Using Digital Screening and Risk Stratification Algorithms to Optimise Preoperative Efficiency

19 Feb

Reducing the time people wait for elective care is central to the 2025/26 NHS priorities, and preoperative patient optimisation remains a major constraint.

It’s well-known that ineffective health optimisation before surgery not only impacts patient outcomes but also significantly disrupts hospital efficiency. NHS England, along with several healthcare initiatives like Getting It Right First Time (GIRFT), the Centre for Perioperative Care (CPOC), and the Royal College of Anaesthetists, have long since introduced guidelines for early screening and risk assessment to tackle this preoperative bottleneck.

But while guidelines are necessary and provide a strong foundation, they don’t solve the logistical challenges of implementation.

The challenges of early screening and risk assessment in preoperative care

Clinicians don’t need convincing that early screening is beneficial, but healthcare teams are stretched to capacity. Gathering all the necessary information spread across paper documents or various systems, coordinating screening with manual assessments like paper-based questionnaires or phone calls, and then identifying the high-risk patients demands time and resources, both of which are in short supply.

The result is often the late identification of high-complexity patients, leading to last-minute cancellations, wasted theatre slots, and increased costs. And importantly, it can be detrimental to patient outcomes, which also affects operational efficiency due to longer lengths of stay as well as readmissions.

It’s increasingly clear—which both CPOC’s Preoperative Assessment and Optimisation Guidance and GIRFT’s support guide advocate for—that digitising preoperative screening is needed to improve patient optimisation before surgery to subsequently enhance the efficiency of perioperative pathways.

It sounds great in theory, but what does digital preoperative optimisation actually look like in practice?

Digital screening and risk stratification in action

We’ve developed a preoperative assessment software called Pathpoint ePOA that integrates an automatic risk stratification algorithm for complexity score attribution, and we tested its impact on earlier identification of patient complexities at an NHS Trust using our software.

But before we get into the results, here is some context on how Pathpoint ePOA works:

When a patient is added to a surgical waitlist, they automatically receive a structured digital preoperative screening questionnaire (with reminders to complete it too).
The system processes their responses, applying nationally approved criteria to generate a complexity score.
This score helps clinicians determine which patients need preoperative optimisation or would benefit from being enrolled in health optimisation programmes while also creating a pool of fit-for-surgery patients to streamline theatre scheduling.

To measure its impact, we compared data from an old preoperative pathway without digital screening and risk assessment against the new pathway incorporating these tools.

The results:

Without digital screening or a risk stratification algorithm, collecting all necessary patient information for preoperative assessment took 26.8 days on average.
With automatic screenings and risk assessments, this was reduced to 9.4 days, with most cases completed within 5 days.
Patients were identified 17.4 days earlier on average, giving clinicians more time to implement preoperative optimisation strategies before surgery.

This reduction in time to assessment is significant. One of the biggest contributors to ineffective preoperative assessments is late identification of high-risk patients, leaving little time for intervention and resulting in avoidable last-minute cancellations, which are often not filled because patients able to come in at short notice have not been identified.

By automating screening and risk stratification, Pathpoint ePOA was able to streamline information-gathering as well as the time-consuming and often manually laborious complexity score determination. This then provides preoperative teams with the time and data they need to plan ahead, conducting timely patient optimisation before surgery while also enabling the identification of patients fit for surgery and available on short notice.

For more details on our findings, check out our poster on Pathpoint ePOA’s risk stratification algorithm benefits, which we presented at the Association of Anaesthetists’ Winter Scientific Meeting 2025.

A more efficient perioperative pathway

Optimising early screening and risk assessment using digital solutions provides a good starting point in improving the efficiency of perioperative pathways and driving elective recovery. It helps hospitals to:

Ensure patients are fully optimised before surgery and thereby reduce last-minute cancellations.
Identify patients who require no optimisation to create a pool of patients willing to come in at short notice, thereby optimising theatre use when last-minute cancellations do occur.
And additionally, it eases administrative burden, allowing clinical teams to focus on care and contributing to productivity improvements.

Find out more on how Pathpoint ePOA can optimise early screening and risk assessment to improve perioperative efficiency.