Pre-operative Assessment Information ePAQ

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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 allows patients to carry out their initial pre-operative assessment online

ePAQ-PO utilises a highly successful technology platform originally developed to assess and monitor pelvic floor disorders in women (ePAQ-PF) which has been used by over 40,000 patients both nationally and internationally.

ePAQ-PO has been developed and trialled at Sheffield Teaching Hospitals NHS FT and is now used in routine clinical practice with over 4000 patient completions to date, 330 in the context of an 18-month protocol driven 2 phase validation study. The results of the face validity have been published in the British Journal of Anaesthesia.1

The results of ePAQ-PO reliability, construct and criterion validity have been published and demonstrates that ePAQ-PO predicts ASA scoring accurately and responses are consistent upon completing the questionnaire a second time.2

Use of ePAQ demonstrates high patient satisfaction and enables efficiency savings through increased productivity and reduced resource requirements.

ePAQ-PO standardised online screening tool is intended to support good quality pre-operative assessment, pathways and care, rather than replace them. Implementation will support improved efficiency, effectiveness, audit and clinical governance.


  • Pre-operative screening is a government priority in the Digital by Default programme launched in 2012. (Download a copy of the Digital by Default document here).
  • 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).
  • Implementing 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).
  • ePAQ-PO is a Digital First High Impact Innovation and counts towards CQUIN (Commissioning for QUality and INnovation) pre-qualification (CQUIN Guidance document download here.)
  • Connecting for Health has highlighted ePAQ-PO as one of its QIPP solutions.
  • Use of ePAQ-PO at Sheffield Teaching Hospitals NHS Trust, has identified potential quality and efficiency improvements. These included:

A reduction in unnecessary pre-operative investigations using evidence-based algorithms e.g. 72 % of clotting screens, 25% of full blood counts and 35% 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).

A reduction in assessment time of ASA grade 1&2 patients by 40%. STH realised a significant reduction of nursing hours per month with observational analysis has indicating an average time of 17 mins for review of ASA grade 1 and 2 patients.

A reduction in unnecessary patient hospital visits- a minimum of 88 visits per month are saved at STH (number growing daily due to increased use).


ePAQ- PO can either be completed in the surgical clinic, immediately following surgical listing using a touchscreen terminal or patients can be issued with a voucher that allows them to complete ePAQ-PO online at their convenience, typically at home.

Either pathway allows patients to provide and record the information about their own condition encouraging active engagement and empowerment in their own healthcare and care pathway from the point of entry.

Both pathways support implementation of a streamlined high quality assessment process either remotely, or via a ‘one stop shop’ approach and offers huge potential to realise both efficiency savings and target attainment e.g. 18 week wait.

Output from the questionnaire is easily updated to include additional clinical information received during subsequent face-to-face consultation.

Incorporated decision making software facilitates the ordering of investigations according to NICE CG3 guidelines.

Skipping rules ensure only relevant questions are asked of each patient, resulting in patients reporting a high value and low burden score.


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. Electronic Personal Assessment Questionnaire Pre-Operative: patient experience and face validity of an interactive, electronic questionnaire for the preoperative assessment of patients due to undergo general anaesthesia: Goodhart I, Andrzejowski J, Berthoud M et al. British Journal of Anaesthesia 2012; 109: 655- 668
  2. Patient-completed, preoperative web-based anaesthetic assessment questionnaire (electronic Personal Assessment Questionnaire Pre-Operative) Development and validation. Iain M. Goodhart, John Andrzejowski, Georgina Jones, Mireille Berthoud, Andy Dennis, Gary Mills and Stephen Radley. Eur J Anaesthesiol 2016; 33:1–8