ePAQ-PO is a Digital First High Impact Innovation and counts towards CQUIN (Commissioning for QUality and INnovation) pre-qualification. For more information about ePAQ_PO and a link to the CQUIN Guidance document, click here

p>Pre-operative screening is a government priority in the 'Digital by Default’ programme launched in 2012. You can download a copy of the ‘Digital by Default’ document here. In partnership with a team from Sheffield Teaching Hospitals NHS Foundation Trust, EPAQ Systems has developed and validated a secure, online questionnaire called EPAQ-PO (Electronic Patient Assessment Questionnaire – Pre-operative) that will allow patients to carry out their initial pre-operative assessment online. Connecting for Health has highlighted ePAQ-PO as one of its QIPP solutions.

ePAQ-PO is a Digital First High Impact Innovation and counts towards CQUIN (Commissioning for QUality and INnovation) pre-qualification 1.

ePAQ-PO has been developed and trialed at Sheffield Teaching Hospitals NHS FT over the last 3 years and is now being introduced into clinical practice. With over 500 patients having completed ePAQ-PO thus far, 300 in the context of a protocol driven validation study, increasing numbers are now being invited to complete the questionnaire, at home, as part of routine clinical practice.

ePAQ-PO exploits a highly successful technology platform originally developed to assess and monitor pelvic floor disorders in women (ePAQ-PF) and over 30,000 patients across 15 NHS Trusts have now used ePAQ-PF. The use of ePAQ in this area of medicine has recorded high patient satisfaction and in at least one NHS Trust, ePAQ-PF has led to an increase in clinical turnover of 10 per cent.

Funding from Yorkshire & Humber Strategic Health Authority is supporting the development of an implementation toolkit for its wider adoption by NHS Trusts.


Digital First estimates that 40 per cent of all pre-operative assessments could be carried out remotely, saving 1.2 million face-to-face appointments and releasing cost efficiencies of £48 million (£34 million assuming a 70 per cent target). Likewise, remote or virtual follow-up clinics after surgery, combining online questionnaires and telephone or video consultations not only save patients the time and effort of travelling to hospital, but could release cost efficiencies of £41 million.

Both these initiatives are made possible by the electronic Personal Assessment Questionnaire (ePAQ).

As part of the pilot of ePAQ-PO (Pre Op) run at Sheffield Teaching Hospitals NHS Trust, potential quality and efficiency improvements have been identified, including a reduction in unnecessary pre-operative investigations (through evidence-based algorithms). As an example, 72 per cent of clotting screens, 25 per cent of full blood counts and 35 per cent of urea and electrolyte tests may be avoided, with a potential saving of up to £120,000 per trust per year (based on an annual caseload of 30,000 patients).

This screening questionnaire can be completed at a surgical clinic, using a touch screen terminal, following the patients initial listing for surgery or subjects can be issued with a voucher that allows EPAQ to be completed online, at their convenience, typically at home. This allows patients the option to provide information about their condition at a time and place that suits them, offering a huge potential to streamline services through a high quality assessment process that may ultimately be enabled, standardised and efficiently initiated in primary care. Well-prepared patients can be encouraged to actively participate and engage in their own healthcare, and be empowered and supported at the point of entry and throughout their care pathway.

The output is easily updated to include additional clinical information during subsequent face-to-face consultation. A further benefit from the use of the EPAQ-PO is the incorporated decision making software that facilitates the ordering of investigations according to NICE CG3 guidelines.

As part of the development, the questionnaire was validated in 330 patients in an 18 month, 2-phase study. The results of the face validity have been publish in the British Journal ofAnaesthesia 2. Skipping rules that ensure only relevant questions are asked of each patient, resulted in patients reporting a high value and low burden score. The results of EPAQ-PO reliability, construct and criterion validity is being prepared for publication and demonstrates that EPAQ-PO predicts ASA scoring accurately and responses are consistent upon completing the questionnaire a second time.

This standardised online screening tool is intended to support good quality pre-operative assessment and good quality medical care, and to augment rather than replace current processes. It is anticipated that it will improve efficiency, audit and clinical governance.


Questions are presented in a way that maximises accessibility, even for patients with little or no computer experience. The screen layout works clearly and simply on the majority of browsers and devices. There is no need for the patient to interact with complex radio buttons or drop down menus. The patient may restart the questionnaire from the point they left off, if for instance, they are interrupted or their internet connection is temporarily lost.

Clinical and secretarial users have access to intuitive screens designed for efficiency and ease of use, providing

  • patient searches
  • voucher creation (to allow patients to access the virtual clinic)
  • questionnaire status (not started, in progress, completed)
  • report viewing and editing. The output clearly differentiates between patient responses and additional annotation. ASA scoring and NICE CG3 alglorithms are included.


ePAQ includes as standard, interfaces to:

  • export raw data as csv
  • export reports as pdf

Links to PAS and import patient demographics, are available.

1 For more about CQUIN download the CQUIN Guidance document. 2 Details of this and other related academic references available on request.