robust, unbiased outcomes.
The project’s biggest challenge was the introduction of their new Electronic Patient Record system shortly after the Definition Health solutions went live. At the height of this challenge were periods whereby the Trust’s patient management system was ‘frozen’. However it became clear that throughout that period the Trust relied heavily on our Digital solution which indeed remained functional and accessible throughout.
Impact
Royal Surrey is now using the three interoperable solutions offered by Definition Health, including Definition LifeBox, a digital pre-operative assessment tool; Definition Connect, a virtual consultation and secure file-sharing platform; and Definition Recovery, which allows the hospital to operate a post-discharge virtual ward. The independent study demonstrated outstanding results across clinical efficiency, patient experience, cost savings, and sustainability:
Enhanced clinical efficiency
- 99.5% patient compliance with the electronic pre-operative assessment
- 95% reduction in DNA rates (from 6.3% to 0.6%)
- 34% reduction in face-to-face pre-assessment appointments
- Improved triage of high-risk patients through streamlined digital communication
- Over 90% of patients agreed it was important to complete part of their surgical pathway at home
- Patients could avoid waiting room delays and complete assessments comfortably from home
- £428,000 efficiency cost-saving over five years
- £132,000 cash-releasing savings over five years
- 39% ROI at Royal Surrey
Avoiding unnecessary patient travel through the use of LifeBox led to a significant reduction in carbon emissions. The independent study calculated a saving of 210 tonnes of CO₂, demonstrating the environmental benefits of shifting to a remote-first digital pre-assessment pathway.
Extrapolated impact
Based on the Royal Surrey results, extrapolated potential efficiency savings across the NHS Surrey Heartlands ICS are estimated at £1.94 million over five years, with £480,000 in cash-releasing savings, delivering a 40% return on investment (ROI).
"Triaging of the high-risk patients has become streamlined as the preop nurses send the POA summary to the anaesthetic consultant, who can access the patient’s profile electronically and give suggestions for further workup if needed."
“Importantly for those patients coming back to hospital for the first time since COVID, they don’t have to sit in waiting rooms filling in forms – they can fill in the pre-assessment questionnaire comfortably at home.”
What happens next?
Following the introduction of the Definition Health Total Digital Surgery Tool at Royal Surrey NHS Foundation trust, the objective will be to roll out to Ashford and St Peter’s Hospitals and others within the ICS. Definition Health also works with other NHS partners including, Homerton, SWLEOC, Luton and Bedford, Mid-Yorkshire and North Cumbria.
As Definition Health’s relationship with Royal Surrey extends into 2025, a primary objective is to complete the integration with Cerner Q2 2024 driving even greater efficiency. The results of the Real World Validation study will serve as a best practice model for other hospitals in the UK. If deployed across the NHS, Definition Health solutions would deliver over £540m of efficiency savings over 5 years and over £130m in cash release savings, all of which could be reinvested in the services provided to patients.
Partnerships with the NHS also support Definition Health’s development pipeline, feedback from patients and clinicians is encouraged to ensure the solutions continue to evolve and respond to emerging clinical regulations and guidelines. Any changes made to health questionnaires or assessments within LifeBox and Recovery are subject to a rigorous clinical approval process. The solutions are web-based rather than native app, therefore any updates are immediately available to all customers without the need for software outage, this ensures all customers are accessing the most up-to-date version of the product.
* This work was commissioned and funded by SBRI Healthcare. SBRI Healthcare is an Accelerated Access Collaborative (AAC) initiative, in partnership with the Health Innovation Network. The views expressed in the publication are those of the author(s) and not necessarily those of SBRI Healthcare or its stakeholders.