The Business case

Current Preoperative or pre-procedure costs

The information in this section is intended to help you in preparing a business case for the implementation or completion of a trial of an Ultraprep program.

In developing a business case, the first requirement is to understand existing costs. It can be difficult to track the expenses of hospitals preoperative and pre-assessment processes and few Trusts know the costs of their existing processes. To understand the current costs, payroll should be examined to identify staff numbers and associated costs onto which “oncosts” can be added. Most preoperative services will also have a revenue budget which will include items such as pre-assessment forms that may not be necessary if Ultraprep is used.

Ultraprep assumptions

In order to build a business case, it is necessary to make some assumptions. When an Ultraprep program is in full use we assume that:

  • 70% of patients can complete Ultraprep assessments without the Trust’s staff input (or cost)
  • 30% of patients need a member of the Trust’s administrative staff to help them

As with all types of assessment, each patient’s information is reviewed by a registered nurse alongside the patient’s hospital notes, electronic patient record and GP referral letter. We estimate that this will take 12 minutes per patient i.e. 5 per hour.

MyPreOp assumptions:

  • 40% of patients need no further review by the pre-procedure team and can go straight to test or be given a TCI date. This means there is no further cost
  • 20% of patients need further diagnostic tests which must be organised and then reviewed
  • 20% of patients need a telephone follow up appointment with a registered nurse taking an additional 30 minutes
  • 20% of patients need a face-to-face appointment with a registered nurse taking an additional 45 minutes. These are the high risk or complex patients who can be identified early using Ultraprep programs
  • To deliver 20,000 MyPreOp based preoperative assessments annually requires one band 6 leader, five band 5 registered nurses, six band 3 admin or HCA staff, i.e. a total of 12 wte staff

Other cost savings to quantify

  • Reduction in patient information leaflet costs if the number of leaflets is minimised- how many leaflets are given to every patient that could be avoided using Ultraprep
  • Reduction in facilities costs if less floor space is needed for the preoperative or pre-procedure service       
  • Decreased revenue costs such as preoperative/ pre-procedure assessment forms if they are now digital           
  • Decrease in paper record storage costs and future scanning costs (@ 3 pence per page)       
  • Reduction in medical records workload and portering costs if digital
  • Rationalisation/standardisation of preoperative/ pre-procedure diagnostic tests                   
  • Reduction in oncosts if staff numbers reduce as oncosts have been excluded
  • Improved day of admission processes reducing theatre late starts
  • Reduction in theatre cancellations leading to increased income
  • Reduction in did not attends and on the day cancellations leading to increased income

Other key benefits

  • Improved patient experience
  • Educational and health improvement opportunities for users of Ultraprep, from the 140 external web links that are available e.g. smoking, alcohol and BMI
  • Early identification of high risk patients as per the National PeriOperative Medicine initiative
  • Decreased patient travel if 60% of patients do not need to re-attend the hospital
  •  Reduction in RTT 18 week breaches as preoperative assessment time reduced using Ultraprep – pathway changes to be mapped
  • Support of enhanced recovery programmes and surgical procedure specific pathways e.g. hips and knees with potential to reduce hospital length of stay reducing bed days

Full details of staff modelling available on request