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Oxford University Hospitals NHS Foundation Trust (OUH) worked with NEC Health Engage to introduce early digital triage for patients undergoing hip and knee surgery at the Nuffield Orthopaedic Centre. The new approach enables earlier identification of medically complex patients, reduces unnecessary hospital visits, and improves theatre efficiency across the pre‑operative pathway. 

Challenge 

OUH faced increasing pressure on its elective orthopaedic pathways, with traditional pre‑operative assessment (POA) relying on multiple in‑person appointments scheduled late in the surgical timeline. This often resulted in medically complex patients being identified too late, causing appointment delays, disrupted clinics, and avoidable theatre cancellations. 

Patients were required to travel repeatedly for assessments, many of which could have been streamlined or avoided if optimisation had begun earlier. The Trust needed a reliable method to start triage as soon as patients were listed for surgery, identify those requiring closer clinical oversight, and release capacity for patients ready to proceed. 

Solution 

To address this, OUH introduced NEC Health Engage Triage for hip and knee surgery patients. 

Digital health screening begins immediately after listing, with clinical algorithms automatically identifying medically complex patients. The redesigned pathway ensures: 

  • Non‑complex patients are booked directly into a telephone POA appointment. 
  • Complex patients receive a combined face‑to‑face assessment, reducing repeat visits and improving workflow. 

The platform integrates with the Trust’s Electronic Patient Record (EPR), eliminating manual data entry and providing the POA team with real‑time clinical information. 

Staff adoption was swift, supported by short training times. Compliance with ISO27001 and NHS Digital Technology Assessment Criteria enabled smooth integration into existing systems, while continuous refinement based on user feedback ensured the pathway embedded effectively into routine practice. 

Results 

The NEC Health Engage model has been recognised as a national exemplar and included in the NHS Digital Playbook for Perioperative Care. 

Evaluation from April 2022 to January 2023 demonstrated: 

  • 75% of patients triaged as suitable for telephone POA 
  • £769 saved per patient compared to the standard pathway 
  • 100% patient satisfaction 
  • 1.3% reduction in cancellation rates 
  • 51,381 km of patient travel avoided 
  • 8.8 tonnes of CO₂ saved (equivalent to nine Paris–New York return flights) 

The new approach reduced avoidable hospital visits, created earlier opportunities for optimisation, and improved operational efficiency across the pathway.

“Our new clinical pathway has enabled us to increase preoperative assessment capacity and commence patient optimisation as soon as individuals are listed for surgery. It has also allowed us to digitise the pathway, reduce hospital visits, and improve carbon footprint.”

Antony Palmer, Consultant Orthopaedic Surgeon, Clinical Lead for NOC Preoperative Assessment, Oxford University Hospitals

“The project has transformed the way we provide pre-assessment care for patients. It is a fantastic example of digital enhancement of a clinical pathway improving patient experience.”

Professor Andrew Price, Trauma and Orthopaedic Surgery Clinical Director, Oxford University Hospitals

“Triaging patients in their surgical pathway has improved the optimisation and management of their complex long-term conditions. This allows the follow-up of patients to be arranged in a timely manner and to reduce unnecessary visits to the hospital.”

Natasha Brand, Specialist Nurse Practitioner, Pre-Assessment Clinic, Oxford University Hospitals

“The benefit of [NEC Health Engage] is to work in a different and effective way to enable us to have a pool of patients fit for surgery so then if we do have any last-minute cancellations, then we have patients to fill the gaps rather than wasting precious theatre time. Regarding staffing efficiencies, I think it has helped develop staff and provide them with additional responsibilities within their role. For example, a nurse associate band four can be given more autonomy to assist with this procedure. This enables the pre-op team to spread their workload effectively and fairly and enable staff to see more patients.”

Lucy Barrett, Deputy Matron for Orthopaedics, Oxford University Hospitals

To learn how NEC Health Engage can support earlier optimisation and improve theatre efficiency within elective pathways, speak to our team or visit necsws.com/health.