Transforming pre-operative assessment: SWLEOC & LifeBox

The South West London Elective Orthopaedic Centre (SWLEOC), in partnership with Defintion Health, has transformed the pre-operative assessment (POA) process through the adoption of LifeBox, an electronic pre-operative assessment (ePOA) solution. By transitioning from a paper-based, manual system to an interactive, remote-first approach, SWLEOC has significantly reduced administrative burden, improved patient experience, and optimised clinic capacity. 

Challenge 

SWLEOC’s traditional paper-based POA system created significant inefficiencies. Each POA appointment required extensive patient attendance time (PAT) and clinician time. A retrospective study found that the patient attendance time (PAT) per POA was 3.2 hours, with 90 minutes of nurse time per appointment. In 2018, this amounted to 16,320 hours of PAT and 7,650 hours of clinician time.

The reliance on in-person POA appointments placed additional pressure on outpatient capacity, creating bottlenecks in patient flow. Additionally, travel requirements and long wait times contributed to poor patient experience, with unnecessary hospital visits impacting patient convenience and increasing environmental impact.

Solution 

In 2019, SWLEOC redesigned the POA service by introducing LifeBox, our electronic pre-operative assessment (ePOA) solution, designed to enhance efficiency and patient experience. The digital platform allowed patients to submit their pre-operative assessments from home, reducing unnecessary travel and clinic congestion. In addition, educational videos meant patients were fully informed and put at ease about their upcoming hospital visit and procedure.

The system flagged high-risk patients for early anaesthetic review, enabling timely interventions and reducing surgery cancellations. In addition, LifeBox consolidated patient data, including MRSA, blood, and COVID test results, into a single platform accessible by clinicians. This integration allowed clinicians to review and interact with assessments in advance, ensuring patients were well-prepared for surgery.

Impact 

By transitioning to a fully virtual POA process during COVID-19, SWLEOC became the fastest recovering elective centre in South West London. Patients could complete their assessments on their smartphone, tablet, or computer, at a time and place convenient for them, reducing stress and improving compliance. Since implementing LifeBox, SWLEOC has achieved remarkable efficiency gains and patient benefits:

• Enhanced clinical efficiency

  • 60% decrease in in-person POA assessments, significantly easing outpatient workload

  • 3,060 outpatient appointments avoided, freeing up clinical resources

  • 2,550 hours of outpatient time freed up for other priorities

  • 800 additional POAs completed per month

  Improved patient experience

  • 9,792 hours of patient attendance time saved through remote POA

  • 1.92 hours average time saved per patient

  • 100% of patients now receive preoperative information videos 

  • 7.8% of patients require digital assistance, ensuring inclusivity.

  Cost and resource savings

  • £94,000 in savings per 5,000 patients, demonstrating the economic benefits of digital transformation

  • £11,000 savings in printing and postal costs.

  • CO2 emissions reduced through elimination of unnecessary patient

"We have been using LifeBox ePOA at SWLEOC now for around 2 years. The app is easy to use and gives me the live access I need to see my patients ahead of any proposed surgery.The feature of remotely accessing patients’ history, observation and some investigations are very convenient. Selecting the anaesthetic review option saves us a lot of time going through the full set of notes. The built-in risk scores and the ability for me to leave comments for my clinicians to read and act upon has allowed us to redesign our POA processes and workflows. The support from the LifeBox team has made a big contribution - they have accommodated our needs and have acted upon our feedback to streamline and fully utilise the services of the app."

Consultant Anaesthetist, SWLEOC Dr Burhan Shawki Al-Saffar