Neglected Questions in Preoperative Assessments and How They’re Costing Patients and Hospitals
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Ensuring digital solutions do not exclude anyone
We partnered with Barking, Havering, and Redbridge University Hospitals NHS Trust to explore something critical but often overlooked in digital health: how digital solutions could unintentionally leave some patients behind.
It was part of a research study, supported by NIHR funding, to better understand how digital solutions could be improved to support patients from underserved communities. We looked at this through our remote preoperative screening solution, Pathpoint ePOA.
Digital preoperative solutions need to do more
Many hospitals are turning to digital preoperative assessments to improve efficiency and manage increasing surgical demand. Pathpoint ePOA, for example, automatically sends patients a digital screening questionnaire once they’re listed for surgery. Their responses generate a complexity score, helping teams prioritise care and identify medical risk early.
But unless these systems are designed with nuance, they risk widening health inequalities.
Traditional phone or face-to-face POAs give clinicians the chance to pick up on anxiety, ask follow-up questions, and provide reassurance. A well-trained nurse might notice something a patient isn’t saying and gently draw it out.
A digital questionnaire won’t do that unless we design it to.
So we asked patients and clinicians: What’s missing? What could help?
What we heard: Surgery affects people far beyond the theatre doors
Our PPI participants—many from ethnic minority backgrounds and underserved communities—shared concerns about language barriers, cultural stigma, and digital confidence. But the challenges extended beyond accessibility.
They told us that some patients will be concerned about surgery not for the surgery itself but for the circumstances around it. “Who will take care of my children?” “How will I afford time off work?” “Who’s going to help me at home after surgery?”
These aren’t small questions. They’re the kind that weigh heavily on patients’ minds, especially those with caregiving duties, low incomes, or chronic conditions. And when those concerns aren’t addressed, patients might delay or cancel surgery. Or they go through with it but struggle afterwards.
What begins as a missed question becomes a recovery derailed.
Clinicians echoed these worries. They told us that social circumstances often don’t come to light until discharge planning, and sometimes too late to make safe or efficient decisions.
When hospitals don’t know if a patient has a safe place to recover or someone to help them, it delays discharge, leads to longer hospital stays, and raises the risk of readmission.
This is also a hospital efficiency problem
When preoperative assessments don’t uncover the whole picture, hospitals see:
Last-minute cancellations
Extended hospital stays due to unsafe discharges
Higher readmission rates from poorly supported recovery
And all of that makes elective recovery harder.
If we want to optimise patients before surgery, we also need to prepare them for what comes after.
So what do we do?
We believe digital tools can—and should—help. But they need to be designed with all patients in mind.
That means:
Asking structured questions about social, emotional, and recovery-related needs
Making questionnaires accessible, clear, and inclusive
Building in optional support content like educational resources, timelines, and joint school-style preparation
Ensuring there’s a follow-up when red flags are raised
The more we understand a patient’s world, the better we can prepare them for surgery and recovery.
The real opportunity of digital transformation
When done right, digital POAs can surface risk earlier and prepare patients more thoroughly. They free up clinical time. And they help patients feel supported, understood, and safe.
Hospitals benefit too:
Better discharge planning
Fewer delays and cancellations
Smoother theatre utilisation
Improved equity across patient groups
We have the chance to make surgical pathways work better for everyone. But that starts with building digital systems that are inclusive and reflect real lives.
