The latest session in the Graphnet Health 2025 webinar series showcased how East Kent Hospitals University NHS Foundation Trust is transforming its perioperative pathway with digital innovation.

Dr Simon Rang, Consultant Anaesthetist and Lead for Perioperative Medicine at East Kent, described how the trust has achieved a 27% reduction in nursing preassessment consultation times for surgical day cases by introducing Graphnet’s waiting list dashboard to automate patient risk stratification and improve clinical decision-making.

The challenge: more patients with greater needs

Like many NHS trusts, East Kent is managing an ageing population with increasing comorbidities. Long waits for surgery also mean that many patients arrive at pre-operative assessment (POA) having had no recent contact with primary care.

Dr Rang explained:

“Many patients haven’t seen a GP for several months or sometimes a year or more before arriving at POA after a long wait for planned surgery Because we’re their first medical contact in a long time we have to be ready.”

From static waiting lists to active ones

Traditionally, waiting for surgery has been a passive period for surgical patients, with little organisational understanding of medical complexity or risk of perioperative complications. With Graphnet’s waiting list dashboard, East Kent can now integrate surgical waiting list data with GP records and automatically stratify patients into high- and low-risk groups.

Low-risk patients can be booked with confidence onto shorter, faster pathways, while higher-risk patients are directed into higher acuity pre-op care, including both detailed medical and nursing assessments and optimisation of relevant co-morbidities.

Dr Rang said:

“We can now confidently triage green and gold patients to low-risk pathways and inform the waiting list coordinators, “you can date these patients at short notice, with as little as two weeks’ notice and we can have them prepared for surgery without issue”

Results: 27% time saving

The most tangible impact of this change has been a 27% reduction in nursing consultation times for day surgery patients. This means that the same number of staff can now see significantly more patients in a nursing clinic, easing bottlenecks and helping the trust move patients through the pathway more efficiently.

By automating the identification of straightforward, low-risk cases in this way, East Kent has reduced the time nursing staff spend in lengthy consultations with patients who do not need them - freeing capacity for those who do. At the same time, the process ensures that patients with more complex needs are picked up early and seen in the right setting.

Dr Rang reflected on how the team initially thought they would need to scale up services, but found that better targeting made the difference:

“We tried to scale that service up, but actually we didn’t need to. All we need to do is have confidence in the system and change our theatre booking processes. We can put patients through efficient nursing preassessment processes at short notice and be confident that they will not be postponed just before surgery because of unresolved medical issues.”

The reduction has not only saved time but also improved patient experience. Shorter appointments mean less time waiting, and fewer on-the-day cancellations or last-minute postponements thanks to earlier identification of risk.

Exploring new approaches

With this foundation in place, East Kent is now exploring how digital risk stratification could allow for even more streamlined low-risk, low-touch pathways.

“We’re also looking at local anaesthetic procedures and, for low-risk patients, potentially not doing any form of pre-assessment beyond a Graphnet-enabled risk stratification. Even for patients requiring a general anaesthetic, we may be able to flip them from a face-to-face appointment to a remote work-up by telephone or digital pre-op system.”

This could remove unnecessary lengthy appointments for some patients while maintaining safety and freeing up clinic slots for those that need their services more.

Working with community and primary care

East Kent has also brought community services into the pathway, ensuring patients get lifestyle support while waiting for surgery.

“We’re fortunate to have a health and lifestyle advisory service run by our Community Trust and Kent County Council. They are always looking for patients motivated to improve their general health and wellbeing, and we are looking for opportunities to optimise patients on our waiting list. It’s a mutually beneficial relationship.”

The Community Trust has access to the Graphnet dashboard and can identify patients for interventions such as smoking cessation, physical fitness or weight management.

“We’ve given the Community Trust access to our Graphnet dashboard so they can filter and case-find patients from our waiting list who would be appropriate for these services.”

This visibility has already encouraged behaviour change:

“Some patients, when simply told they might be contacted as part of their surgical booking, have gone on to make lifestyle changes independently. A few have joined Weight Watchers, and many have stopped smoking even before One You Kent has reached out to them.”

At the primary–secondary care interface, East Kent also worked with GPs to agree who should take responsibility for optimisation.

“Patients were beginning to get stuck in a war of words about whose responsibility optimisation was. So, we met with a local lead GP, worked through some of the more common medical pre-operative problems, and created an A4 sheet outlining roles and responsibilities. We agreed the parameters, have a standard communication sheet that is electronically sent to GP practices, and that’s now working well.”

Looking ahead

The trust is now exploring:
•    Remote pre-assessment for some low-risk patients.
•    Reducing unnecessary face-to-face appointments for minor procedures.
•    Expanding patient numbers who are invited to join community optimisation services to support more patients earlier.

Dr Rang concluded:

“We still have some way to go, but this has already made a big difference. Consultation times are down, patients are better prepared, and we’re building a more proactive, collaborative pathway.”

East Kent in the wider CIPHA story

The East Kent experience is part of a broader shift across the NHS, supported by the Combined Intelligence for Population Health Action (CIPHA) programme.

CIPHA integrates data from GP practices, hospitals, social care, mental health services, and community teams into a single view, enabling proactive, preventative care. Across 11 Integrated Care Systems (ICSs), it is already transforming outcomes:

•    In Frimley, remote monitoring supported by CIPHA tools has delivered a 40% reduction in emergency department attendances.
•    In Cheshire and Merseyside, population health dashboards have helped identify vulnerable households, leading to targeted support such as the Warm Homes for Lungs project.
•    In Wirral, CIPHA tools were used to launch a diabetes prehabilitation service, reducing surgery postponements by optimising diabetic patients ahead of operations.

East Kent’s success adds to this evidence. By turning a dormant waiting list into an active population health tool, the trust has shown how CIPHA can help improve efficiency, reduce inequalities, and deliver better outcomes for patients.

 

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