Centralised Pre-Operative Assessment (CPOA)



The initial Pre-Operative Assessment (POA) Lead Improvement Team (LIT) initially met in January 2013 and although this was not a true microsystem by definition, the purpose of both teams was the same: to prepare and assess the fitness of the patient for anaesthesia and surgery. The microsystem improvement approach has enabled two teams to commence working together to understand variances in practice and start to agree standards for cross-site practice.

Helped engender good relationships


There are Centralised Pre-Operative Assessment (CPOA) Clinics on both the Royal Hallamshire Hospital (RHH) and Northern General Hospital (NGH) sites where the majority of patients are assessed for fitness to proceed with Anaesthesia and Surgery. The CPOA at NGH has been operating since 2008 and RHH centralised services fairly rapidly 2 years ago with both units working independently thereafter.


The work had one key aim: to improve the experience for patients attending the centralised Pre-operative assessment clinic and ensuring the experience was equitable on both NGH and RHH sites of the Trust. The aim of adopting the microsystem coaching methodology in achieving continuous quality improvement with frontline staff including all staff groups working in the departments from administrative staff to Consultants who engage with the patients.


The 5P’s assessment carried out by the Lead Improvement Team demonstrated variances in practice between both sites.

Helped me understand why it may be beneficial to take a step back and look at things in a different way

Data collected for the 5P’s assessment consisted of:
  • A patient Survey
  • Two Staff Surveys
  • High Level Process Map
  • Activity data
  • Patient cycle time in POA
  • Time to be first seen in POA


Made me aware you need evidence even for qualitative changes

The initial theme the LIT agreed to work was patient information.
Global Aim - The process starts with the letter received by the patient with a POA appointment and ends with the patient leaving POA with essential patient information. By working on this process, we expect patients to be fully informed and aware of the importance in the preparation phase prior to surgery resulting in an improvement in patient and staff satisfaction, increased productivity and efficiency by reducing DNA’s, on the day surgery cancellation due to the patient being unfit.

Specific Aim -  By introducing an essential information instruction document for patients leaving CPOA there is expected to be an increase in the calls to CPOA to highlight illness and a reduce in the number of calls related to TCI date, Medication and Fasting information before their surgery date by 20% in 3 months and monitor the impact on the day cancellation of surgery due to patient being unfit.

It is important to work on this now because we have identified the need to improve patient/staff satisfaction, increase productivity and reduce wasted appointments.

The team mapped the patient information process and identified small change ideas throughout the process.

Change ideas:

  • Introduce electronic patient information into CPOA website
  • Develop a standardised CPOA appointment letter for Specialty use
  • Develop an essential information instruction document for patients leaving CPOA
  • Develop standardised information/instruction for TAU


Patient information - The team agreed to test the third change idea in the list above ‘develop an essential information instruction document for patients leaving POA’ as this was within their control. A document was developed and finalised by the team, tested against the Trust patient information guidelines and a cohort of patients were asked to comment on the document in advance of the planned PDSA start date of the 24th June 2013.

The PDSA is in the early stages and unexpected staffing issues have hindered the patient call data collection within the clinics, therefore patients will continue to receive the essential information instruction document and the clinics will re-commence collecting the data when this is achievable.


The quotes indicate the staff benefits of being engaged and participating in the microsystem process, also how resources can impact on the progress of the tests of change. The LIT have commenced work on the second theme Cross Site Standardisation and are keen to progress and demonstrate improvements in the near future.

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