NHS Lanarkshire's electronic pre-operative assessment process optimises patient flow and helps fill surgical slots

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An electronic pre-operative assessment platform to support the Innovative delivery of care pathways

Working with Buddy Healthcare, the NHS Lanarkshire hospital Board has launched “Elsie”, its new ePreOp digital platform. Elsie was designed to replace the previous resource-heavy “paper-based” system, which required every patient, no matter their fitness for surgery, to attend a hospital appointment to answer questions with a nurse.

As part of Elsie’s rollout, while preparing for their surgery, pre-operative assessment patients are now guided and educated through a pre-operative care pathway via a mobile App. The process helps hospitals to identify patients that don't need to come to the hospital, reducing the clinical time required per patient and increasing workforce efficiency. This supports the effort to make surgery waiting list management more efficient by automating patient communication and also providing data collection during the patient journey.

Key results:

  • Only around 45% of patients should only need to attend the hospital on the day of surgery using the initial patient assessment. 
  • 89% of the patients said they did not need to contact the clinic by phone.
  • 91% of the patients would recommend the app to friends or relatives in a similar situation.
  • The patients rate the ease of downloading and using the app with about 4.5 out of 5.


Before COVID-19 there was an 8 week wait for patients to get a pre-operative assessment appointment. We were very short staffed and our processes while very robust, were very old fashioned. Everything was on paper, whereas the rest of the hospital is digital. This has been an enormous project for our team across Lanarkshire, easily the biggest innovation we have seen in the last twenty years.

- Dr. Miriam Stephens, Lead for Pre-operative Assessment in Lanarkshire

As part of the automated process, patients use Buddy’s mobile ‘Elsie’ app to:

  • Access specific hospital-based information, i.e when arriving for surgery, how to find the surgery unit, or where to park
  • Receive pre-habilitation information to inform the patient about “keeping fit for surgery”
  • Use in App two-way communication to allow the patient to ask questions, advise of a change of circumstance and for Staff to provide information in reply 
  • Automated care path instructions and reminders, i.e. fasting and medicine reconciliation details
  • Receive clearly communicated updates on any changes to events
  • Provide feedback and influence service improvements

It benefits both care teams and patients:

  • Care teams can manage and monitor patient engagement throughout the patient care path and outcomes
  • Care teams can assess the patients via the Elsie App care path to see if they are “fit for surgery”
  • Care teams can work more flexibly - any location
  • Patients in any location and at their preferred choice of time can submit assessment forms and questionnaires from their mobile device, as this is monitored and managed in the clinical dashboard
  • Patients clinically assessed as “fit for surgery” don’t need to visit the hospital before surgery. The app manages medicine reconciliation, fasting, health check etc.
  • Patients can be identified via the App care path, that they are supported both at home and by an employer to come to the Hospital at “short notice” to fill surgery slot cancellations
  • Remarkably less patient and staff travel, less CO2, supporting the NHS Net Zero.

Remote patient monitoring and assessment

With Buddy Healthcare's electronic pre-operative assessment platform, the surgical teams in three NHS Lanarkshire hospitals can now remotely assess and monitor patients' progress and surgical readiness. The care teams use the clinical dashboard to gather and visualise patients' submitted health data. The clinical dashboard allows the care teams to manage a clinic or department of patients and monitor progress. It notifies of uncompleted tasks or reduced engagement when necessary.

The digital solution enhances pre-operative assessment clinic efficiency, optimises waiting list management, reduces unnecessary pre-operative hospital visits, and allows patient care at the right time and place.

Filling surgical slots by identifying flexible patients

The BuddyCare digital platform can help hospitals to fill surgical slots caused by late cancellations. With the patients' submitted and viewed data, NHS Lanarkshire's care team can quickly and easily identify fit patients ready for surgery with short notice to fill cancelled surgery slots. The new digital pre-operative assessment process supports the NHS Lanarkshire area hospitals’ efforts to process the backlog of elective surgeries postponed due to COVID-19 by a more efficient pre-operative process and helps to optimise operating theatres.

One of our issues is we don’t have enough space for our staff to work on site in Wishaw. With Elsie, we can get our nurses to work more flexibly. We won’t need to wait for one of our doctors to physically come to the pre-assessment clinic anymore. They can do their work remotely, on any site in Lanarkshire. It will make our processes much more efficient. It feels like we are catching up with the rest of the
working world.

We had long felt an electronic system would be better, but with Buddy Healthcare's Elsie App, we have a fully interactive system. The patients don't have to take time off to come all the way to hospital, or even do a telephone appointment in many cases. They can fill in a lot of the details themselves on the App. Our specialist nurses will check it, and for a lot of patients, they won't need to see us at all at pre-assessment.

- Senior nurse Mandy Gilroy

Feedback from patients

  • 91% of the patients would recommend the Elsie App to friends and relatives in a similar situation.
  • Patients rated the Elsie App in terms of usefulness 4,5/5.
  • Great idea, more time efficient for myself and the hospital.

     - Patient who used Elsie App

NHS Lanarkshire's Pre-assessment team produced a video about Elsie


About NHS Lanarkshire

NHS Lanarkshire is the 3rd largest Board in Scotland. Population 655,000 across rural and urban communities in Lanarkshire.

  • Hospital sites see around 300,000+ patients/year
  • Around 25,000 surgeries/year
  • Annual Budget of £980 million